February 2007

Grant Results

SUMMARY

On May 28–30, 2003, staff at the Centers for Disease Control and Prevention (CDC) and five other groups sponsored a conference to draft recommendations to encourage trauma center staff to screen patients for alcohol and other drug problems and to counsel those who screen positive and refer them for treatment.

Key Recommendations

  • Make screening, brief intervention and referral to treatment, when necessary, for substance use problems a component of trauma care.
  • Change state insurance regulations that allow medical insurers to exclude coverage for injuries related to substance use problems.
  • Insurers should reimburse trauma center staff for screening patients, and providing a brief intervention and referral for treatment, when necessary.
  • Fund research, with involvement from trauma center staff, to find effective ways to implement programs of screening, a brief counseling intervention, and referral.

Funding
The Robert Wood Johnson Foundation (RWJF) provided a grant of $25,000 to help pay the costs of publishing the conference proceedings in a special supplement to the Journal of Trauma: Injury, Infection and Critical Care. In addition to the CDC, five other groups provided financial support for the conference. (See the Appendix.)

 See Grant Detail & Contact Information
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THE PROBLEM

More than three million people are hospitalized in the nation's trauma centers each year, and an estimated 30 to 50 percent of these patients may have a problem with alcohol, according to Daniel Hungerford, an epidemiologist at the CDC's National Center for Injury Prevention and Control.

Studies have shown that screening hospitalized trauma patients for alcohol problems and counseling them using a variety of brief interventions can decrease their risk of future drinking-related injuries and emergency department visits.

(Hungerford says research on brief interventions for trauma patients has concentrated on patients with alcohol problems. There is some evidence that these interventions may be effective with patients with other substance use problems, but studies have not been conducted in the trauma center setting.)

Despite the available evidence, clinicians at trauma centers do not routinely address their patients' alcohol and substance use problems because:

  • A law in many states, known as the Uniform Accident and Sickness Policy Provision, allows insurance companies to reject claims for injuries that are related to alcohol or drug use.
  • Many trauma surgeons are not aware of how useful a systematic program of screening, a brief counseling intervention and referral for treatment can be for people with alcohol or substance use problems.

Staff at the CDC's National Center for Injury Prevention and Control, Division of Injury and Disability Outcomes organized a similar conference in 2001—"Alcohol Problems Among Emergency Department Patients: Proceedings of a Research Conference on Identification and Intervention"—directed at emergency department physicians. The proceedings are available online.

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THE PROJECT

Staff at the CDC's National Center for Injury Prevention and Control, Division of Injury and Disability Outcomes organized a conference, "Alcohol and Other Drug Problems Among Hospitalized Trauma Patients: Controlling Complications, Mortality and Trauma Recidivism."

Approximately 100 participants—including trauma surgeons, researchers in substance abuse and representatives from government agencies and professional associations—attended the conference in Arlington, Va., May 28–30, 2003.

The goal of the conference was to craft recommendations for trauma center staff to screen patients for alcohol and drug problems and to counsel those who screen positive and refer them for treatment.

A steering committee—which included the CDC, funding organizations (see the Appendix), as well as prominent trauma surgeons and representatives from several other associations and government agencies—planned the event and approved the final recommendations.

Conference organizers published the conference proceedings—including recommendations, summaries of group discussions and presentations—in a special supplement to the Journal of Trauma: Injury, Infection and Critical Care.

Challenges

  • There were delays in production of the special supplement to the Journal of Trauma because the editing and publishing processes took longer than anticipated. (See Lessons Learned.)
  • The first version of the supplement, dated September 2005 and distributed December 2005, contained numerous printing errors. (A corrected version was distributed in February 2006.)

Communications

  • The supplement was mailed to 4,400 subscribers to the Journal of Trauma: Injury, Infection and Critical Care.
  • The CDC purchased 4,000 copies of the supplement to distribute to interested individuals throughout the country, as well as members of the Indian Health Service. The CDC also provides free access to the supplement in two ways: The report is available online.
  • Innovators Combating Substance Abuse program, funded by RWJF and headquartered at the Johns Hopkins University School of Medicine purchased 1,000 copies. Innovators Combating Substance Abuse awards grants to researchers, artists, policy-makers and others who address substance abuse problems in new ways.

Other Funding

RWJF provided a grant of $25,000 to help pay the costs of publishing the conference proceedings in a special supplement to the Journal of Trauma: Injury, Infection and Critical Care. In addition to the CDC, five other groups provided financial support for the conference. (See the Appendix.)

