ࡱ> TS( / 0DArialNew Romanll\b0DWingdingsRomanll\b0 DTimes New Romanll\b0@ .  @n?" dd@  @@`` X$Jo..   21  !  (',-2468:=>?@ABCDEFGHI 0AA@83ʚ;ʚ;g4EdEd@/ b0 ppp@ <4dddd8i0l8 80___PPT10 aStrategies Used to Improve Alcohol Screening and Brief Intervention What we have learned from you bD  Heather Liszka, MD, MS  IntroductionXCompilation of strategies described by  Best Practices during the 2-year course of the study Define  Best Practice Best Practices achieved >50% performance on screening, diagnosis, brief intervention, or referral (For ex, >50% hypertensive patients screened) 2-5 practices qualified for each topic 6uu Methods{Qualitative analysis of transcripts from SC and FLA Network Meetings Supplemented by relevant notes from final Site Visits {|ResultsHow did Best Practices achieve change? Organization of Results according to the TRIP model Prioritize Performance Involve All Staff Redesign Delivery Systems Use EMR Tools Patient Activation Z]  M]M Results Prioritize Performance   8Set aside time for AATRIP site visit, all staff attended Integration of alcohol screening into Vitals Signs Motivated clinicians ready to take alcohol screening to the next level (assessment-> diagnosis-> intervention) Clinician shifts focus of visit to allow for discussion about alcohol use and hypertension. 99Results EMR Tools   Alcohol Screening Template incorporated into Nursing Note a/o all HTN and CPE templates. Results automatically documented in HM or lab table from Quicktext links in template. Qtext for referral places as well. Date of last AUDIT-C is imported (in red) and/or score is imported into template. Once AUDIT-C score>4, conditional logic triggered to open up more text for diagnoses. These are  REQ and must be addressed in order to sign the note. .P8,  Results Involve All Staff   jAdoption of screening is an easily delegated function. Clinical staff and registration can incorporate this easily in their screening process. Have staff attend all site visits Communication loops between doctors and staff standardized for the transition from screening to assessment Staff systematically reinforce information from the guidelines to patients.  k Results Delivery System Redesign !  Establish protocols: screening done on all adults, some targeted physicals and hypertensives only in the second year. Screening done as part of vitals signs or health maintenance review. Integration of Alcohol Screening Template into major templates: Nursing Template, Htn, CPE,O Results Patient Activation*   Distribute the AA-TRIP educatioanl pamphlet to patients to make patients more aware of guidelines If patient hesitant to answer questions, staff reinforced messages regarding guidelines. Outreach or reminders to sub-groups identified by inquiries or other data lists with subsequent follow-up (e.g., generate lists of HTN patients not at goal BP and contact these patients to schedule office visits)  rSummary- Best Practices0Delegation of the screening function to staff. Make it part of routine, with vitals, etc. Facilitate documentation process as much as possible using template quicktext. Steeper learning/adoption curve for implementing the brief intervention or diagnosis of any alcohol disorders. Requires commitment. (/1 /!"#$%&'()* ~ 0` 3fffff3̙3f̙` ̙3f` ff3f` f33f3f` 3ffƍ` fff3` f33̙` 3f|>?" dZ@$?lKd@   l@  P`lA n?" dd@   @@``PT   @ ` `p>> H @   (  .T   "\\   "h  s *"   $0e0e BCDELF>5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E?|b4"%>Ul @   `c"$  f\   "n"  0G"r B T??"  <   ^*    `lm ??"`@a   ^*    `r ??"\5  b* B  s *޽h ? 3fffff3̙3f̙80___PPT10. gĖ Capsules  0 } u   (  T p  "p  6/"@  F 0 "  B\3G0* "pp  F 0 rZ    # "  n" B 0G" R r  T??"L    <6 "4 `   W#Click to edit Master subtitle style$ $   `p; ??"`>   b*    `A ??"`@a   ^*    `E ??"`0  b* "   fHG0* ??"p   T Click to edit Master title style! !B  s *޽h ? 3fffff3̙3f̙80___PPT10. gĖ0 zr (    0< P    P*    0H     R*  d  c $ ?    