Improving Outcomes Among Medical/Surgical Inpatients With Alcohol Use Disorders

2017-08-23 18:23:21 | BioPortfolio


This project aims to help Veterans who are in the hospital and have untreated alcohol problems. First, the investigators will adapt a Decision Aid that explains alcohol-related treatment options and their risks and benefits. Then, the investigators will determine the effectiveness of an intervention called DO-MoST (for Drinking Options-Motivate, Shared Decisions, Telemonitor), whereby a Decision Coach helps Veterans make decisions about alcohol-related behaviors and treatments they prefer, and keeps in contact by phone to continue to help with drinking and treatment decisions. DO-MoST is designed to increase rates at which Veterans decide to reduce or quit drinking, and begin and remain in treatment, and to improve drinking- and medical-related outcomes over time. It may also decrease Veterans' use of expensive health services such as hospitalizations and emergency visits. Finally, the investigators will study how VA can use DO-MoST on an ongoing, more widespread basis. The project should increase patient-centered health care for Veterans with alcohol problems to benefit their recovery.


In fiscal year 2014, over 57,000 Veterans with diagnosed alcohol use disorders (AUDs) received VHA inpatient medical-surgical services. This likely underrepresents the prevalence of AUDs among Veteran inpatients, because these conditions often go undiagnosed during hospital stays. The high prevalence of AUDs among VHA medical-surgical inpatients is of critical concern because AUDs and medical conditions exacerbate one another, and their co-occurrence increases the use of costly health services. Yet, there are no evidence-based strategies that improve outcomes in this patient population by means of increased utilization (initiation, engagement) of AUD treatment services. The investigators have identified Drinking Options: Motivate, Shared Decisions, Telemonitor (DO-MoST) as a potential solution to the critical need for evidence-based strategies.

This project will evaluate DO-MoST as a new and innovative intervention to facilitate the transition from inpatient medical-surgical care to AUD treatment in primary and specialty care settings, thereby improving Veterans' AUD and medical outcomes. DO-MoST entails use of motivational interviewing and a decision aid during the inpatient stay to facilitate informed choices about post-discharge drinking options and resources for help to change drinking, if desired, followed by telephone calls with the patient to continue to motivate and support decisions. In addition to determining the effectiveness of DO-MoST, this project includes a process evaluation - that is, will gather information from providers and patients on DO-MoST's implementation at the two project sites - to inform VA's potential widespread implementation of DO-MoST with medical-surgical patients with AUDs.

Using an effectiveness/implementation Hybrid Type 1 design, incorporating a randomized controlled trial (RCT) and process evaluation to facilitate future implementation, this project has three Specific Aims.

Aim 1: Adapt a decision aid being implemented with AUD patients in non-VA primary care settings to be appropriate for Veterans with AUDs in medical-surgical inpatient settings. With this prototype, the investigators will conduct alpha testing with patients and providers, and adapt and pilot the decision aid to finalize it for use in the RCT.

Aim 2: Conduct DO-MoST at two VA facilities (Ann Arbor and Palo Alto) and evaluate its effectiveness.

The primary hypotheses are: Patients in DO-MoST, compared to patients in usual care (UC), will be more likely to (1) utilize AUD help (initiate, engage), (2) have better AUD (fewer heavy drinking days) and medical (physical status) outcomes, and (3) have fewer and more delayed acute care episodes (Emergency Department visits, rehospitalizations). Patients will be assessed at baseline, and 3, 6, and 12 months post-discharge, for outcomes and non-VA health care; VA health care will be assessed with VA databases. GLMM analyses will be conducted to compare the UC and DO-MoST groups on course of outcomes.

Aim 3: Conduct a qualitative process evaluation to inform the wider implementation of DO-MoST, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The purpose is to provide guidance for VA facilities' broader adoption of DO-MoST in the future, including its possible adaptation for diverse subpopulations of Veterans, such as patients with mental health diagnoses (e.g., PTSD).