Recommendations

  • Make screening, brief intervention and referral to treatment for substance use disorders a component of trauma care.
  • Change state insurance regulations that allow medical insurers to exclude coverage for injuries related to substance use problems.
  • Insurers should reimburse trauma center staff for screening patients, and providing a brief intervention and referral for treatment, when necessary.
  • Fund research, with involvement from trauma center staff, to find effective ways to implement programs of screening, a brief intervention, and referral for treatment.
  • Share with medical professionals the results of research demonstrating the effectiveness of these programs in the treatment of substance use problems.
  • Make programs that include screening and a brief intervention a routine practice in trauma centers, even as research on the best way to implement these programs is conducted.
  • Create systems for reporting substance use problems to public health officials so they can put together better data about this group of patients.

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LESSONS LEARNED

  1. Secure an agreement to publish meeting proceedings prior to holding the meeting. Hungerford proposed the idea of proceedings at a board meeting of the American Association for the Surgery of Trauma, which agreed to be a sponsor of the meeting. The editor of the Journal of Trauma is a member of the association's board and agreed to carry the proceedings in a special supplement of the journal. (Project Director/Hungerford)
  2. When planning a meeting of this scale, recruit one or two well-known people in the field to agree to moderate a panel or give a presentation. Hungerford says he was able to leverage the participation of Larry M. Gentilello, M.D., a well-respected trauma surgeon at the University of Texas Southwestern Medical School and an award recipient of the Innovators in Combating Substance Abuse program, to gain the participation of other respected leaders in the field. (Project Director/Hungerford)
  3. The editors of the proceedings spent many more hours than they had anticipated getting the content ready to be published. Hungerford notes that the quality of the manuscripts varied greatly and required the services of a contract editor, in addition to more of his own time than expected, and time of his co-editor, Gentilello. (Project Director/Hungerford)
  4. Consider establishing an additional peer-review mechanism to review manuscripts for proceedings published in journals. Hungerford and Gentilello served as both editors and peer reviewers of the articles published. For editors not comfortable serving both roles, it may be advisable to assign the peer-review function to different individuals. (Project Director/Hungerford)

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AFTER THE GRANT

Since the conference, a number of the recommendations have been acted on, including:

  • Beginning in September 2006, the American College of Surgeons Committee on Trauma required all Level I trauma centers to screen and provide a brief intervention to patients with alcohol problems. Hungerford and other experts are writing a 16-page training brochure, which the American College of Surgeons will distribute to trauma centers, Hungerford says.
  • The Centers for Medicaid & Medicare Services (CMS) has announced that Medicaid will reimburse providers for screening and brief discussions with patients about their alcohol or drug problems, beginning in January 2007.
  • Hungerford and others are building a Web site with detailed instructions about how to launch a program of screening and brief counseling interventions with patients who have substance abuse issues.

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GRANT DETAILS & CONTACT INFORMATION

Project

Conference to Address Alcohol Problems Among Hospitalized Trauma Patients

Grantee

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (Atlanta,  GA)

  • Amount: $ 25,000
    Dates: June 2003 to December 2005
    ID#:  047395

Contact

Daniel Hungerford
(770) 488-4142
DHungerford@cdc.gov

Web Site

http://www.cdc.gov/injury/index.html

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APPENDICES


Appendix 1

Meeting Funders

The following groups funded this project:

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Gentilello LM, Ebel BE, Wickizer TM, Salkever DS and Rivara FP. "Alcohol Interventions for Trauma Patients Treated in Emergency Departments and Hospitals: A Cost Benefit Analysis." Annals of Surgery, 241(4): 541–550, 2005. Abstract available online.

Schermer CR, Moyers TB, Miller WR and Bloomfield LA. "Trauma Center Brief Interventions for Alcohol Disorders Decrease Subsequent Driving Under the Influence Arrests." Journal of Trauma: Injury, Infection and Critical Care, 60(1): 29–34, 2006. Abstract available online.

Reports

"Alcohol Problems Among Emergency Department Patients: Proceedings of a Research Conference on Identification and Intervention," March 19–21, 2001. The proceedings are available online.

"Alcohol and Other Drug Problems Among Hospitalized Trauma Patients: Controlling Complications, Mortality, and Trauma Recidivism," Journal of Trauma, September 2005. The report is available online.

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Report prepared by: Linda Wilson
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Victor A. Capoccia

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