Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA (SDK, SR, MLR, AYW); The Grayken Center for Addiction, Boston Medical Center (SDK, MLR, AYW); Division of General Internal Medicine and Mongan Institute, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (BB).
J Addict Med. 2021;15(1):20-26. doi: 10.1097/ADM.0000000000000693.
To determine how commonly medical inpatients with opioid use disorder (OUD) referred for postacute medical care were rejected due to substance use or treatment with opioid agonist therapy (OAT). Additionally, to assess for changes in rejection rates following the United States Attorney's May 2018 settlement with a Massachusetts nursing facility for violating anti-discrimination laws for such rejections.
We linked electronic referrals to private Massachusetts postacute medical care facilities from Boston Medical Center in 2018 with clinical data. We included referrals with evidence of OUD using ICD-10 diagnosis codes or OAT receipt. We identified the frequency of referrals where the stated rejection reason was substance use or OAT and classified these as discriminatory. We used segmented regression to assess for changes in proportion of referrals with substance use and OAT-related rejections before and after the settlement.
In 2018, 219 OUD-associated hospitalizations resulted in 1648 referrals to 285 facilities; 81.8% (1348) were rejected. Among hospitalizations, 37.4% (82) received at least 1 discriminatory rejection. Among rejections, 15.1% (203) were discriminatory (105 for OAT and 98 for substance use). Among facilities, 29.1% (83) had at least one discriminatory rejection. We found no differences in proportion of discriminatory rejections before and after the settlement.
Individuals hospitalized with OUD frequently experience explicit discrimination when rejected from postacute care despite federal and state protections. Efforts are needed to enhance enforcement of anti-discrimination laws, regulations, and policies to ensure access to postacute medical care for people with OUD and ongoing medical needs.
确定因药物使用或接受阿片类激动剂治疗（OAT）而被拒绝接受急性后医疗护理的患有阿片类药物使用障碍（OUD）的住院患者的常见程度。此外，评估自 2018 年 5 月美国检察官办公室与马萨诸塞州一家违反反歧视法的护理机构就此类拒绝行为达成和解以来，拒绝率的变化情况。
我们将 2018 年波士顿医疗中心向马萨诸塞州私人急性后医疗护理机构的电子转介与临床数据相联系。我们纳入了使用 ICD-10 诊断代码或 OAT 收据有证据表明存在 OUD 的转介。我们确定了以药物使用或 OAT 为理由的转介的频率，并将这些理由归类为歧视性的。我们使用分段回归评估和解前后与药物使用和 OAT 相关的转介被拒绝的比例变化。
2018 年，219 例与 OUD 相关的住院治疗导致 1648 例转介至 285 家机构；81.8%（1348 例）被拒绝。在住院患者中，37.4%（82 例）至少有一次歧视性拒绝。在拒绝转介中，15.1%（203 例）是歧视性的（105 例是 OAT，98 例是药物使用）。在机构中，29.1%（83 家）至少有一次歧视性拒绝。我们没有发现和解前后歧视性拒绝的比例存在差异。
尽管有联邦和州的保护，但患有 OUD 的住院患者在被拒绝接受急性后医疗护理时经常遭受明确的歧视。需要努力加强对反歧视法律、法规和政策的执行，以确保患有 OUD 和持续医疗需求的人能够获得急性后医疗护理。
