From the Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR (CAK); Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR (RC, PTK, HE); School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR (DM); Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR (CDM); Department of Medicine, Division of Hospital Medicine, Oregon Health & Science University, Portland, OR (HE).
J Addict Med. 2022;16(5):570-576. doi: 10.1097/ADM.0000000000000972. Epub 2022 Feb 8.
Addiction consult services (ACS) care for hospitalized patients with substance use disorder, including opioid use disorder (OUD). Medicaid Accountable Care Organizations (ACOs) could enhance access to ACS. This study extends data from Oregon's only ACS to Oregon's 15 regional Medicaid Coordinated Care Organizations (CCOs) to illustrate the potential value of enhanced in- and out-patient care for hospitalized patients with OUD. The study objectives were to estimate the effects of (1) expanding ACS care through CCOs in Oregon, and (2) increasing community treatment access within CCOs, on post-discharge OUD treatment engagement.
We used a validated Markov model, populated with Oregon Medicaid data from April 2015 to December 2017, to estimate study objectives.
Oregon Medicaid patients hospitalized with OUD with care billed to a CCO (n = 5878) included 1298 (22.1%) patients engaged in post-discharge OUD treatment. Simulation of referral to an ACS increased post-discharge OUD treatment engagement to 47.0% (95% confidence interval [CI] 45.7%, 48.3%), or 2684 patients (95% CI 2610, 2758). Ten of fifteen (66.7%) CCOs had fewer than 20% of patients engage in post-discharge OUD care. Without ACS, increasing outpatient treatment such that 20% of patients engage increased the patients engaging in post-discharge OUD care from 12.9% or 296 patients in care at baseline to 20% (95% CI 18.1%, 21.4%) or 453 (95% CI 416, 491).
ACOs can improve care for patients hospitalized with OUD. Implementing ACS in ACO networks can potentially improve post-discharge OUD treatment engagement, but community treatment systems must be prepared to accept more patients as inpatient addiction care improves.
成瘾咨询服务(ACS)为患有物质使用障碍(包括阿片类药物使用障碍)的住院患者提供服务。医疗补助有条件支付组织(ACO)可以增加 ACS 的可及性。本研究将俄勒冈州唯一 ACS 的数据扩展到俄勒冈州的 15 个区域医疗补助协调护理组织(CCO),以说明为患有阿片类药物使用障碍的住院患者提供强化门诊和住院治疗的潜在价值。本研究的目的是估计以下两种情况对出院后阿片类药物使用障碍治疗参与的影响:(1)通过俄勒冈州的 CCO 扩大 ACS 护理;(2)增加 CCO 内的社区治疗机会。
我们使用经过验证的 Markov 模型,利用俄勒冈州医疗补助数据(2015 年 4 月至 2017 年 12 月)进行了研究。
俄勒冈州医疗补助患者因阿片类药物使用障碍住院,由 CCO 计费(n = 5878),其中 1298 名(22.1%)患者在出院后接受了阿片类药物使用障碍治疗。转诊至 ACS 的模拟增加了出院后阿片类药物使用障碍治疗的参与率,达到 47.0%(95%置信区间[CI] 45.7%,48.3%),即增加了 2684 名患者(95% CI 2610,2758)。15 个 CCO 中有 10 个(66.7%)的患者接受出院后阿片类药物使用障碍护理的比例低于 20%。如果没有 ACS,增加门诊治疗,使 20%的患者参与,将使基线时接受治疗的 12.9%或 296 名患者中的阿片类药物使用障碍患者增加到 20%(95% CI 18.1%,21.4%)或 453 名(95% CI 416,491)。
ACO 可以改善患有阿片类药物使用障碍的住院患者的护理。在 ACO 网络中实施 ACS 可以潜在地提高出院后阿片类药物使用障碍治疗的参与率,但随着住院成瘾治疗的改善,社区治疗系统必须准备好接受更多的患者。