0$  0  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  6\ۗ _P   P*    6T՗ _   R*  H  0޽h ? 3380___PPT10.x~ (    0 P    X*   00     Z*   6\ _P   X*   6d` _   Z* H  0޽h ? 3380___PPT10.lP+00  0(  x  c $R p   x  c $HI4    H  0޽h ? 3380___PPT10. gN=$ 0 $(  r"  S @ `   r  S <   H  0޽h ? 3fffff3̙3f̙80___PPT10.wW1$ 0 $(  r"  S  `   r  S    H  0޽h ? 3fffff3̙3f̙80___PPT10.wp2$ 0 $(  r"  S  `   r  S 81   H  0޽h ? 3fffff3̙3f̙80___PPT10.w0ב $ 0  $(  r"  S  % `   r  S %   H  0޽h ? 3fffff3̙3f̙80___PPT10.w\$ 0 $(  r"  S , `   r  S $   H  0޽h ? 3fffff3̙3f̙80___PPT10.w0 0 @0(  x"  c $( `   x  c $   H  0޽h ? 3fffff3̙3f̙80___PPT10.w\$ 0 $(  r"  S ľ `   r  S d   H  0޽h ? 3fffff3̙3f̙80___PPT10.wPB0  0 `0(  x"  c $ `   x  c $pE   H  0޽h ? 3fffff3̙3f̙80___PPT10.w\0 0 @0(  x  c $L= `   x  c $ 4   H  0޽h ? 3380___PPT10. gI0  (  X  C       S `k 0    Clinician gets in habit of doing  talk with every positive Audit-C screen. Usually begins with EtOH and Htn link. Clinician shifts focus of visit to allow for discussion about alcohol use and hypertension. Questions fit into SHx and made it part of conversation. Used conversational approach, let the patient do most of the talking. Limit talk to 3-5 min, but expect to get behind. 8>axH  0޽h ? 3380___PPT10.xp~0 .(  X  C      S pR 0   0Quick text available to document diagnoses and brief intervention with only one  click. Qtext for referral places as well so providers can not only click that they are doing a referral, but also click where they are referring to: AA, Health Dept, etc. YH  0޽h ? 3380___PPT10.xpb0  r(  X  C      S t 0   tAdoption of screening is an easily delegated function. Clinical staff and registration can incorporate this easily in their screening process. Staff a/o registration identify htn patients on the schedule before the day starts. Staff ask first 1-3 questions of AUDIT (some asked 1st 5 questions). Communication loops between doctors and staff standardized for the transition from screening to assessment Verbal or written message on pt chart for provider. Staff leave positive screen template visible on room computer. Staff systematically reinforce information from the guidelines to patients. Staff comfortable explaining reason for screening, giving explanation of link between alcohol and health. xls ls H  0޽h ? 3380___PPT10.y9,\c0 0 s(   X   C       S 8 0   uOCompeting issues for the patient visit and time factors in to limit encounter.  PH   0޽h ? 3380___PPT10.z ѱ 0 @(  X  C      S  0    H  0޽h ? 3380___PPT10.Dz  0 P(  X  C      S $ 0    H  0޽h ? 3380___PPT10.Dz  0 `(  X  C      S s 0    H  0޽h ? 3380___PPT10.0N 0 p(  X  C      S 4; 0    H  0޽h ? 3380___PPT10.0N 0  (   X   C       S  0    H   0޽h ? 3380___PPT10. 0 $(  $X $ C     $ S ؄ 0    H $ 0޽h ? 3380___PPT10.r@,BAT < zCEI *LVN PRG6*W\`Tfhjlnq#s7u*Oh+'0$ hp ( L X dpxdStrategies Used to Improve Alcohol Screening and Brief Intervention What we have learned from youHeather Liszka Capsules roylanlf10Microsoft Office PowerPoint@p b@`آq g@@Gg  JJ  y--$xx--'̙--$xPxP--'--J$#   " % (+-/122V2Y2\1_/a-c+e(f%f"feca_\YV--'3f--$ UU[[?[?[?U?UU--'--$ UUVWXYZ[[[UU--'@Arial-. 3f<2 #Strategies Used to Improve Alcohol ."System-@Arial-. 3f72 % Screening and Brief Intervention.-@Arial-. 3f32 -"What we have learned from youi.-@Arial-. ff(2 QSHeather Liszka, MD, MS.-՜.+,0    On-screen Showu=   Arial WingdingsTimes New Roman CapsulesbStrategies Used to Improve Alcohol Screening and Brief Intervention What we have learned from you IntroductionMethodsResultsResults Prioritize PerformanceResults EMR ToolsResults Involve All Staff!Results Delivery System RedesignResults Patient ActivationSummary- Best Practices  Fonts UsedDesign Template Slide Titles  _uroylanlfroylanlf  !"#$%&'()*+,-./0123456789:<=>?@ABDEFGHIJLMNOPQRURoot EntrydO)Current UserKSummaryInformation(;PowerPoint Document(uDocumentSummaryInformation8C