We (will) Ask Everyone*

Transcription

1 We (will) Ask Everyone* Indiana and Wishard Health received $8.3 Million to improve early substance use detection and intervention. Goal: Screen every primary care patient over the age of 18 at least once per year and offer brief intervention and referral as appropriate. 10 CHCs, 5 Years, 100K Patients Starting with Westside!

2 The Problem: A Lost Opportunity 20.8 million of 23.2 million people needing treatment for substance use did not receive it. Annual cost estimates are $184.6 billion for alcohol abuse and $143 billion for drug abuse. 53.7% of patients said their healthcare provider did nothing about their substance abuse, with 43% said they were never diagnosed, and 10.7% believed their provider knew about the addiction but did nothing. 74.1% of patients said their primary care physician was not involved in their decision to seek treatment, and 16.7% said the physician was involved a little.

3 The Solution: Is Burt!

4 The Solution: SBIRT Pronounced S-BURT, like Burt, not SBIRT, like SPURT X

5 The Solution: SBIRT Screening Brief Referral to Intervention Treatment S. Screening for problems with validated brief items BI. Brief Intervention by a professional who discusses alcohol and drug use issues with those who may be at risk RT. Referral to Treatment if warranted. Not all that different from what we already do here at Westside, but a more systematic and structured approach to early identification

6 SBIRT has proven efficacy SBIRT has been shown to increase identification of at-risk/harmful users decrease frequency and severity of alcohol use increase number of patients with risky use or substance abuse disorders receiving treatment improve self-assessment of overall health decrease psychiatric symptoms precipitated by alcohol/drug use reduce injuries that require either treatment in the ED or readmission to trauma services

7 And is cost-beneficial What's more, SBIRT has been shown to be Cost-Beneficial. Upfront dollars led to significant ROI. For example, Project TrEAT 48-month outcome data demonstrated a $43,000 reduction in health care costs for every $10,000 invested in early intervention Low Burden. SBIRT can be implemented to have relatively minimal impact on overall provider time and resources.

8 1. Increase integration of substance use screening and initial treatment throughout the Wishard CHCs Process development: Who does what? Training and support Policy and systems change Aligns with the Medical Home Model Underway in Medical Residency at PCC4 2. Increase uptake of SBIRT by other health organizations throughout the state

9 Timeline IndianaSBIRT Project Timeline 3 CHCs 15K Patients 3 New CHCs 21K Patients 4 New CHCs 21K Patients 10 CHCs 100K Patients YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 Protocol Development, Implementation, Formative Evaluation and Ongoing Improvement Statewide Dissemination Efforts: Capture, Outreach, Training, and Support

10 Initial Rollout: Westside ü Starting low tech but in a high volume setting ü Organic process development, heavy stakeholder involvement ü MA completes a pre-assessment with each patient, once per year. ü MA hands off pre-screen to BHS ü BHS conducts follow up as appropriate S, BI, RT happen here ü BHS documents for clinician ü Continually improving and responding to individual clinic needs while simultaneously moving toward a standardized process at all the CHCs

11 From Intake to Discharge PSA Gathers Demographics and Passes to Prescreening MAs/Nurses prescreen patient and notify BHS BHS Conducts SBIRT Patient sees Provider

12 The Key: An SBIRT Questionnaire PLACE&PATIENT&LABEL&HERE&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& (Name&&&DOB) SBIRT QUESTIONNAIRE Question # 1 GENDER: Question # 2 RACE: Male Female Transgender Refused Missing Other Black/African American Caucasian/White Asian American Indian Native Hawaiian Other Pacific Islander Alaska Native Refused MEDICAL ASSISTANTS/NURSES PSA Question # 3 HISPANIC/LATINO: IF YES, ETHNICITY: Question # 4 VETERAN STATUS: Question # 5 SSN (Last 4 Digits): Question # 6 MEN: WOMEN: Question # 7 Yes No Refused Missing Central American Puerto Rican Cuban South American Dominican Yes No Refused How many times in the PAST YEAR have you had 5 or more drinks in a day? (record number) Anything greater than 0 is positive. How many times in the PAST YEAR have you had 4 or more drinks in a day? (record number) Anything greater than 0 is positive. How many times in the PAST YEAR have you used an illegal drug or used a prescription drug for nonmedical reasons? (record number) Anything greater than 0 is positive. Question #8 Mexican Refused Other Over the PAST 2 WEEKS, have you often been bothered by: 1. Little interest or pleasure in doing things? Yes No DISPOSITION 2. Feeling down, depressed, or hopeless? Yes No *** A "yes" to either question is considered a positive prescreen. REFUSED NEGATIVE POSITIVE EXAM ROOM # FOLLOW-UP REQUIRED (Reason)

13 Intake: PSAs Check Patient In Red Sheet Dated Within 1 Year? No Lavender Sticker dated within 1 Year? No Apply Label to Lavender Sheet Fill in PSA Section of SBIRT Questionnaire (Lavender Sheet) Apply New Lavender Sticker Yes Yes Put Chart In Basket for MAs Finished

14 Preassessment MA Retrieves Chart Red Sheet in File? No Lavender Sheet in File? Yes Complete MA Section of SBIRT Questionnaire (Lavender Sheet) Date Lavender Sticker Any Positive Answers? Yes Write Room # on Lavender Sheet and Place in Positive Basket Yes No No Put Red & Lavender Sheets in Positive Basket Don't Contact BHS Place Lavender Sheet in Negative Basket Contact BHS

15 MA to BHS: SBIRT

16 Discussion Questions? Suggestions for Improvement? Potential Problems?

17 Conclusions and Next Steps People aren t asked. They should be. SBIRT is an effective way to not only increase our asking, but to improve entry into related care its also valuable as a launching pad and testing ground for care integration and its underway.