VA-ALCOHOL AUDIT-C POSITIVE F/U EVAL (925)    REMINDER DEFINITION (811.9)

Name Value
NAME VA-ALCOHOL AUDIT-C POSITIVE F/U EVAL
PRINT NAME Positive AUDIT-C Needs Evaluation
CLASS NATIONAL
SPONSOR Office of Patient Care Services
USAGE *
EDIT HISTORY
  1. EDIT DATE:   2009-11-18 10:02:53
    EDIT BY:   USER,SEVENTEEN
    EDIT COMMENTS:   
    Exchange Install
    
DESCRIPTION
This reminder is due for patients who have a Positive Alcohol Use 
 
It resolves by documentation of direct alcohol related advice and 
education about alcohol related medical problems.  Options for further 
assessment and referral are also included.
 
It is intended for use by providers.
 
Update March 2009
1. Add SUD stop codes as an exclusion if the patient was seen during the 
90 days prior to the most recent positive AUDIT-C or is a current patient 
Screen.  It becomes due with an AUDIT-C score of 5 or more.
in an SUD clinic.
2. Make advice and feedback to the patient consistent and not forced.
3. Reverse the sequence of the feeback and the advice.
4. Update the reminder term for No Alcohol in the past year to represent 
include only the HF.  Remove the AUDC from this term to prevent an 
incorrect entry of AUDC=0 to override a positive AUDC entered for the 
same visit.
 
This setting of AUDIT-C of 5 or higher is for the national performance 
measure.  There are still patients who have lower scores who drink above 
the safe limit and these patients should also be counseled.
 
The dialog includes assessment tools and documentation of advice,
counseling and referral
FINDINGS
  1. FINDING ITEM:   AUDC
    MH SCALE:   276
    CONDITION:   I +V>4
    OCCURRENCE COUNT:   5
    USE STATUS/COND IN SEARCH:   YES
    INTERNAL CONDITION:   I +V>4
    NO. OF FOUND TEXT LINES:   3
    NO. NOT FOUND TEXT LINES:   0
    FOUND TEXT:   
    The patient's last screen for problem alcohol use was positive with a high
    score.  Patients with an AUDIT-C of 8 or higher are at high risk of
    alcohol dependency.  A brief intervention is indicated.
    
    USE IN PATIENT COHORT LOGIC:   AND
  2. FINDING ITEM:   VA-ALCOHOL USE INFORMATION
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  3. FINDING ITEM:   VA-ALC USE INTERVENTIONS
    WITHIN CATEGORY RANK:   0
    OCCURRENCE COUNT:   4
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  4. FINDING ITEM:   VA-ALC ED MEDICAL PROBLEMS
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   AND
  5. FINDING ITEM:   VA-ALCOHOL NONE PAST 1YR
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  6. FINDING ITEM:   AUDC
    MH SCALE:   276
    CONDITION:   I +V<5
    OCCURRENCE COUNT:   2
    INTERNAL CONDITION:   I +V<5
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  7. FINDING ITEM:   VA-SUD CLINIC VISIT
    OCCURRENCE COUNT:   -1
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    BEGINNING DATE/TIME:   T-90
  8. FINDING ITEM:   VA-SUD CLINIC VISIT
    ENDING DATE/TIME:   T
    OCCURRENCE COUNT:   2
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    BEGINNING DATE/TIME:   T-365
FUNCTION FINDINGS
  1. FUNCTION FINDING NUMBER:   1
    LOGIC:   FN(1)'>FN(2)
    USE IN RESOLUTION LOGIC:   AND
    FUNCTION STRING:   MRD(1)'>MRD(3)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  2. FUNCTION FINDING NUMBER:   2
    LOGIC:   FN(1)'>FN(2)
    USE IN RESOLUTION LOGIC:   AND
    FUNCTION STRING:   MRD(1)'>MRD(4)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  3. FUNCTION FINDING NUMBER:   3
    LOGIC:   FN(1)'
    USE IN PATIENT COHORT LOGIC:   AND
    FUNCTION STRING:   MRD(1)'
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  4. LOGIC:   FN(1)=0
    FUNCTION STRING:   DIFF_DATE(1,3)=0
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
  5. LOGIC:   FN(1)=0
    FUNCTION STRING:   DIFF_DATE(1,4)=0
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
  6. FUNCTION FINDING NUMBER:   6
    FOUND TEXT:   
    The patient was seen in an SUD clinic during the 90 days prior to the 
    most recent positive AUDIT-C.
    \\
    
