• Kevin A Hallgren, Theresa E Matson, Malia Oliver, Katie Witkiewitz, Jennifer F Bobb, Amy K Lee, Ryan M Caldeiro, Daniel Kivlahan, and Katharine A Bradley.
• Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. khallgre@uw.edu.
• J Gen Intern Med. 2022 Jun 1; 37 (8): 188518931885-1893.

BackgroundAlcohol use disorder (AUD) is highly prevalent but underrecognized and undertreated in primary care settings. Alcohol Symptom Checklists can engage patients and providers in discussions of AUD-related care. However, the performance of Alcohol Symptom Checklists when they are used in routine care and documented in electronic health records (EHRs) remains unevaluated.ObjectiveTo evaluate the psychometric performance of an Alcohol Symptom Checklist in routine primary care.DesignCross-sectional study using item response theory (IRT) and differential item functioning analyses of measurement consistency across age, sex, race, and ethnicity.PatientsPatients seen in primary care in the Kaiser Permanente Washington Healthcare System who reported high-risk drinking on the Alcohol Use Disorder Identification Test Consumption screening measure (AUDIT-C ≥ 7) and subsequently completed an Alcohol Symptom Checklist between October 2015 and February 2020.Main MeasureAlcohol Symptom Checklists with 11 items assessing AUD criteria defined in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5), completed by patients during routine medical care and documented in EHRs.Key ResultsAmong 11,464 patients who screened positive for high-risk drinking and completed an Alcohol Symptom Checklist (mean age 43.6 years, 30.5% female), 54.1% reported ≥ 2 DSM-5 AUD criteria (threshold for AUD diagnosis). IRT analyses demonstrated that checklist items measured a unidimensional continuum of AUD severity. Differential item functioning was observed for some demographic subgroups but had minimal impact on accurate measurement of AUD severity, with differences between demographic subgroups attributable to differential item functioning never exceeding 0.42 points of the total symptom count (of a possible range of 0-11).ConclusionsAlcohol Symptom Checklists used in routine care discriminated AUD severity consistently with current definitions of AUD and performed equitably across age, sex, race, and ethnicity. Integrating symptom checklists into routine care may help inform clinical decision-making around diagnosing and managing AUD.© 2021. Society of General Internal Medicine.

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