Unhealthy alcohol use and the joint commission
An impetus for a standardized approach to SBIRT for
unhealthy alcohol use, is the recent inclusion by JCAHO
of SBIRT as a quality care measure for hospitalized patients
[5], and these recommendations have been summarized
[6]. In brief, JCAHO has recommended
screening for unhealthy use in all patients, brief intervention
for patients with unhealthy use, in-hospital
treatment or referral for alcohol use disorders, and consideration
of medications for alcohol dependence treatment.
Performance of these tasks would be measured by
self-reported outcomes through phone contact within 2
weeks of discharge.
This JCAHO initiative is grounded in the recognition
that unhealthy alcohol use and other drug use is a major
determinant of health in hospitalized patients, but has
been criticized due to insufficient evidence on the overall
effectiveness of SBIRT among general hospital inpatients
[6]. In that regard, the JCAHO quality initiative extends
beyond the evidence, but represents an attempt to integrate
research findings into medical care. This intent must
be applauded, and should be used as a springboard to further
develop methods that will improve patient outcomes
following an index hospitalization. The more severe nature
of unhealthy alcohol use in the hospital, the process of
SBIRT, and the intended outcomes should drive the research
agenda. Some thoughts in this regard are listed in
Table 7, which is not meant to be exhaustive. Research efforts
must be geared toward generic processes of care and
quality assessment, as the intent will be to improve patient
outcomes in settings where personnel with unique interests
in this field are not always present.