# Improving Outcomes among Medical/Surgical Inpatients with Alcohol Use Disorders

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

In FY2014, over 57,000 Veterans with diagnosed alcohol use disorders (AUDs) received VHA inpatient
medical-surgical services. This likely underrepresents the prevalence of AUDs among Veteran inpatients,
because these conditions often go undiagnosed during hospital stays. The high prevalence of AUDs among
VHA medical-surgical inpatients is of critical concern because AUDs and medical conditions exacerbate one
another, and their co-occurrence increases the use of costly health services. Yet, there are no evidence-based
strategies that improve outcomes in this patient population by means of increased utilization (initiation,
engagement) of AUD treatment services. We have identified Drinking Options: Motivate, Shared Decisions,
Telemonitor (DO-MoST) as a potential solution to the critical need for evidence-based strategies.
 This project will evaluate DO-MoST as a new and innovative intervention to facilitate the transition from
inpatient medical-surgical care to AUD treatment in primary and specialty care settings, thereby improving
Veterans' AUD and medical outcomes. DO-MoST entails use of motivational interviewing and a decision aid
during the inpatient stay to facilitate informed choices about post-discharge drinking options and resources for
help to change drinking, if desired, followed by telephone calls with the patient to continue to motivate and
support decisions. In addition to determining the effectiveness of DO-MoST, this project includes a process
evaluation – that is, will gather information from providers and patients on DO-MoST's implementation at the
two project sites – to inform VA's potential widespread implementation of DO-MoST with medical-surgical
patients with AUDs.
 Using an effectiveness/implementation Hybrid Type 1 design, incorporating a randomized controlled
trial (RCT) and process evaluation to facilitate future implementation, this project has three Specific Aims.
Aim 1: Adapt a decision aid being implemented with AUD patients in non-VA primary care settings to be
appropriate for Veterans with AUDs in medical-surgical inpatient settings. With this prototype, we will conduct
alpha testing with patients and providers, and adapt and pilot the decision aid to finalize it for use in the RCT.
Aim 2: Conduct DO-MoST at two VA facilities (Ann Arbor and Palo Alto) and evaluate its effectiveness.
The primary hypotheses are: Patients in DO-MoST, compared to patients in usual care (UC), will be more likely
to (1) utilize AUD help (initiate, engage), (2) have better AUD (fewer heavy drinking days) and medical
(physical status) outcomes, and (3) have fewer and more delayed acute care episodes (Emergency
Department visits, rehospitalizations). Patients will be assessed at baseline, and 3, 6, and 12 months post-
discharge, for outcomes and non-VA health care; VA health care will be assessed with VA databases. GLMM
analyses will be conducted to compare the UC and DO-MoST groups on course of outcomes.
Aim 3: Conduct a qualitative process ...

## Key facts

- **NIH application ID:** 10201716
- **Project number:** 5I01HX002024-04
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** MARK A. ILGEN
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-09-01 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10201716

## Citation

> US National Institutes of Health, RePORTER application 10201716, Improving Outcomes among Medical/Surgical Inpatients with Alcohol Use Disorders (5I01HX002024-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10201716. Licensed CC0.

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