Abstract
BackgroundAddiction medicine consultation services (ACS) may improve outcomes of hospitalized patients with substance use disorders (SUD). Our aim was to examine the difference in length of stay and the hazard ratio for a routine hospital discharge between SUD patients receiving and not receiving ACS.MethodsStructured EHR data from 2018 of 1,900 adult patients with a SUD-related diagnostic code at an urban academic health center were examined among 35,541 total encounters. Cox proportional hazards regression models were fit using a cause-specific approach to examine differences in hospital outcome (i.e., routine discharge, leaving against medical advice, in-hospital death, or transfer to another level of care). Models were adjusted for age, sex, race, ethnicity, insurance status, and comorbidities.ResultsLength of stay was shorter among encounters with a SUD that received a SUIT consultation versus those admissions that did not receive one (5.77 v. 6.54 days, p<0.01). In adjusted analyses, admissions that received a SUIT consultation had a higher hazard of a routine discharge [hazard ratio (95% confidence interval): 1.16 (1.03–1.30)] compared to those not receiving a SUIT consultation.ConclusionsThe SUIT consultation service was associated with a reduced length of stay and an increased hazard of a routine discharge. The SUIT model may serve as a benchmark and inform other health systems attempting to improve outcomes in SUD patient cohorts.
Highlights
Substance misuse continues to expand across the United States with alcohol and opioid misuse driving this epidemic and related hospitalizations [1,2,3]
Admissions that received a Substance Use Intervention Team (SUIT) consultation had a higher hazard of a routine discharge [hazard ratio (95% confidence interval): 1.16 (1.03–1.30)] compared to those not receiving a SUIT consultation
The SUIT consultation service was associated with a reduced length of stay and an increased hazard of a routine discharge
Summary
Substance misuse continues to expand across the United States with alcohol and opioid misuse driving this epidemic and related hospitalizations [1,2,3]. Individuals with substance use disorders (SUD) tend to have greater frequencies of hospitalizations, longer lengths of stay (LOS), and more unplanned readmissions compared to the general population of hospitalized patients [1, 4, 5]. The Affordable Care Act expanded funding for treatment and service delivery [6, 7], the ever-expanding opioid epidemic has driven the emergence of addiction consultation services and systems-level interventions in the treatment of SUD [8]. One study [11] found that SUD-related care accounted for 20% of Medicaid general hospital stays. Addiction medicine consultation services (ACS) may improve outcomes of hospitalized patients with substance use disorders (SUD).
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