Abstract Background Screening and treatment for unhealthy alcohol use (UAU) and alcohol use disorder (AUD) are recommended but underutilized, particularly in hospital settings. Objective To determine whether a comprehensive screening and treatment protocol for UAU in hospitalized patients can help reduce alcohol use. Design Quality improvement study at single-center safety-net hospital. Participants 27,914 patients were admitted from 9/2022 to 9/2024, and 18,146 (65.0%) were screened with AUDIT-PC, with 1085 (6.0%) screening positive (≥ 5). Substance use navigators (SUNs) identified 257 additional patients with UAU through referral methods. Intervention SUNs approached eligible patients and conducted full AUDIT and brief behavioral counseling. Patients with AUDIT ≥ 12 were offered medications for AUD (MAUD) during hospitalization and at discharge. Main Measures Intervention delivery, 30-day return hospital encounters (readmission or emergency department), and change in AUDIT score among high-risk patients. Key Results Of the 1342 intervention-eligible patients, 81% were men, and the mean age was 51 years. 54% were Caucasian, 30% Hispanic/Latinx, and 9% Black. 17% were unhoused, and 18% were uninsured. Of these 1342, 800 (59.6%) patients engaged in the intervention. The mean AUDIT score was 15 (median 14, IQR 8–21). For the 489 (61.1%) patients with AUDIT ≥ 12, 231 (47.2%) were started on medication before discharge. For the 126 patients with repeat AUDIT (25.8%), the mean reduction was 14.2 points (95% CI: −15.4, −12.2). For those with AUDIT ≥ 12, 128 (26.2%) patients had a return hospital encounter within 30 days of discharge. Patients without return encounters had significantly larger reductions in AUDIT score than those who had return encounters (mean reduction −16.2 vs −9.1 points (difference −7.1, 95% CI: −3.1, −11.0)). Conclusions UAU screening and risk-stratified treatment (including pharmacotherapy) can be delivered in diverse hospitalized patients, and were accompanied by short-term changes in alcohol risk score among patients reached for follow-up.
Ramesh et al. (Thu,) studied this question.