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Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis

  • Honora EnglanderEmail author
  • Konrad Dobbertin
  • Bonnie K. Lind
  • Christina Nicolaidis
  • Peter Graven
  • Claire Dorfman
  • P. Todd Korthuis
Original Research

Abstract

Background

Hospitalizations due to medical and surgical complications of substance use disorder (SUD) are rising. Most hospitals lack systems to treat SUD, and most people with SUD do not engage in treatment after discharge.

Objective

Determine the effect of a hospital-based addiction medicine consult service, the Improving Addiction Care Team (IMPACT), on post-hospital SUD treatment engagement.

Design

Cohort study using multivariable analysis of Oregon Medicaid claims comparing IMPACT patients with propensity-matched controls.

Participants

18–64-year-old Oregon Medicaid beneficiaries with SUD, hospitalized at an Oregon hospital between July 1, 2015, and September 30, 2016. IMPACT patients (n = 208) were matched to controls (n = 416) using a propensity score that accounted for SUD, gender, age, race, residence region, and diagnoses.

Interventions

IMPACT included hospital-based consultation care from an interdisciplinary team of addiction medicine physicians, social workers, and peers with lived experience in recovery. IMPACT met patients during hospitalization; offered pharmacotherapy, behavioral treatments, and harm reduction services; and supported linkages to SUD treatment after discharge.

Outcomes

Healthcare Effectiveness Data and Information Set (HEDIS) measure of SUD treatment engagement, defined as two or more claims on two separate days for SUD care within 34 days of discharge.

Results

Only 17.2% of all patients were engaged in SUD treatment before hospitalization. IMPACT patients engaged in SUD treatment following discharge more frequently than controls (38.9% vs. 23.3%, p < 0.01; aOR 2.15, 95% confidence interval [CI] 1.29–3.58). IMPACT participation remained associated with SUD treatment engagement when limiting the sample to people who were not engaged in treatment prior to hospitalization (aOR 2.63; 95% CI 1.46–4.72).

Conclusions

Hospital-based addiction medicine consultation can improve SUD treatment engagement, which is associated with reduced substance use, mortality, and other important clinical outcomes. National expansion of such models represents an opportunity to address an enduring gap in the SUD treatment continuum.

KEY WORDS

substance-related disorders hospitalization substance use treatment Medicaid 

Notes

Acknowledgments

Authors would like to acknowledge the entire IMPACT clinical and research teams. Specifically, they would like to thanks Alisa Patten and Devin Collins for their contributions to this paper, and Dr Melissa Weimer, Daren Ford, and O'Nesha Cochran Dumas for their dedication as the original IMPACT clinical team

Funding Information

This study was funded by the OHSU School of Medicine. IMPACT is funded by Oregon Health & Science University and CareOregon. The OHSU School of Medicine funded IMPACT evaluation activities. Dr. Korthuis’ time was supported by the National Institutes of Health and National Institute on Drug Abuse (UG3DA044831, UG1DA015815). This publication was made possible with support from the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1TR002369 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

Compliance with Ethical Standards

This study was approved by the Oregon Health & Science University (OHSU) Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The funders had no role in the design, conduct, and reporting of this study.

Supplementary material

11606_2019_5251_MOESM1_ESM.xlsx (37 kb)
ESM 1 (XLSX 36 kb)

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of MedicineOregon Health & Science UniversityPortlandUSA
  2. 2.Center for Health Systems EffectivenessOregon Health & Science UniversityPortlandUSA
  3. 3.Portland State University School of Social WorkPortlandUSA
  4. 4.Oregon Clinical and Translational Research InstituteOregon Health & Science UniversityPortlandUSA

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