Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients

Kathleen A. McGinnis, Janet P. Tate, Emily C. Williams, Melissa Skanderson, Kendall J. Bryant, Adam J. Gordon, Kevin L. Kraemer, Stephen A. Maisto, Stephen Crystal, David A. Fiellin, Amy C. Justice

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement. Methods Using data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis. Results Among 1082 HIV+ and 1160 uninfected men, 14% and 22% had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9% and 14% had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa = 0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa = 0.46). Moderate agreement was consistent across subgroups. Conclusions EMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening.

Original languageEnglish (US)
Pages (from-to)196-202
Number of pages7
JournalDrug and Alcohol Dependence
Volume168
DOIs
StatePublished - Nov 1 2016

Fingerprint

Electronic medical equipment
Electronic Health Records
HIV
Research
Alcohols
Biomedical Research
Screening
Surveys and Questionnaires
Veterans
Hepatitis C
Quality Improvement
HIV-1
Cohort Studies
Aging of materials
Research Personnel
Demography

All Science Journal Classification (ASJC) codes

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Keywords

  • AUDIT-C
  • Alcohol consumption
  • Electronic health record
  • HIV
  • Population-based screening
  • Veterans

Cite this

McGinnis, Kathleen A. ; Tate, Janet P. ; Williams, Emily C. ; Skanderson, Melissa ; Bryant, Kendall J. ; Gordon, Adam J. ; Kraemer, Kevin L. ; Maisto, Stephen A. ; Crystal, Stephen ; Fiellin, David A. ; Justice, Amy C. / Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. In: Drug and Alcohol Dependence. 2016 ; Vol. 168. pp. 196-202.
@article{6fe016ccd85b4c1aac7c7a8e2e34527c,
title = "Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients",
abstract = "Background Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement. Methods Using data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis. Results Among 1082 HIV+ and 1160 uninfected men, 14{\%} and 22{\%} had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9{\%} and 14{\%} had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa = 0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa = 0.46). Moderate agreement was consistent across subgroups. Conclusions EMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening.",
keywords = "AUDIT-C, Alcohol consumption, Electronic health record, HIV, Population-based screening, Veterans",
author = "McGinnis, {Kathleen A.} and Tate, {Janet P.} and Williams, {Emily C.} and Melissa Skanderson and Bryant, {Kendall J.} and Gordon, {Adam J.} and Kraemer, {Kevin L.} and Maisto, {Stephen A.} and Stephen Crystal and Fiellin, {David A.} and Justice, {Amy C.}",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.drugalcdep.2016.09.015",
language = "English (US)",
volume = "168",
pages = "196--202",
journal = "Drug and Alcohol Dependence",
issn = "0376-8716",
publisher = "Elsevier Ireland Ltd",

}

McGinnis, KA, Tate, JP, Williams, EC, Skanderson, M, Bryant, KJ, Gordon, AJ, Kraemer, KL, Maisto, SA, Crystal, S, Fiellin, DA & Justice, AC 2016, 'Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients', Drug and Alcohol Dependence, vol. 168, pp. 196-202. https://doi.org/10.1016/j.drugalcdep.2016.09.015

Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. / McGinnis, Kathleen A.; Tate, Janet P.; Williams, Emily C.; Skanderson, Melissa; Bryant, Kendall J.; Gordon, Adam J.; Kraemer, Kevin L.; Maisto, Stephen A.; Crystal, Stephen; Fiellin, David A.; Justice, Amy C.

In: Drug and Alcohol Dependence, Vol. 168, 01.11.2016, p. 196-202.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients

AU - McGinnis, Kathleen A.

AU - Tate, Janet P.

AU - Williams, Emily C.

AU - Skanderson, Melissa

AU - Bryant, Kendall J.

AU - Gordon, Adam J.

AU - Kraemer, Kevin L.

AU - Maisto, Stephen A.

AU - Crystal, Stephen

AU - Fiellin, David A.

AU - Justice, Amy C.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement. Methods Using data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis. Results Among 1082 HIV+ and 1160 uninfected men, 14% and 22% had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9% and 14% had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa = 0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa = 0.46). Moderate agreement was consistent across subgroups. Conclusions EMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening.

AB - Background Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement. Methods Using data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis. Results Among 1082 HIV+ and 1160 uninfected men, 14% and 22% had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9% and 14% had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa = 0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa = 0.46). Moderate agreement was consistent across subgroups. Conclusions EMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening.

KW - AUDIT-C

KW - Alcohol consumption

KW - Electronic health record

KW - HIV

KW - Population-based screening

KW - Veterans

UR - http://www.scopus.com/inward/record.url?scp=84989284833&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84989284833&partnerID=8YFLogxK

U2 - 10.1016/j.drugalcdep.2016.09.015

DO - 10.1016/j.drugalcdep.2016.09.015

M3 - Article

C2 - 27694059

AN - SCOPUS:84989284833

VL - 168

SP - 196

EP - 202

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

ER -