SPARC trial tools

 SPARC TRIAL

The Sustained Patient-Centered Alcohol-Related Care (SPARC) trial was a stepped-wedge cluster randomized implementation trial conducted from 2015 to 2018 in Kaiser Permanente Washington, an integrated health system with 25 practices in Washington state. The SPARC trial was designed to improve (1) population-based alcohol-related prevention and (2) alcohol use disorder (AUD) treatment across 22 primary care practices.  The study simultaneously implemented a broader program of behavioral health integration: screening and addressing depression, suicidality, and cannabis and other drug use. Implementation of the intervention was led by Kaiser Permanente Washington clinical leaders as a quality improvement initiative in partnership with researchers. Within the health system, implementation of the SPARC program was referred to as behavioral health integration (BHI) and later as integrated mental health

The SPARC intervention

Kaiser Permanente Washington, like other health systems in the region and across the country, has been working to improve access, reliability, and quality of care for patients with mental health and substance use concerns through behavioral health integration into primary care clinics. The goal is to create a welcoming environment for primary care patients to address common problems—depression and unhealthy alcohol use—with evidence-based care from primary care teams, as recommended by the US Preventive Services Task Force (USPSTF).  Evidence-based approaches to depression and unhealthy alcohol use are implemented with standard work, and include cannabis and drug screening because these commonly impact depression and unhealthy alcohol use. 

Our goal is for there to be “no wrong door” to begin getting help for mental health and addictions care, with primary care being the ideal place to address these concerns due to the longitudinal and trusting relationships between primary care teams and their patients.  There are 4 care processes of behavioral health care in Kaiser Permanente, which are the core elements of this work:

1. Screen: universal annual screening for depression and unhealthy alcohol, cannabis, and drug use
2. Assess & monitor: positive screens to guide care
3. Offer patient-centered care: for depression and unhealthy alcohol, cannabis, and drug use, including preventive advice for unhealthy alcohol use and shared decision-making for patients with depression, anxiety, and addictions.
4. Follow-up: with a standard monitoring tool to identify response to care and when treatment needs to be adapted.