In summary, this project will develop a decision aid and comprehensively examine DO-MoST as a novel and groundbreaking approach to providing a bridge between inpatient medical-surgical treatment and AUD treatment. Decision Aids have been used successfully in a number of contexts, but never with medical-AUD inpatients. The investigator's operations partners from VHA Mental Health Services and Medical Service are committed to directly addressing the dangerous, costly pattern of Veterans obtaining inpatient medical-surgical services but not receiving the AUD treatment they need. The project is focused on priorities in the VA Blueprint for Excellence, of HSR&D Service, and of the PIs' HSR&D Centers of Innovation.

Study Design


Alcohol Use Disorder


Drinking Options - Motivate, Shared Decisions, Telemonitor (DO-MoST)


VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto
United States


Not yet recruiting


VA Office of Research and Development

Results (where available)

View Results


Published on BioPortfolio: 2017-08-23T18:23:21-0400

Clinical Trials [1142 Associated Clinical Trials listed on BioPortfolio]

Unhealthy Alcohol Drinking and Anesthetic Requirement in Women

Unhealthy alcohol drinking is negatively influencing health of people and costing a large number of annual finance via "secondhand" effects. Additionally, unhealthy alcohol use covers a sp...

Binge Drinking Among Youngs is a Risk Factor for Alcohol Use Disorders

The purpose of this study was to assess drinking habits and patterns of alcohol consumption, smoking habits, use of illicit drugs and the prevalence of binge drinking and alcohol use disor...

Smartphone Technology: Young Adult Drinking

Exploring technology based tools to reduce drinking is important. The purpose of this research study is to compare different BAC monitoring apps for their effects on alcohol drinking and r...

Efficacy of Gabapentin in Alcohol Dependency Treatment

The study aims to study the effect of gabapentin on the number of alcohol drinking days and heavy drinking days in the Thai clinical alcohol-dependent population by using the double-blinde...

YANAS Smartphone Technology

It is important to explore use of technology to reduce drinking. The purpose of this research study is to compare different types of mobile technology for their effects on alcohol drinking...

PubMed Articles [6632 Associated PubMed Articles listed on BioPortfolio]

Investment in drinking identity is associated with alcohol consumption and risk of alcohol use disorder.

Problematic alcohol consumption is elevated among those who identify (i.e., associate themselves) with drinking. We extended prior research on drinking identity by considering two dimensions of invest...

Motives for drinking alcohol and eating palatable foods: An evaluation of shared mechanisms and associations with drinking and binge eating.

Young adulthood is a high-risk period for heavy drinking and binge eating, both of which can impact weight and lead to obesity. Examining motives for drinking alcohol and eating palatable foods may fa...

Reasons to stop drinking alcohol among patients with rheumatoid arthritis in Sweden: a mixed-methods study.

The aims were to identify patients with rheumatoid arthritis (RA) who had stopped drinking alcohol and compare them with patients drinking alcohol, and to explore reasons for stopping drinking alcohol...

Processing Transdermal Alcohol Concentration (TAC) data to Detect Low-Level Drinking.

Several studies have objectively quantified drinking through the use of Alcohol Monitoring System's (AMS) transdermal alcohol concentration (TAC) device known as SCRAM CAM. Criteria that AMS uses to d...


Societal-level volume and pattern of drinking and alcohol control policy have received little attention in the alcohol and injury literature. The aim of this study was to estimate the association betw...

Medical and Biotech [MESH] Definitions

Behaviors associated with the ingesting of alcoholic beverages, including social drinking.

Substances interfering with the metabolism of ethyl alcohol, causing unpleasant side effects thought to discourage the drinking of alcoholic beverages. Alcohol deterrents are used in the treatment of alcoholism.

Alcohol consumption among college students.

FIBROSIS of the hepatic parenchyma due to chronic excess ALCOHOL DRINKING.

Consumption of ALCOHOLIC BEVERAGES by persons under the legal drinking age.

More From BioPortfolio on "Improving Outcomes Among Medical/Surgical Inpatients With Alcohol Use Disorders"

Quick Search


Relevant Topic

Surgical treatments
Surgery is a technology consisting of a physical intervention on tissues. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being exci...

Searches Linking to this Trial