The Denver Collaborative to Reduce Alcohol-Exposed Pregnancy

1. The Denver Collaborative to Reduce Alcohol-Exposed Pregnancy Kellie Teter, Karen Peterson, Pam Gillen, Grace Alfonsi & Team October 2012 PSEP Meeting

2. Context • Denver Health and Hospital Authority (Denver Health) is the largest safety net health care system in Colorado, and in fact in Region VIII • It is an integrated health care system, joining a hospital with neighborhood community health centers • Denver Public Health (DPH) is a Department of Denver Health

3. Context, cont. • Through its Community Health Services, Denver Health provides primary care (medical, dental and mental health) to about 20% of adults and 35% of children residing in Denver County • Over 3500 deliveries occur yearly at Denver Health • Despite this integrated system and efforts to streamline services, however, Denver Health and DPH continue to operate within numerous silos

4. Context, cont. • No alcohol or contraceptive use data (except anecdotal) from entirety of DH system • The STD clinic at DPH has data in reproductive age women (2010 – 11) • 34% report binge, 20% heavy, and 19% both binge and heavy drinking • Therefore, 35% report risky drinking • The risky drinking women have an ineffective contraception rate of 60% Binge drinking = 4 or more drinks on at least one occasion in the last 90 days Heavy drinking = 8 or more drinks/week during at least one week in the last 90 days

5. LEAN Process

6. Identifying Initial Condition } Black box about what happens at this step because no consistent documentation is required

7. Initial Condition

8. Target Condition

9. Progress: EMR Questions • DH is adopting a new electronic medical record (EMR) • Team was able to identify and influence key participants in the EMR processto ensure alcohol, drug and tobacco screening would be mandatory components of the EMR • SBIRT questions formed the backbone of these sections • Contraceptive questions still in progress but will be detailed as the CHS sites are Title X sites

10. New EMR: Alcohol/Drug Questions

11. New EMR: Tobacco Questions

12. Progress: Educational Modules • Prior to rollout of EMR in 1/13, plan is to educate staff about AEP so that they utilize the new EMR capability well • Team has been developing 10-minute educational modules to deliver in clinic settings across the DH system

13. Educational Modules, cont. • Team educators will negotiate with the clinics about how much time is available and which topics are most important for their staffs • Goal is to deliver as many modules as possible • as a single presentation • as short presentations spread over time

14. Module topics • How much is too much? • Why is too much alcohol bad news? • Fetal development and substance use • Use vs. Abuse vs. Dependence • Techniques to cut down and/or quit alcohol use • Youth Health and substance use • Marijuana information and side effects

15. What is one drink? 1/2 Oz. Absolute Alcohol Beer Table wine Hard Liquor 12 oz. Beer X 4% alcohol = .48 oz. AA 1.2 oz. Liquor X 40% alcohol = .48 oz. AA 4 oz. Wine X 12% alcohol = .48 oz. AA Module 1: How much is too much?

16. Alcohol MetabolismApproximate Blood Alcohol Concentrations (BAC) 130 pound woman (after 1, 2 or 3 drinks in one hour) Module 2: Why is too much alcohol bad news?

17. Timeline of Fetal Development Module 3: Fetal development and substance use

18. Diffusion of Alcohol Across Placenta Following ONEDrink Module 3: Fetal development and substance use

19. Module 5: Use vs. Abuse vs. Dependence 71% Encourage to continue current behavior lifetime abstinence current abstinence low risk drinking 25% hazardous drinking Brief Intervention harmful drinking dependence symptoms 4% Refer for Treatment dependence

20. 71% Low-risk or no Alcohol Use 25% Excessive Alcohol Use 4% Alcohol Dependent Module 5: Use vs. Abuse vs. Dependence

21. Posters/Presentations • Denver Health Day of Celebration (5/12) • Colorado AHEC Conference (9/12) • APHA Conference (11/12) • CityMatCH Conference (12/12)