    LOGIC:   FN(1)&(FN(2)
    USE IN PATIENT COHORT LOGIC:   AND NOT
    FUNCTION STRING:   FI(7)&(MRD(7)
    NO. FOUND TEXT LINES:   3
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  7. FUNCTION FINDING NUMBER:   7
    FOUND TEXT:   
    The patient has recent SUD clinic visits.
    \\
    
    LOGIC:   FN(1)>FN(2)&(FN(3)>14)
    USE IN PATIENT COHORT LOGIC:   AND NOT
    FUNCTION STRING:   MRD(8)>MRD(1)&(DIFF_DATE(1,8)>14)
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
TECHNICAL DESCRIPTION
This reminder is triggered by the AUDIT-C score generated from the
ALCOHOL USE SCREEN clinical reminder.  It uses branching logic and 
will display different screens depending on the AUDIT-C score.  A score 
of 8 or more will display a screen geared towards patients with a higher 
risk of alcohol abuse or dependence.  A score of less than 8 will display 
a screen to guide counseling and assessment for those with a lower risk 
of dependence.
INTERNAL PATIENT COHORT LOGIC (SEX)&(AGE)&FI(1)&FF(3)&'FF(6)&'FF(7)
PATIENT COHORT FINDINGS COUNT 6
PATIENT COHORT FINDINGS LIST SEX;AGE;1;FF3;FF6;FF7
CUSTOMIZED RESOLUTION LOGIC (FI(3)&FI(4))&(FF(1)!FF(4))&(FF(2)!FF(5))
INTERNAL RESOLUTION LOGIC (FI(3)&FI(4))&(FF(1)!FF(4))&(FF(2)!FF(5))
RESOLUTION FINDINGS COUNT 6
RESOLUTION FINDINGS LIST 3;4;FF1;FF4;FF2;FF5
INFORMATION FINDINGS COUNT 5
INFORMATION FINDINGS LIST 2;5;6;7;8
WEB SITES
  1. URL:   http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm
    WEB SITE TITLE:   NIAAA Helping patients who drink too much
GENERAL COHORT FOUND TEXT
Patients with no prior history of alcohol related problems or prior
Patients with prior alcohol problems and ANY positive AUDIT-C score should
be considered for referral to a Substance Abuse program.  These patients
are at high risk of dependence.
 
Standard drinks:   \\
     0.5 fluid ounces of absolute alcohol  \\
     12 ounces of beer                      \\
     5 ounces of wine                       \\
     1.5 ounces of 80-proof spirits         \\
treatment for alcohol abuse or dependence who have an AUDIT-C score of
4-7 (score of 3-7 for women) should be advised to stay within recommended
drinking limits.
 
RECOMMENDED LIMITS:
    Men:   <= 14 drinks/wk and maximum of 4 drinks/occasion
    Women: <=  7 drinks/wk and maximum of 3 drinks/occasion
 
# OF GEN. COHORT FOUND LINES 18
# GEN. COHORT NOT FOUND LINES 0
# GEN. RES. FOUND LINES 0
# GEN. RES. NOT FOUND LINES 0
BASELINE AGE FINDINGS
  1. REMINDER FREQUENCY:   99Y
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
# SUM. COHORT FOUND LINES 0
# SUM. COHORT NOT FOUND LINES 0
# SUM. RES. FOUND LINES 0
# SUM. RES. NOT FOUND LINES 0