Achieving the Quadruple Aim through SBIRT Implementation

From the 2021 HVPAA National Conference

Tiffany Wandy (LifeBridge Health), Sarah Forr, Courtney Newkirk

Background

Starting in 2020, LifeBridge Health undertook the implementation of the SBIRT (Screening, Brief Intervention, and Referral to Treatment) method for assessing alcohol and substance abuse in adult and adolescent patients seen at 28 of our primary care practice locations.

To better serve at-risk substance users, our primary care practices leveraged relationships with patients to provide opportunities for early intervention before more severe consequences occur. Unhealthy alcohol and other drug use are among the most common causes of preventative morbidity and mortality despite frequent presentation in primary care. These unhealthy substance abuse practices can complicate existing conditions such as diabetes, hypertension, cardiovascular disease and mental health, and can interact with prescribed medications. Substance abuse often goes unrecognized, so using the SBIRT tool, known as the AUDIT-C screening tool, allows providers to efficiently focus on larger numbers of patients who may use drugs and/or alcohol in unhealthy ways, but do not yet have a substance abuse disorder.

Objective

To utilize the AUDIT-C screening tool to effectively incorporating mental health and substance abuse screenings as a routine preventative service in primary care.

Methods

The implementation focused on training our primary care providers and office staff on best practices for identifying patients, administering the screening tool, providing follow up, tracking progress, optimizing the EHR, fully documenting patient complexity, and accurately billing for services rendered.

The three-month implementation at each site consisted of:

  • Assembling a planning team
  • Conducting a workflow analysis
  • Selecting screening instruments
  • Developing a customized protocol
  • Modifying the EMR for screening, billing, data collection and reporting needs
  • Training all relevant staff
  • Piloting services
  • Reporting

Results

To date, 16 of our 28 primary care practices have expressed interest in implementing the SBIRT workflow and it has been fully operationalized in four of those practices. To date, 4,196 patients have been screened and of those, 165 resulted in positive screenings. As a result of the 165 positive screenings, 58 patients received brief interventions and 43 patients have been successfully referred to treatment for follow up.

Conclusions

The goal of the implementation process was to incorporate substance abuse screening into the primary care setting. To achieve this goal, we integrated the AUDIT-C screening tool into the EHR to optimize workflow, improve patient satisfaction and provide early intervention to those at risk for developing alcohol or drug related addictions. Through this process, we were able to train providers and staff on best practices for identifying at-risk patients and screening them effectively.

Clinical Implications

Research has also shown that larger numbers of people whose patterns of use put them at risk of developing alcohol or drug problems can be identified through screening. Implementing SBIRT in our PCP offices has been an effective way to target the quadruple aim of improving the clinical experience, improving outcomes, lowering costs, and improving the patient experience.

In the future, our goal is to incorporate SBIRT into all LifeBridge primary care offices and demonstrate the following:

  • Decreased frequency and severity of drug and/or alcohol use
  • Decreased ED visits and/or inpatient hospital stays
  • Demonstrated net cost savings