Unhealthy alcohol use is the third leading cause of preventable death in the United States (U.S.). The U.S. Preventive Services Task Force recommends screening for unhealthy alcohol use but little is known about how best to do so. We used quality improvement techniques to implement a systematic approach to screening and counseling primary care patients for unhealthy alcohol use. Components included use of validated screening and assessment instruments; an evidence-based 2-visit counseling intervention using motivational interviewing techniques for those with risky drinking behaviors who did not have an alcohol use disorder (AUD); shared decision making about treatment options for those with an AUD; support materials for providers and patients; and training in motivational interviewing for faculty and residents. Over the course of one year, we screened 52% (N=5,352) of our clinic’s patients and identified 294 with positive screens. Of those 294, appropriate screening-related assessments and interventions were documented for 168 and 72 patients, respectively. Although we successfully implemented a systematic screening program and structured processes of care, ongoing quality improvement efforts are needed to screen the rest of our patients and to improve the consistency with which we provide and document appropriate interventions.

A quality improvement intervention using geriatric-specific note templates, housestaff training, and reminders increased documentation of function, cognition and ACP for postacute care.

Background and Objectives: Older adults are the fastest growing subset of the population and residency training in the basic concepts of care to the older adult is limited. We created a 1-day interactive training program, Advanced Geriatric Evaluation Skills (AGES), to upskill first-year primary care residents in the care of older adults. Methods: An interprofessional faculty team developed and taught the IRB-approved course to a convenience sample of family medicine and internal medicine interns in 2017, 2018, and 2019. Topics addressed common geriatric presentations seen in the outpatient setting. The faculty provided useful tips and hints for successful workup, diagnosis, and treatment. Results: Over the 3 years, 56 of the 135 (41%) first-year primary care residents participated. Residents reported that the course was well organized, relevant, and well taught, and they appreciated the dedicated time to focus on caring for older adults. During 2019, residents completed a pre- and posttest with 25 multiple-choice questions. The average score on the pretest was 76% and the average on the posttest was 88%. Ninety percent of the residents improved their score from the pre- to the posttest. Conclusions: The development of an AGES program provided a structured geriatric didactic curriculum for primary care residents. The course was well received by the residents, was reported to be relevant and timely, and resulted in increased knowledge in the care of older adults in the outpatient setting.

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