Using Mental Health Assistant AUDITC data to describe patterns of alcohol use Carol Achtmeyer, Emily

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Using Mental Health Assistant AUDIT-C data to
describe patterns of alcohol useCarol
Achtmeyer, Emily C. Williams, Kathleen Lysell,
Bryan Volpp, Katharine A. BradleyPresented
byCarol Achtmeyer, MN ARNP

• VA Quality Enhancement Research Initiative
• VA Health Services Research Development
• VA Center of Excellence in Substance Abuse
  Treatment Education
• VA Puget Sound Primary and Specialty Medicine
• carol.achtmeyer_at_va.gov

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The Mental Health Assistant (MHA)

• Tool to administer/score MH screening tests
• AUDIT-C most common
• Over 5 million since 2003
• Usually used via Clinical Reminders (CR)
• MHA data stored as response strings
• Sequence of numbers/letters
• Correlate to answers of screening questions

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The MHA AUDIT-C

• Currently used in Alcohol Use Screen CR
• 3-digit response strings to AUDIT-C
• i.e. 323, 124, 444
• Response Strings can determine
• Answers to individual questions
• Total AUDIT-C score
• Frequency of alcohol use patterns

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Extracting Response Strings

• Text answers to questions in patient chart
• Response strings not viewable within CPRS
• Response strings stored in VistA
• Psych Instrument Patient File
• Extract using fileman query

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Scoring the AUDIT-C
01234
POINTS
Item checked equals 2 points
001234
Item checked equals 2 points
01234
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Scoring the AUDIT-C
Item checked 2 points
Item checked 1 points
Item checked 1 points
Score 4 String 211
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Interpreting AUDIT-C MH data

• Total Score can be interpreted in variety of ways
• Depends on answers to individual questions
• AUDIT-C of 4 may indicate risky or non risky
  drinking
• 310 drinks 2-4 times/week, 3-4/occ, never gt6
• not over recommended limits non risky drinking
• 211 drinks 2-4x/mo, 3-4/occ, less than monthly
  gt 6 drinks
• over recommended limits risky drinking

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MHA AUDIT-C Data

• Data extracted VA facility for 2 year period
• fileman query
• Evaluated frequency of response patterns
• No patient level data
• Aggregate data
• De-identified

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Results

• 65,484 AUDIT-C response strings
• 90 combinations of response strings identified

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Results Continued

• Most common string 400
• N11387, 17 of all scores
• Represents non risky drinking
• 1249 occurrences where score was 4, but pattern
  was risky drinking
• i.e. 211,301,112
• 9 of all scores of 4 represented risky drinking

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Response String Frequency
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Changes in MHA3

• New functionality coming in clinical reminders
  patch 6
• Allow cohort or resolution logic according to
  individual response strings
• Many new tests in MHA3
• PTSD
• PHQ9
• Braden Scale
• All generate response strings in a similar way to
  AUDIT-C

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More Changes

• Data from MHA3 will no be sent to centralized
  data base, allow for greater analysis and
  national trends for commonly administered MHA
  tests
• MHA3 will be available on CPRS toolbar
• Greater presence in CPRS

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Summary

• The Mental Health Assistant will soon be more
  widely accessible in CPRS
• MHA3 contains more screening tests than
  previously available
• Data generated from these screening tests can be
  extracted via fileman queries (and eventually via
  national data base)
• These data allow for analysis of patterns and
  trends
• MHA response strings can be useful in creating
  custom clinical reminders based on responses to
  individual questions

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Changes in alcohol screening

• Performance Measure likely for FY 08
• Probable AUDIT-C cut off 5 to require counseling
• Scores of 4 may still benefit from counseling if
  pattern reflects risky drinking

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Fileman Extract AUDIT-C Response Strings

• PSYCH INSTRUMENT PATIENT
• Select Local Fileman with Inq.Pr.Se.List.Exp.
  Option PR Print File Entry
• OUTPUT FROM WHAT FILE PSYCH INSTRUMENT PATIENT//
• NAME FILEMAN QUERY FOR AUDIT-C RESPONSE STRINGS
• SORT BY INSTRU"AUD"L1// PSYCH INSTR PT NCHCS
• By 'INSTRU', do you mean PSYCH INSTRUMENT
  PATIENT 'INSTRUMENT'? Yes// (Yes)
• WITHIN INSTRU"AUD", SORT BY INSTRUMENT//
  (multiple)
• INSTRUMENT SUB-FIELD DATE// (multiple)
• DATE SUB-FIELD COMPLETION DATE//
• START WITH COMPLETION DATE Jan 1,2007// (JAN
  01, 2007)
• GO TO COMPLETION DATE AUG 01,2007// (AUG 01,
  2007)
• WITHIN COMPLETION DATE, SORT BY
• STORE IN 'SORT' TEMPLATE
• FIRST PRINT FIELD INSTRUMENT// (multiple)
• FIRST PRINT INSTRUMENT SUB-FIELD DATE//
  (multiple)
• FIRST PRINT DATE SUB-FIELD COMPLETION
  DATEX//
• THEN PRINT DATE SUB-FIELD "!"//

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Questions?
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AUDIT-C Scoring (text version)