Implementation of a Hospital-Based Screening and Treatment Program for Unhealthy Alcohol Use
8 affiliations
- 1Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, TX USA
- 2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- 3Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA
- 4CommUnity Care Health Centers, Austin, TX USA
- 5Central Health, Travis County Health District, Austin, TX USA
- 6Department of Population Health, Dell Medical School at The University of Texas at Austin, Austin, TX USA
- 7The University of Texas at Austin, Steve Hicks School of Social Work, Austin, TX USA
- 8Department of Medicine, Duke University, Durham, NC USA
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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11606-026-10473-9.
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BibTeX
@article{ramesh2026implementation,
title = {{Implementation of a Hospital-Based Screening and Treatment Program for Unhealthy Alcohol Use}},
author = {Jananie Ramesh and Christopher Moriates and John Embers and Alanna Boulton and Nicole Kluz and Rachel Holliman and Frances Ibarra and Ohenewaa Dede-Bamfo and Patrick Chang and Mary Velasquez and Michael Pignone},
journal = {Journal of General Internal Medicine},
year = {2026},
month = may,
doi = {10.1007/s11606-026-10473-9},
url = {https://doi.org/10.1007/s11606-026-10473-9},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Implementation of a Hospital-Based Screening and Treatment Program for Unhealthy Alcohol Use
AU - Jananie Ramesh
AU - Christopher Moriates
AU - John Embers
AU - Alanna Boulton
AU - Nicole Kluz
AU - Rachel Holliman
AU - Frances Ibarra
AU - Ohenewaa Dede-Bamfo
AU - Patrick Chang
AU - Mary Velasquez
AU - Michael Pignone
PY - 2026
DA - 2026/05/14
JO - Journal of General Internal Medicine
DO - 10.1007/s11606-026-10473-9
UR - https://doi.org/10.1007/s11606-026-10473-9
AB - 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11606-026-10473-9.
SN - 0884-8734
SN - 1525-1497
ER -