# Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes

> **NIH NIH R01** · KAISER FOUNDATION RESEARCH INSTITUTE · 2021 · $479,741

## Abstract

ABSTRACT
 Hazardous drinking is a significant public health problem, affecting approximately 20% of U.S. adult
primary care patients, contributing to about 65,000 deaths and costing the US health system more than $250
billion annually. Clinical trials have documented the efficacy and cost-effectiveness of Alcohol Screening and
Brief Intervention (ASBI), including in the health system studied here, and it is now a widely-endorsed
approach to identification and early intervention for hazardous use. However, relatively few studies have
examined real-world ASBI implementation and, its long-term sustainability, and their relationship to patient
outcomes, utilization and cost. This study will take advantage of an ongoing health system-wide ASBI initiative
in a large, heterogeneous health care delivery system, Kaiser Permanente Northern California, which in 2013
incorporated ASBI into its adult primary care workflow and conducts an average of 145,000 screenings and
9,500 brief intervention (BIs) monthly for adult primary care patients. Using a theory-driven conceptual
framework, this innovative study will rigorously examine the factors which facilitate or impede successful real-
world ASBI implementation and long-term sustainability. Guided by the PRISM (Practical, Robust
Implementation and Sustainability Model) framework, this mixed-methods study will use electronic health
record (EHR) data from 1/1/2014 to 12/31/2021, along with primary care provider surveys, patient telephone
interviews, and qualitative key informant interviews to examine ASBI implementation (1/1/2014 –
12/31/2015), short-term sustainability (1/1/2016-12/31/2018) and long-term sustainability (1/1/2019 –
12/31/2021) outcomes (screening and BI rates); patient outcomes (heavy drinking days and typical drinking
quantity and frequency, health services utilization and costs); and the fidelity and quality of BIs. We will use
the PRISM domains to enhance our understanding of ASBI implementation and long-term sustainability. First,
we will employ indirect standardization (observed-to-expected ratios) methodology to benchmark ASBI
implementation, short- and long-term sustainability performance over 8 years and examine associating factors.
Second, we will conduct multi-level models analyses to determine whether and how ASBI implementation and
sustainability are related to patient drinking outcomes and use of health services and costs. Finally, we will
measure BI fidelity and quality by asking patients and PCPs about their experiences receiving and delivering
BIs, and examine how they are related to patient outcomes. Results will provide concrete, pragmatic guidance
on factors which facilitate successful ASBI implementation and long-term sustainability that can be used
widely by this and other health systems to improve how we identify and treat the full spectrum of unhealthy
alcohol use, and how we implement, sustain and study population-based responses to it.

## Key facts

- **NIH application ID:** 10172807
- **Project number:** 5R01AA027477-03
- **Recipient organization:** KAISER FOUNDATION RESEARCH INSTITUTE
- **Principal Investigator:** Stacy Ann Sterling
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $479,741
- **Award type:** 5
- **Project period:** 2019-08-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10172807

## Citation

> US National Institutes of Health, RePORTER application 10172807, Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes (5R01AA027477-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10172807. Licensed CC0.

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