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Research Studies is a compilation of published research articles funded by ´óÏóÊÓƵor authored by ´óÏóÊÓƵresearchers.

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1 to 17 of 17 Research Studies Displayed
Kenzie ES, Weekley T, Barnes C
Co-created improvement goals and strategies for implementing SBIRT and MAUD in primary care settings in a facilitator-supported, tailored implementation study.
This study’s goal was to create improvement goals and and strategies for implementing screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) in primary care settings in a facilitator-supported, tailored implementation study. The authors used practice facilitation to support the implementation of SBIRT and MAUD in 48 clinical practices across Oregon, Washington, and Idaho. They used clinic contact logs, individual interviews, group periodic reflections with practice facilitators, and exit interviews with clinic staff to inform qualitative analysis. Clinics identified goals spanning SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. Goals addressed both the technical (e.g., data tracking) and social (e.g. staff training) aspects of SBIRT and MAUD. A decision tree was also created that summarized emergent findings into a tool to support future implementation of SBIRT in primary care settings.
AHRQ-funded; HS027080.
Citation: Kenzie ES, Weekley T, Barnes C . Co-created improvement goals and strategies for implementing SBIRT and MAUD in primary care settings in a facilitator-supported, tailored implementation study. Transl Behav Med 2025 Jan 16; 15(1). doi: 10.1093/tbm/ibae059..
Keywords: Primary Care, Implementation, Evidence-Based Practice, Alcohol Use, Substance Abuse, Behavioral Health, Screening
Davis MM, Coury J, Sanchez V
Improving screening, brief intervention and referral to treatment for unhealthy alcohol use in diverse, low-resourced primary care clinics.
This paper discusses the results of the ANTECEDENT (Partnerships to Enhance Alcohol Screening, Treatment, and Intervention) practice-facilitator implementation study, whose goal was to increase screening brief intervention and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) use in diverse primary care clinics. From November 2019 to April 2023, the authors conducted a convergent parallel mixed methods evaluation using participants from small- to medium-sized primary care clinics in Northwestern U.S. Clinics received foundational support (i.e., baseline/exit assessment, access to SBIRT Oregon website) and the option for supplemental implementation support (e.g., practice facilitation, expert consultation) over the 15-month intervention period. They recruited 75 unique clinics; 66 participated and 48 (73%) completed the study. Eight participating clinics chose to receive foundational support only while 58 chose to engage in supplemental support activities. The forty-two clinics that received supplemental support and completed the intervention engaged in practice facilitation, data review (38%), HIT support (31%), expert consultation (19%), and peer-to-peer learning (5%). There was significant improvement shown in self-reported SBIRT process outcomes. Positive experiences were described by clinics with ANTECEDENT support and highlighted remaining barriers to SBIRT and MAUD implementation.
AHRQ-funded; HS027080.
Citation: Davis MM, Coury J, Sanchez V . Improving screening, brief intervention and referral to treatment for unhealthy alcohol use in diverse, low-resourced primary care clinics. BMC Health Serv Res 2024 Nov 12; 24(1):1384. doi: 10.1186/s12913-024-11870-8.
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Screening, Primary Care
Jortberg BT, Dickinson LM, Fernald DH
Improving care for unhealthy alcohol use: results from the Facilitating Alcohol Screening and Treatment (FAST) Colorado Study.
Researchers investigated the effectiveness of virtual practice facilitation of screening, brief intervention, medication-assisted treatment (MAT), or referral for treatment (SBI/RT + MAT) for unhealthy alcohol use and examined the potential added benefits of alcohol use eLearning modules in primary care practices in Colorado. The results provided initial evidence for the successful use of virtual practice facilitation.
AHRQ-funded; HS027079.
Citation: Jortberg BT, Dickinson LM, Fernald DH . Improving care for unhealthy alcohol use: results from the Facilitating Alcohol Screening and Treatment (FAST) Colorado Study. J Am Board Fam Med 2024 Nov-Dec; 37(6):1027-37. doi: 10.3122/jabfm.2024.240048R1..
Keywords: Alcohol Use, Substance Abuse, Screening, Behavioral Health, Primary Care, Quality Improvement, Quality of Care
Rockwell MS, Funk AJ, Huffstetler AN
Screening for unhealthy alcohol use among patients with multiple chronic conditions in primary care.
