{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:42:30Z","timestamp":1791495750037,"version":"4.3.4"},"reference-count":82,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Unhealthy alcohol use is common and affects morbidity and mortality but is often neglected in medical settings, despite guidelines for both prevention and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To test an implementation intervention to increase (1) population-based alcohol-related prevention with brief interventions and (2) treatment of alcohol use disorder (AUD) in primary care implemented with a broader program of behavioral health integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>The Sustained Patient-Centered Alcohol-Related Care (SPARC) trial was a stepped-wedge cluster randomized implementation trial, including 22 primary care practices in an integrated health system in Washington state. Participants consisted of all adult patients (aged \u226518 years) with primary care visits from January 2015 to July 2018. Data were analyzed from August 2018 to March 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The implementation intervention included 3 strategies: practice facilitation; electronic health record decision support; and performance feedback. Practices were randomly assigned launch dates, which placed them in 1 of 7 waves and defined the start of the practice\u2019s intervention period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>\n                      Coprimary outcomes for prevention and AUD treatment were (1) the proportion of patients who had unhealthy alcohol use and brief intervention documented in the electronic health record (\n                      <jats:italic>brief intervention<\/jats:italic>\n                      ) for prevention and (2) the proportion of patients who had newly diagnosed AUD and engaged in AUD treatment (\n                      <jats:italic>AUD treatment engagement<\/jats:italic>\n                      ). Analyses compared monthly rates of primary and intermediate outcomes (eg, screening, diagnosis, treatment initiation) among all patients who visited primary care during usual care and intervention periods using mixed-effects regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 333\u202f596 patients visited primary care (mean [SD] age, 48 [18] years; 193\u202f583 [58%] female; 234\u202f764 [70%] White individuals). The proportion with brief intervention was higher during SPARC intervention than usual care periods (57 vs 11 per 10\u202f000 patients per month;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). The proportion with AUD treatment engagement did not differ during intervention and usual care (1.4 vs 1.8 per 10\u202f000 patients;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.30). The intervention increased intermediate outcomes: screening (83.2% vs 20.8%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), new AUD diagnosis (33.8 vs 28.8 per 10\u202f000;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.003), and treatment initiation (7.8 vs 6.2 per 10\u202f000;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this stepped-wedge cluster randomized implementation trial, the SPARC intervention resulted in modest increases in prevention (brief intervention) but not AUD treatment engagement in primary care, despite important increases in screening, new diagnoses, and treatment initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02675777\">NCT02675777<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2022.7083","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T11:01:19Z","timestamp":1677495679000},"page":"319","source":"Crossref","is-referenced-by-count":66,"title":["Integrating Alcohol-Related Prevention and Treatment Into Primary Care"],"prefix":"10.1001","volume":"183","author":[{"given":"Amy K.","family":"Lee","sequence":"first","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"},{"name":"Mental Health and Wellness Department, Kaiser Permanente Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F.","family":"Bobb","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie E.","family":"Richards","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"},{"name":"Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol E.","family":"Achtmeyer","sequence":"additional","affiliation":[{"name":"Veterans Affairs Puget Sound Health Care System, Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evette","family":"Ludman","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malia","family":"Oliver","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Caldeiro","sequence":"additional","affiliation":[{"name":"Mental Health and Wellness Department, Kaiser Permanente Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Parrish","sequence":"additional","affiliation":[{"name":"Mental Health and Wellness Department, Kaiser Permanente Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula M.","family":"Lozano","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwen T.","family":"Lapham","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"},{"name":"Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily C.","family":"Williams","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"},{"name":"Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle"},{"name":"Veterans Affairs Puget Sound Health Care System, Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Glass","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"},{"name":"Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle"},{"name":"Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine A.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"},{"name":"Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle"},{"name":"Department of Medicine, School of Medicine, University of Washington, 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