Trauma center brief interventions for alcohol disorders decrease subsequent driving under the influence arrests.

BACKGROUND: A substantial number of trauma center admissions are related to driving under the influence (DUI); however, there has been no prior report of brief intervention (BI) after injury reducing subsequent DUI arrests. The hypothesis of this study was that injured patients receiving BI would have a lower risk of DUI arrest within 3 years of discharge than those receiving standard care (SC). METHODS: This prospective, randomized clinical trial randomly allocated patients involved in motor vehicle collisions to receive SC or a BI regarding alcohol use. The primary outcome measure was DUI arrest within 3 years of hospital discharge. DUI arrests were documented by matching demographic information to state traffic safety data. RESULTS: After randomization (N = 126), BI and SC groups were similar in age, prior DUI arrests, and alcohol screening score. BI sessions lasted an average of 30 minutes and were performed by either a social worker or a trauma surgeon. Approximately one in six participants (n = 21, 16.7%) had a DUI arrest within 3 years of hospital discharge. Within 3 years of hospital discharge, 14 of 64 patients (21.9%) in the SC group had an arrest for DUI compared with only 7 of 62 patients (11.3%) who received the BI. Multivariate analysis demonstrated that BI was the strongest protective factor against DUI arrest (odds ratio [OR], 0.32; 95% confidence interval < or =CI], 0.11-0.96). Prior number of DUIs (OR, 1.43; 95% CI, 1.03-2.01) and age (OR, 0.94; 95% CI, 0.88-0.99) were also associated with DUI arrest post-hospitalization, but alcohol screening score (OR, 1.06; 95% CI, 0.99-1.13) was not. The absolute risk reduction implies that only nine patients would need to receive a BI to prevent one DUI arrest. CONCLUSION: Patients who receive BI during a trauma center admission are less likely to be arrested for DUI within 3 years of discharge. BI represents a viable intervention to reduce DUI after trauma center admission.

Development of a large-scale obstetric quality-improvement program that focused on the nulliparous patient at term.

OBJECTIVE: The purpose of this study was to identify an appropriate population and a balanced set of maternal and neonatal measures to drive a hospital network obstetric quality improvement program. STUDY DESIGN: Sutter Health, a large Northern California health care system with>40,000 births annually, served as the site for this project. We chose to focus on the standardized nulliparous patients: term, singleton, and vertex. A multidisciplinary task force evaluated and selected perinatal outcome and process measures. Data from every hospital were collected prospectively electronically and analyzed centrally. RESULTS: Outcome measures that were selected included term, singleton, and vertex rates of 3rd/4th-degree laceration, cesarean birth, 5-minute Apgar score of <7, and patient satisfaction. The process measures included episiotomy, induction (37-41 weeks), and admittance with cervical dilation of > or =3 cm. Data collection completeness improved each quarter; by the end of 2002, the data collection completeness rate had reached 99.7%. Every measure demonstrated a large variation among our hospitals, which indicates opportunities for improvement. CONCLUSION: This balanced set of measures for term, singleton, and vertex patients has been straightforward to collect over a large and diverse hospital system and has engaged all participants successfully.

Trauma patient willingness to participate in alcohol screening and intervention.

BACKGROUND: Screening and brief interventions for alcohol disorders in the trauma setting are not routine. Perceived barriers to screening and treatment include the perception that patients find the topic offensive and the feasibility of screening all patients. The hypothesis of the study was that discussing alcohol use would be acceptable to patients independent of race or screening test score. Additional aims were to describe whether patients had access to alcohol screening via a primary care physician, to see what types of treatment patients thought appropriate, and to evaluate the feasibility of screening all trauma patients for alcohol disorders. METHODS: We surveyed 150 trauma inpatients regarding the offensiveness of discussing alcohol use and the appropriateness of different treatment options. We asked whether they had access to a primary care physician. As part of our routine screening program, we evaluated the proportion of patients we were able to screen with the Alcohol Use Disorders Identification Test, refusal rates, and whether any patients were not screened. Analysis of covariance and logistic regression were used to evaluate responses. RESULTS: A part-time research assistant approached 90% of 163 patients. Seventy percent were successfully screened, of which 45% screened positive for problematic alcohol use. Of the patients we were unable to screen, one third did not speak English and one half had injuries precluding interaction, leaving 16 patients (9.8%) that were "missed." One patient (<1%) refused screening. One hundred fifty consecutive patients participated in the survey. The ethnic distribution was 26% Native American, 40% Hispanic, 30% white, 2% African American, and 2% other. A brief counseling session was acceptable to all ethnic groups. There were ethnic differences in acceptability of other types of treatment. Ninety-four percent of patients thought that somebody from the trauma team should talk with patients about alcohol. Alcohol Use Disorders Identification Test score did not predict whether patients would be offended (p = 0.48). Forty-five percent had a primary care physician and only 10% had ever spoken to their physician about alcohol use. CONCLUSION: The majority of trauma patients are not offended by discussing alcohol use while hospitalized for injury and can feasibly be screened for alcohol disorders. Treatment types may need to be culturally tailored.