# Multi-level Influences of Alcohol Based Quality and Outcome Measures

> **NIH NIH R21** · UNIVERSITY OF WASHINGTON · 2022 · $206,032

## Abstract

Project Summary
Unhealthy use of alcohol remains a critical problem with high-risk drinking increasing by almost 30% between
2001-2002 and 2012-2013. Excessive alcohol use is the third leading cause of preventable death, and is linked
to chronic medical conditions, lost productivity and direct cost to health systems. Evidence-based practices are
available to prevent and treat unhealthy alcohol use and its detrimental consequences. To facilitate uptake of
these practices, health systems use quality measures to identify aspects of care being done well and monitor
areas for improvement. The National Quality Forum has endorsed several care quality measures for unhealthy
alcohol use, which have been adopted for routine decision-making by health systems. These include indicators
for initiation and engagement in treatment for alcohol and other drug (AOD) abuse or dependence (equivalent to
substance use disorder), as well as follow-up after an emergency department visit for AOD abuse or
dependence. Another area proposed for broader adoption is universal screening for unhealthy alcohol use.
Despite adoption of these five measures by health systems, the generalizability of these alcohol-related quality
measures has not been fully established. This includes the lack of knowledge on the expected variability and
reliability of quality measured at different levels of a health system (e.g., clinics, providers). In addition, limited
information exists on the meaningful drivers of improved performance to guide health systems with quality
improvement efforts. This study seeks to address these scientific evidence gaps through the following two
specific aims: 1) examine the variability and reliability of care quality measures for unhealthy alcohol use, and 2)
identify multi-level factors associated with care quality for unhealthy alcohol use. For each of the five quality
measures of focus, hierarchical modeling will be applied to characterize the variability and reliability at four levels
of health care delivery: patient, provider, clinic and community. Hypothesis generating analyses in Aim 2 will
extend hierarchical models from Aim 1 and examine the influence of an expansive set of explanatory variables
conceptually related to receipt of guideline concordant care. Research in all aims will be conducted within the
Kaiser Permanente Washington (KPWA) Health System, which is part of one of the largest nonprofit healthcare
systems in the US. KPWA is an ideal setting given its hierarchical structure and extensive administrative and
electronic health record data to measure quality and multi-level determinants of care quality. Together, scientific
insights gained from this study will provide best practices for the measurement of quality indicators and enhance
reporting tools that disseminate quality information. This will support the study team's long-term goal of
increasing the effectiveness of strategic performance reporting to accelerate efforts to improve care quality...

## Key facts

- **NIH application ID:** 10590820
- **Project number:** 1R21AA030058-01A1
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Joseph Edwin Glass
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $206,032
- **Award type:** 1
- **Project period:** 2022-09-13 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10590820

## Citation

> US National Institutes of Health, RePORTER application 10590820, Multi-level Influences of Alcohol Based Quality and Outcome Measures (1R21AA030058-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10590820. Licensed CC0.

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