Community hospital admission from the emergency department by persons with substance use disorders.

Persons with a substance use disorder (SUD) are less likely to be insured and may have limited access to appropriate care, thereby increasing their reliance on emergency departments (EDs). We investigated whether health conditions and insurance status are significant predictors of admission to a community hospital directly from an ED visit with an SUD diagnosis. We analyzed the 2008 Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project. Lack of health insurance was disproportionately likely in ED visits that carried an SUD diagnosis, whether alcohol- or drug-related. Using regression analysis, most SUD and non-SUD diagnostic categories and many procedure categories were significantly related to subsequent hospital admission. Controlling for clinical characteristics, SUD-related ED visits covered by public or private insurance had substantially higher odds of leading to hospital admission than did uninsured visits. Policies that broaden insurance coverage may improve access to inpatient care for persons with SUDs.