# Trajectories of alcohol screening and brief intervention (ASBI) performance and their associations with long-term performance and alcohol use outcomes: an observational study in a large US integrated healthcare delivery system

## TL;DR

This study examines how alcohol screening and brief intervention performance in healthcare facilities changed over five years and how these changes relate to long-term alcohol use outcomes.

## Contribution

The study identifies distinct performance trajectories of ASBI and links them to long-term outcomes in a large healthcare system.

## Key findings

- Facilities with early high ASBI performance showed better long-term sustainability.
- Improving BI performance was associated with reduced binge drinking over time.
- Low-BI-performance facilities served more patients from deprived neighborhoods.

## Abstract

Unhealthy alcohol use is a public health problem with significant health, social and economic impacts. Alcohol screening and brief intervention (ASBI) in adult primary care is an evidence-based approach enabling early identification and intervention of unhealthy alcohol use. However, large-scale implementation and sustainment of ASBI in routine clinical practice remains a challenge, and little is known about its population-level impact. Using electronic health record (EHR) data in a large integrated healthcare system in Northern California that implemented systematic ASBI in adult primary care in mid-2013, this observational study examined: 1) trajectories of ASBI performance over 5 years post systematic implementation, and 2) their associations with both later ASBI performance and alcohol use outcomes.

Using the health plan’s EHR data, we calculated annual screening rates of adults with a primary care visit, and brief intervention (BI) rates among those with a positive screen (i.e., reporting alcohol consumption exceeding the age and sex specific daily and weekly low-risk National Institute on Alcohol Abuse and Alcoholism guidelines), for 57 medical facilities from years 2014 to 2021. We conducted latent class growth analysis using annual screening and BI rates to characterize trajectories of ASBI performance from years 2014–2018. Multivariable mixed-effects models were fit to examine the associations of ASBI performance trajectories with later ASBI performance and facility-level alcohol use outcomes.

Three distinct screening performance trajectory groups (low-, middle- and high-performance) and four distinct BI performance trajectory groups (low-, improving-, middle- and high-performance) were identified. Facilities in the low-BI-performance group had panels of patients living in more deprived neighborhoods compared to the other 3 BI performance groups. After accounting for repeated measures and adjusting for time and patient panel characteristics, we found that screening and BI performance trajectories during 2014–2018 were significantly associated with screening and BI rates 2019–2021, respectively. We also observed a steeper decline in percentages reporting “exceeding daily drinking limits” and “having 5 + binge drinking days” over time among patients of facilities in the improving- and high-BI-performance groups.

Early success in ASBI performance is associated with long-term sustainability and may be associated with long-term population-level drinking outcomes.

The online version contains supplementary material available at 10.1186/s43058-025-00842-6.