Adding an Alcohol-Related Risk Score to an Existing Categorical Risk Classification for Older Adults: Sensitivity to Group Differences

Journal of the American Geriatrics Society

Volume 55 Issue 3 Page 445 - March 2007

• Sandra R. Wilson, PhD^*
• ^*Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, California; ,
• Arlene Fink, PhD
• David Geffen School of Medicine, School of Public Health, University of California at Los Angeles, Los Angeles, California; Langley Research Institute, Pacific Palisades, California; ,
• Shinu Verghese, MS^*
• ^*Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, California; ,
• John C. Beck, MD
• David Geffen School of Medicine, School of Public Health, University of California at Los Angeles, Los Angeles, California;
  
• Langley Research Institute, Pacific Palisades, California; ,
• Khue Nguyen, PharmD^§§Department of Clinical Pharmacy, School of Pharmacy, University of California at San Francisco, San Francisco, California;
• Healthcare Division, Palo Alto Medical Foundation, Palo Alto, California; and , and
• Philip Lavori, PhD^¶
• ^¶Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.

• From the ^*Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, California; David Geffen School of Medicine, School of Public Health, University of California at Los Angeles, Los Angeles, California; Langley Research Institute, Pacific Palisades, California; ^§Department of Clinical Pharmacy, School of Pharmacy, University of California at San Francisco, San Francisco, California; Healthcare Division, Palo Alto Medical Foundation, Palo Alto, California; and ^¶Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.

Address correspondence to Sandra R. Wilson, PhD, 795 El Camino Real, Ames Building, Palo Alto, CA 94301. E-mail: wilsons@pamfri.org

Abstract

OBJECTIVES:

To evaluate a new alcohol-related risk score for research use.

DESIGN:

Using data from a previously reported trial of a screening and education system for older adults (Computerized Alcohol-Related Problems Survey), secondary analyses were conducted comparing the ability of two different measures of risk to detect postintervention group differences: the original categorical outcome measure and a new, finely grained quantitative risk score based on the same research-based risk factors.

SETTING:

Three primary care group practices in southern California.

PARTICIPANTS:

Six hundred sixty-five patients aged 65 and older.

MEASUREMENTS:

A previously calculated, three-level categorical classification of alcohol-related risk and a newly developed quantitative risk score.

RESULTS:

Mean postintervention risk scores differed between the three experimental conditions: usual care, patient report, and combined report (P<.001). The difference between the combined report and usual care was significant (P<.001) and directly proportional to baseline risk. The three-level risk classification did not reveal approximately 57.3% of the intervention effect detected by the risk score. The risk score also was sufficiently sensitive to detect the intervention effect within the subset of hypertensive patients (n=112; P=.001).

CONCLUSION:

As an outcome measure in intervention trials, the finely grained risk score is more sensitive than the trinary risk classification. The additional clinical value of the risk score relative to the categorical measure needs to be determined.