This study investigated the impact of multiple chronic conditions on screening for unhealthy alcohol use in primary care. Analyzing electronic health records from 67 Virginia practices (2020-2023), the results showed that 58% of 11,789 patients had multiple chronic conditions. While 69% were screened for alcohol use, only 16% used a U.S. Preventive Services Task Force-recommended instrument. Patients with physical and mental health conditions were less likely to receive screening, despite being more likely to screen positive for unhealthy alcohol use. The findings highlight the need for improved alcohol-related preventive services in primary care, especially for patients with complex health issues.
AHRQ-funded; HS027077.
Citation: Rockwell MS, Funk AJ, Huffstetler AN . Screening for unhealthy alcohol use among patients with multiple chronic conditions in primary care. AJPM Focus 2024 Aug; 3(4):100233. doi: 10.1016/j.focus.2024.100233..
Keywords: Screening, Alcohol Use, Chronic Conditions, Primary Care, Substance Abuse, Behavioral Health, U.S. Preventive Services Task Force (USPSTF)
Huffstetler AN, Villalobos G, Brooks EM
The current state of alcohol screening and management in Virginia primary care practices: an evaluation of preventive service use.
This study used the recommendations of the US Preventive Services Task Force on screening and behavioral counseling for adults over 18 years for unhealthy alcohol use to examine the current state of alcohol screening and management in Virginia primary care practices. Clinicians were advised to use the following recommended screening instruments: the Alcohol Use Disorders Identification Test-Concise and or Single Alcohol Screening Question. Baseline data showed that clinicians appropriately screened only 10.8% of patients and only identified 9.6% as having risky drinking. However, 24% of patients reported risky drinking on a survey, demonstrating the implementation gap of the USPSTF recommendation and opportunity to improve health.
AHRQ-funded; HS027077.
Citation: Huffstetler AN, Villalobos G, Brooks EM . The current state of alcohol screening and management in Virginia primary care practices: an evaluation of preventive service use. Med Clin North Am 2023 Nov; 107(6s):e1-e17. doi: 10.1016/j.mcna.2023.07.001..
Keywords: U.S. Preventive Services Task Force (USPSTF), Alcohol Use, Screening, Substance Abuse, Behavioral Health, Primary Care, Evidence-Based Practice
Lin Y, Sharma B, Thompson HM
External validation of a machine learning classifier to identify unhealthy alcohol use in hospitalized patients.
This study’s objective was to validate a machine learning approach to alcohol screening using a natural language processing (NLP) classifier developed at an independent medical center. This retrospective cohort study took place at a midwestern US tertiary-care, urban medical center that has an inpatient structured universal screening model for unhealthy substance use and an active addiction consult service. The cohort included 57,605 unplanned admissions of adult patients between October 23, 2017 and December 31, 2019 with electronic health record (EHR) documentation of manual alcohol screening. The authors examined error in manual screening and reviewed discordance between the NLP classifier and AUDIT-derived reference. The classifier demonstrated adequate sensitivity and specificity for routine clinical use as an automated screening tool for identifying at-risk patients.
AHRQ-funded; HS026385.
Citation: Lin Y, Sharma B, Thompson HM . External validation of a machine learning classifier to identify unhealthy alcohol use in hospitalized patients. Addiction 2022 Apr;117(4):925-33. doi: 10.1111/add.15730..
Keywords: Alcohol Use, Behavioral Health, Screening, Electronic Health Records (EHRs), Health Information Technology (HIT)
Jonas DE, Barclay C, Grammer D
The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care.
This paper describes a randomized, controlled trial to evaluate the effect of primary care practice facilitation and telehealth services on evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use in primary care practices in North Carolina with 10 or fewer providers. The study will produce important evidence about the effect of practice facilitation on uptake of evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use when delivered on a large scale to small and medium-sized practices. The results of this rigorously conducted evaluation are expected to have a positive impact by accelerating the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices.
AHRQ-funded; HS027078.
Citation: Jonas DE, Barclay C, Grammer D . The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care. Trials 2021 Nov 16;22(1):810. doi: 10.1186/s13063-021-05641-7..
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Screening, Implementation
Zubiago J, Murphy M, Guardado R
Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic.
During the COVID-19 pandemic, due to lapses in harm reduction services, several public health experts forecasted subsequent increases in diagnosis of HIV in PWUD. As many inpatient hospitals reworked patient flow during the COVID-19 surge, the investigators hypothesized that HIV testing in PWUD would decrease. To answer this question, they compiled a deidentified list of hospitalized patients with electronic medical record indicators of substance use-a positive urine toxicology screen, prescribed medications to treat opioid use disorder, a positive CIWA score, or a positive CAGE score-admitted between January, 2020 and August, 2020.
