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Inpatient addiction medicine consultation and post-hospital substance use disorder treatment engagement: a propensity-matched analysis.
Open accessAbstract
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.
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“Hospitalizations are critical opportunities to engage patients who are at high risk for overdose to prevent future overdoses, as hospital addiction care with referral to treatment increases outpatient SUD treatment engagement.19,20”
From Assessment of Annual Cost of Substance Use Disorder in US Hospitals (2021) · cites this paper as [19]
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Metadata
- Authors
- Englander, H., Dobbertin, K., Lind, B. K., Nicolaidis, C., Graven, P., Dorfman, C., & Korthuis, P. T.
- Affiliations
- Oregon Health & Science University (US)
- Portland State University (US)
- Corresponding author
- Englander, Honora
- Venue
- Journal of General Internal Medicine
- Published
- 2019-08-13
- Volume
- 34
- Issue
- 12
- Pages
- 2796-2803
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC6854181
- OpenAlex
- W2967197326
- Cited by
- 234
- References
- 46
- Citations by year
- 2026: 21 · 2025: 42 · 2024: 39 · 2023: 40 · 2022: 32 · 2021: 35 · 2020: 21 · 2019: 3
- FWCI
- 17.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- PDXScholar (Portland State University) (submittedVersion)
- Funders
- Oregon Health and Science University (n/a)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Sociology and Political Science › Homelessness and Social Issues
- Keywords
- substance use disorders, impact, continuity of care, harm reduction, pharmacotherapy, behavior therapy, Medicaid beneficiaries, Oregon, peer recovery support
- MeSH terms
- Addiction Medicine, Adolescent, Adult, Continuity of Patient Care, Female, Humans, Inpatients, Male, Medicaid, Middle Aged, Oregon, Patient Discharge, Referral and Consultation, United States, Treatment Outcome, Substance-Related Disorders, Young Adult, Propensity Score
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