Monday, January 2, 2012

Revolutionizing Health Care Related to Alcohol Use

My current organization, Allina Hospitals and Clinics, has embarked on an ambitious and to my knowledge unprecedented effort to rationalize our approach to alcohol throughout the system. (The Veterans Health Administration has been addressing alcohol use in primary care for several decades and is as usual way ahead of private care, yet another example where government beats private care by a wide margin. However, their system is so unlike private practice that what happens in the VHA is difficult to translate.) I am leading Allina's effort and we've developed an ambitious agenda and a very aggressive timeline. If we're successful it will be almost a revolution across a large HCO (health care organization.) Allina consists of 11 hospitals, about 60 primary care clinics and many speciality clinics. Last year, there were more than 1 million hospital admissions and almost 4 million clinic visits within the Allina system.

I'm excited about this. It is nothing short of amazing that a large HCO would choose alcohol as a major focus across the organization. So far, the response has been enthusiastic. Physicians and other clinicians are very frustrated with the lack of consistency across parts of the system. They are frustrated that there seem to be so few options for patients admitted to hospital. Even if someone has been through 12 step rehab a dozen or more times, that is still the only option available: another run through rehab. They are desperate for something new. Clinicians are realistic. Most of what we do in medicine is care for chronic incurable conditions. Although we sometimes make people completely well, more often we help mitigate the ravages of an incurable condition. And sometimes we are pretty poor at even that. In cases with really severe, progressive illness we are often pretty helpless, along with the patients and families. So health care professionals are comfortable with care that is less than curative but is at least comforting, and perhaps that slows the rate of deterioration. And they want to be involved and active in managing chronic diseases.

Allina's initiative is remarkable in that it will address alcohol across an entire HCO. This includes emergency departments, primary care, hospital and ICU care and specialty addiction treatment. The goal is to create a fully integrated system that addresses alcohol wherever a heavy drinker interacts with the system and that coordinates the flow of care across boundaries such as inpatient/outpatient care and primary/specialty care. All of this is intended to be as fully evidence based as possible, which is always a challenge but it's an important aspiration. The vision is very ambitious and I am unaware of any other quite like it. If it succeeds, it can serve as an example for other HCOs.

Translating the science to practice is a daunting challenge. Allina is to be commended for choosing alcohol as a focus for such an effort. I'll keep you updated as this progresses.


  1. What an ambitious and great-sounding undertaking. In future blogs, please tell us what this will look like from the patient's perspective. That is, as people with alcohol problems of varying degrees of severity – from those who are severely dependent to "functioning alcoholics" to problem drinkers – interact with different levels of the health care system, what will their substance use disorder care look like, and who will be providing that care?

  2. I look forward to following your organization, Allina Hospitals and Clinics, embarking on an approach to alcohol throughout your system. As part of a 2nd interview process, I have recently met with a behavioral health team over at Mercy Hospital. They made it clear their frustration with return chronic substance abuse cases. I would like to gather more information regarding this as to see if there is something I can do. For example go out into the field and identify any barriers the person faces that would prevent readmit. What keeps the client from completing discharge recommendations. If you have any Ideas regarding this issue it would be greatly appreciated.

    Thanks Donald Kvam BA LADC.

  3. Yes, kudos to Allina for the clarity of thought in recognizing the benefits in patient welfare and cost savings from investing in such a systemic approach. Mark, I hope you will be able to post interim results as they become available?


Comments are welcome.