AHRQ-funded; HS026008.
Citation: Zubiago J, Murphy M, Guardado R . Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic. J Subst Abuse Treat 2021 May;124:108266. doi: 10.1016/j.jsat.2020.108266..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Alcohol Use, Hospitalization, COVID-19, Public Health, Screening
Burner E, Zhang M, Terp S
Feasibility and acceptability of a text message-based intervention to reduce overuse of alcohol in emergency department patients: controlled proof-of-concept trial.
The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an emergency department (ED) screening program to reduce risky alcohol use in low-income, urban patients. A case-control study was designed using a SMS text message-capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message-based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the NIH Health Rethinking Drinking campaign. Of 1028 patients screened, 9.2% exhibited risky alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT) in the ED. Almost a quarter of the patients did not have an SMS text-messaging capable phone, leaving 76% eligible patients. Changes in behavior were similar between the two groups. The number of drinking days reported in the prior 30 days decreased by 5 and the number of heavy drinking days decreased by 4.1. Patients reported an 11-point increase in motivation to change alcohol use via the Change Questionnaire.
AHRQ-funded; HS022402.
Citation: Burner E, Zhang M, Terp S . Feasibility and acceptability of a text message-based intervention to reduce overuse of alcohol in emergency department patients: controlled proof-of-concept trial. JMIR Mhealth Uhealth 2020 Jun 4;8(6):e17557. doi: 10.2196/17557..
Keywords: Alcohol Use, Substance Abuse, Emergency Department, Telehealth, Health Information Technology (HIT), Screening, Prevention
Kuhns LM, Carlino B, Greeley K
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
This study looked at rates of substance use screening and related documentation among adolescents aged 12-17 in outpatient pediatric clinics in a large academic medical center. The authors abstracted a random sample of 127 records and coded clinical notes to describe screening cases and related characteristics. They then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and identify related factors. Rates of screening by providers was 72% for each common substance and a total of 6% of patients reported substance use during screening.
AHRQ-funded; HS026385.
Citation: Kuhns LM, Carlino B, Greeley K . A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice. Subst Abuse Treat Prev Policy 2020 May 25;15(1):36. doi: 10.1186/s13011-020-00276-4..
Keywords: Children/Adolescents, Substance Abuse, Screening, Ambulatory Care and Surgery, Alcohol Use, Practice Patterns, Primary Care
Huffstetler AN, Kuzel AJ, Sabo RT
Practice facilitation to promote evidence-based screening and management of unhealthy alcohol use in primary care: a practice-level randomized controlled trial.
Investigators are initiating a clinic-level randomized controlled trial aimed to evaluate how primary care clinicians can impact unhealthy alcohol use through screening, counseling, and medication-assisted therapy (MAT). After completion of the intervention, researchers will conduct a mixed methods analysis to identify changes in screening rates, increase in provision of brief counseling and interventions as well as MAT, and the reduction of alcohol intake for patients after practices receive practice facilitation. They propose practice facilitation as a robust and feasible intervention to assist in making changes within the practice and believe that the process can be replicated and used in a broad range of clinical settings. They anticipate that these statements will be supported by their evaluation of this approach.
AHRQ-funded; HS027077.
Citation: Huffstetler AN, Kuzel AJ, Sabo RT . Practice facilitation to promote evidence-based screening and management of unhealthy alcohol use in primary care: a practice-level randomized controlled trial. BMC Fam Pract 2020 May 20;21(1):93. doi: 10.1186/s12875-020-01147-4..
Keywords: Alcohol Use, Primary Care, Primary Care: Models of Care, Screening, Care Management, Prevention
Mabry-Hernandez I, Scoulios N
´óÏóÊÓƵAuthor: Mabry-Hernandez I
Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults.
This case study concerns a 20-year-old male university student with a history of exercise-induced asthma presenting for his yearly physical. He expresses that he occasionally misses classes in the morning because he is tired.
AHRQ-authored.
Citation: Mabry-Hernandez I, Scoulios N . Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults. Am Fam Physician 2019 Jun 15;99(12):771-72..
