Kuye Ifedayo O, Prichett Laura M, Stewart Rosalyn W, Berkowitz Scott A, Buresh Megan E
Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Hosp Med. 2024 May;19(5):377-385. doi: 10.1002/jhm.13302. Epub 2024 Mar 8.
Prior single-hospital studies have documented barriers to acceptance that hospitalized patients with opioid use disorder (OUD) face when referred to skilled nursing facilities (SNFs).
To examine the impact of OUD on the number of SNF referrals and the proportion of referrals accepted.
DESIGN, SETTINGS, AND PARTICIPANTS: A retrospective cohort study of hospitalizations with SNF referrals in 2019 at two academic hospitals in Baltimore, MD.
OUD status was determined by receipt of medications for OUD during admission, upon discharge, or the presence of a diagnosis code for OUD.
The cohort included 6043 hospitalizations (5440 hospitalizations of patients without OUD and 603 hospitalizations of patients with OUD). Hospitalizations of patients with OUD had more SNF referrals sent (8.9 vs. 5.6, p < .001), had a lower proportion of SNF referrals accepted (31.3% vs. 46.9%, p < .001), and were less likely to be discharged to an SNF (65.6% vs. 70.3%, p = .003). The effect of OUD status on the number of SNF referrals and the proportion of referrals accepted remained significant in multivariable analyses. Our subanalysis showed that reduced acceptances were driven by the hospitalizations of patients discharged without medications for OUD and those receiving methadone. Hospitalizations of patients discharged on buprenorphine were accepted at the same rates as hospitalizations of patients without OUD.
This multicenter retrospective cohort study found that hospitalizations of patients with OUD had more SNF referrals sent and fewer referrals accepted. Further work is needed to address the limited discharge options for patients with OUD.
先前的单中心研究记录了患有阿片类药物使用障碍（OUD）的住院患者在转诊至专业护理机构（SNF）时面临的接受障碍。
研究OUD对SNF转诊数量及转诊接受比例的影响。
设计、地点和参与者：一项对2019年马里兰州巴尔的摩市两家学术医院有SNF转诊的住院病例进行的回顾性队列研究。
根据入院时、出院时接受的OUD药物治疗情况或OUD诊断代码来确定OUD状态。
该队列包括6043例住院病例（5440例无OUD患者的住院病例和603例有OUD患者的住院病例）。有OUD患者的住院病例发出的SNF转诊更多（8.9次对5.6次，p <.001），SNF转诊接受比例更低（31.3%对46.9%，p <.001），且出院至SNF的可能性更小（65.6%对70.3%，p =.003）。在多变量分析中，OUD状态对SNF转诊数量及转诊接受比例的影响仍然显著。我们的亚组分析表明，接受率降低是由未接受OUD药物治疗出院的患者以及接受美沙酮治疗的患者的住院病例导致的。接受丁丙诺啡出院的患者的住院病例接受率与无OUD患者的住院病例相同。
这项多中心回顾性队列研究发现，有OUD患者的住院病例发出的SNF转诊更多，但接受的转诊更少。需要进一步开展工作以解决OUD患者出院选择有限的问题。
