Date of Award

Winter 2018

Project Type

Clinical Doctorate

College or School




Program or Major


Degree Name


First Advisor

Kerry Nolte

Second Advisor

Paul Calandrella


Background: Screening for the use of alcohol and drug use in primary care practices has been shown to decrease substance misuse both in quantity and frequency. Integrating evidenced based clinical practice guidelines for substance use, into a sustainable process, can reduce substance misuse, improve patient care, and reduce health risks and the financial burden of the sequelae of substance use on our health care system.

Purpose: The purpose of this project was to evaluate and optimize the current practice of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use in a Vermont based primary care practice.

Methods: The Donabedian Quality of Care Model provided the conceptual framework for this process evaluation. A gap analysis of SBIRT process points was conducted to inform this project and synthesized into an SBIRT Process Flowchart. Chart reviews were then completed on SBIRT current practice processes, which identified gaps in the process, and allowed for collaboration with staff to improve the screening process.

Intervention: An evaluation was conducted of the current SBIRT screening process in a primary care setting over a five-month period. Gaps identified were addressed in multiple PDSA (Plan, Do, Study, Act) cycles with interventions including process improvements with flagging patients, screener scoring, risk stratification and appropriate Electronic Medical Record (EMR) documentation. Results: During the project period, overall error rates decreased from 29.3% to 7% and successful SBIRT screening rose from 72% to 93%.

Conclusions: Ongoing education and training improved the scoring, appropriate risk stratification and documentation in our outpatient primary care practice. Although improvement was made in most of the key quality indicators, ongoing work is needed to ensure delivery of interventions and treatment for those patients who need it, and that related documentation is completed.