Keywords: U.S. Preventive Services Task Force (USPSTF), Alcohol Use, Substance Abuse, Screening, Prevention, Primary Care, Case Study
Shafer PR, Borsky A, Ngo-Metzger Q
´óÏóÊÓƵAuthor: Shafer PR, Borsky A, Ngo-Metzger Q, Miller T, Meyers D
The practice gap: national estimates of screening and counseling for alcohol, tobacco, and obesity.
The authors of this study estimated screening and counseling rates for tobacco and alcohol use, and obesity by using a nationally representative sample of adults aged 35 years and older. Receipt of the recommended level of services ranged from nearly two-thirds for obesity and tobacco use to less than half for alcohol misuse. The authors conclude that care delivery shows significant room for improvement, but primary care practices may need additional resources to raise their screening and counseling rates.
AHRQ-authored.
Citation: Shafer PR, Borsky A, Ngo-Metzger Q . The practice gap: national estimates of screening and counseling for alcohol, tobacco, and obesity. Ann Fam Med 2019 Mar;17(2):161-63. doi: 10.1370/afm.2363..
Keywords: Alcohol Use, Lifestyle Changes, Obesity, Prevention, Primary Care, Screening, Substance Abuse, Tobacco Use
Clark BJ, Rubinsky AD, Ho PM
Alcohol screening scores and the risk of intensive care unit admission and hospital readmission.
This study sought to determine whether alcohol misuse was associated with admission to an intensive care unit (ICU) among patients receiving outpatient care. Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0 percent for abstinent patients, 1.6 percent for patients with lower-risk alcohol use, 1.8 percent for patients with moderate alcohol misuse, and 2.5 percent for patients with severe alcohol misuse.
AHRQ-funded; HS022800.
Citation: Clark BJ, Rubinsky AD, Ho PM . Alcohol screening scores and the risk of intensive care unit admission and hospital readmission. Subst Abus 2016 Jul-Sep;37(3):466-73. doi: 10.1080/08897077.2015.1137259.
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Keywords: Alcohol Use, Hospital Readmissions, Intensive Care Unit (ICU), Ambulatory Care and Surgery, Screening, Substance Abuse
Williams EC, Achtmeyer CE, Young JP
Local implementation of alcohol screening and brief intervention at five Veterans Health Administration primary care clinics: Perspectives of clinical and administrative staff.
The researchers conducted a qualitative key informant study to describe local implementation of alcohol screening and brief intervention from the perspectives of frontline adopters in VA primary care . Findings suggest that the local process of implementing alcohol screening and brief intervention may have inadequately addressed important adopter needs.
AHRQ-funded; HS022800.
Citation: Williams EC, Achtmeyer CE, Young JP . Local implementation of alcohol screening and brief intervention at five Veterans Health Administration primary care clinics: Perspectives of clinical and administrative staff. J Subst Abuse Treat 2016 Jan;60:27-35. doi: 10.1016/j.jsat.2015.07.011.
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Keywords: Alcohol Use, Screening, Primary Care
Williams EC, Achtmeyer CE, Thomas RM
Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: a multi-site qualitative study.
The researchers aimed to understand factors that might contribute to low sensitivity of alcohol screening. Their qualitative study in nine clinics found that implementation of alcohol screening facilitated by a clinical reminder resulted primarily in verbal screening in which questions were not asked verbatim and were otherwise adapted.
AHRQ-funded; HS022800; HS013853.
Citation: Williams EC, Achtmeyer CE, Thomas RM . Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: a multi-site qualitative study. J Gen Intern Med 2015 Aug;30(8):1125-32. doi: 10.1007/s11606-015-3248-z..
Keywords: Alcohol Use, Screening, Primary Care, Health Information Technology (HIT)
Lapham GT, Rubinsky AD, Williams EC
Decreasing sensitivity of clinical alcohol screening with the AUDIT-C after repeated negative screens in VA clinics.
The purpose of this study was to evaluate the performance of repeat annual clinical alcohol screening in 4 samples of VA outpatients with 1–4 prior consecutive negative annual screens. It found that among patients with repeated negative clinical alcohol screens, the proportion who subsequently screened positive a year later was low and decreased as patients had more prior negative screens.
AHRQ-funded; HS022800.
Citation: Lapham GT, Rubinsky AD, Williams EC . Decreasing sensitivity of clinical alcohol screening with the AUDIT-C after repeated negative screens in VA clinics. Drug Alcohol Depend 2014 Sep 1;142:209-15. doi: 10.1016/j.drugalcdep.2014.06.017..
Keywords: Screening, Alcohol Use, Substance Abuse

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