JMIR Publications

ABSTRACT

Background:

The National Institute on Alcohol Abuse and Alcoholism recommends using the Alcohol Symptom Checklist administered on paper or computerized formats to assess alcohol use disorder (AUD) symptoms in routine care when patients report high-risk drinking. However, it is unknown whether Alcohol Symptom Checklist response characteristics differ based on whether checklists are administered online (e.g., questionnaire completed remotely via patient portal before an appointment) versus in-clinic (e.g., questionnaire completed on paper after appointment check-in).

Objective:

This study evaluated the psychometric performance of the Alcohol Symptom Checklist when completed online versus in-clinic.

Methods:

This cross-sectional, psychometric study obtained electronic health record (EHR) data from Alcohol Symptom Checklists completed by adult patients from an integrated health system in Washington state. The sample included patients who had a primary care visit in 2021 at one of 32 primary care practices, were due for annual behavioral health screening, and reported high-risk drinking on the behavioral health screen (AUDIT-C score ≥7). After the screening process, patients with high-risk drinking were typically asked to complete the Alcohol Symptom Checklist – an 11-item questionnaire on which patients self-report whether they had experienced each of the 11 AUD criteria listed in the DSM-5 over a past-year timeframe. Patients could complete the Alcohol Symptom Checklist online (e.g., on a computer, smartphone, or tablet from any location) or in-clinic (e.g., on paper as part of the rooming process at clinical appointments). We examined sample and measurement characteristics and conducted differential item functioning analyses using an item response theory framework to examine measurement consistency across these two assessment modalities.

Results:

Among 3,243 patients meeting eligibility criteria for this secondary analysis (71% male, 70% white, and 62% non-Hispanic), 1640 (51%) completed the Alcohol Symptom Checklist online while 1603 (49%) completed it in-clinic. Approximately 46% and 48% reported ≥2 AUD criteria (threshold for AUD diagnosis) on online and in-clinic versions (P=.37), respectively. A small degree of differential item functioning was observed for 5 of 11 items. This differential item functioning produced only minimal impact on total scores that are used clinically to assess AUD severity, affecting total criteria count by a maximum of 0.13 criteria (on scale ranging 0-11).

Conclusions:

A web-based Alcohol Symptom Checklist completed online typically prior to patient check-in performed similarly well to an in-clinic modality typically administered on paper by a medical assistant at the time of the appointment. Findings have implications for using online AUD symptom assessments to streamline workflows, reduce staff burden, reduce stigma, and potentially assess patients who do not receive in-person care or outside of in-person appointments. Future studies should evaluate ways to ensure that patients who report symptoms on Alcohol Symptom Checklists completed online or in-clinic receive appropriate follow-up and treatment. Clinical Trial: n/a