ALCOHOL USE DISORDER (AUD) SCREENING FOLLOWS DIAGNOSIS RATHER THAN PRECEDING IT: EVIDENCE OF SYSTEMIC WORKFLOW GAPS FROM NORSTELLALINQ REAL-WORLD DATA
Author(s)
Isabella Even-Chen, BA1, ilan behm, MPH2, Rahul Das, PhD3, Allison Perry, PhD1.
1Norstella, New York, NY, USA, 2Norstella, Englewood, CO, USA, 3Norstella, Yardley, PA, USA.
1Norstella, New York, NY, USA, 2Norstella, Englewood, CO, USA, 3Norstella, Yardley, PA, USA.
OBJECTIVES: To characterize AUD screening patterns relative to formal diagnosis timing, quantify the gap between diagnosis and screening, and assess screening penetration by AUD severity.
METHODS: A retrospective cohort study was conducted using NorstellaLinQ’s US real-world linked open claims, structured EHR, and clinical notes (June 2020-present). From 10,711,582 patients with AUD indicators in claims and EHR, 1,908,909 had EHR activity, 1,376,492 had at least one clinical note, and 403,771 had meaningful AUD note signals; 318,270 met confirmed AUD criteria (F10.xx codes or acamprosate/disulfiram) and formed the analytical cohort. Screening timing relative to diagnosis was classified as pre- or post-diagnosis, average lags were calculated, and screening rates were assessed by severity (F10.9, F10.1, F10.2).
RESULTS: Among 318,270 confirmed AUD patients within the 403,771-patient clinical notes cohort, 81% who received a positive AUD screen were screened after their formal diagnosis, with an average lag of approximately 197 days between diagnosis and screening. Among those screened post-diagnosis, the average lag between diagnosis and first screen was approximately 500 days. Severe AUD patients (F10.2) showed the highest screening rates at 16%; rates were lower among moderate (F10.1) and mild (F10.9) AUD patients. Across confirmed AUD patients, clinical note volumes by concept were: diagnosis (344,381), alcohol consumption (286,768), care team interactions (194,455), treatment (185,048), and screening (51,855).
CONCLUSIONS: AUD screening occurs predominantly after diagnosis and often hundreds of days later, limiting its utility as an early detection mechanism. Even among the highest-severity patients, screening rates remain below 20%. These findings quantify a systemic workflow gap with direct implications for clinical pathway design and real-world evidence frameworks supporting coverage decisions for AUD treatments.
METHODS: A retrospective cohort study was conducted using NorstellaLinQ’s US real-world linked open claims, structured EHR, and clinical notes (June 2020-present). From 10,711,582 patients with AUD indicators in claims and EHR, 1,908,909 had EHR activity, 1,376,492 had at least one clinical note, and 403,771 had meaningful AUD note signals; 318,270 met confirmed AUD criteria (F10.xx codes or acamprosate/disulfiram) and formed the analytical cohort. Screening timing relative to diagnosis was classified as pre- or post-diagnosis, average lags were calculated, and screening rates were assessed by severity (F10.9, F10.1, F10.2).
RESULTS: Among 318,270 confirmed AUD patients within the 403,771-patient clinical notes cohort, 81% who received a positive AUD screen were screened after their formal diagnosis, with an average lag of approximately 197 days between diagnosis and screening. Among those screened post-diagnosis, the average lag between diagnosis and first screen was approximately 500 days. Severe AUD patients (F10.2) showed the highest screening rates at 16%; rates were lower among moderate (F10.1) and mild (F10.9) AUD patients. Across confirmed AUD patients, clinical note volumes by concept were: diagnosis (344,381), alcohol consumption (286,768), care team interactions (194,455), treatment (185,048), and screening (51,855).
CONCLUSIONS: AUD screening occurs predominantly after diagnosis and often hundreds of days later, limiting its utility as an early detection mechanism. Even among the highest-severity patients, screening rates remain below 20%. These findings quantify a systemic workflow gap with direct implications for clinical pathway design and real-world evidence frameworks supporting coverage decisions for AUD treatments.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD124
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Mental Health (including addiction)