Association for Public Policy Analysis & Management

UCLA Internal Medicine Service is implementing a Screening, Brief Intervention Referral to Treatment (SBIRT) program. Alcohol use disorder and alcohol misuse are prevalent and expensive to society and the health system. There is some evidence to suggest that SBIRT can minimize these costs. We performed an analysis to determine the most efficient screening methods and implementation recommendations. First, we created criteria to evaluate alcohol screening tools. Second, we performed a cost benefit analysis of screening all patients according to age, sex and drinking behavior to establish cutoffs for various levels of intervention. Our analysis reveals that it is beneficial to administer alcohol use screenings at the established cutoffs for both sexes and across all ages except for females sixty-five and above. For females over age sixty-five, a screening threshold one below the existing standard is required for the health system to benefit. Overall, the combination of AUDIT-C for males and AUDIT for females optimizes the clinic’s net benefit.  Additionally, we provide recommendations for UCLA-IMS to implement SBIRT. Our recommendations address frequency of alcohol screening, technological programming, best practices, and programming a smart electronic health record for reimbursement and incorporating other important screenings.