•About half of those with opioid use disorder had another substance use disorder.•Compared with their counterparts with opioid use disorder only, these adults were—•Less likely to use opioid use ...disorder medication treatment•More likely to receive intensive services•Barriers to outpatient care for these adults must be addressed.
Multiple substance use is common among adults who misuse opioids. Adverse consequences of drugs are more severe among multisubstance users than among single drug users. This study sought to determine whether adults with opioid use disorder (OUD) and at least one other substance use disorder (SUD) are less likely than adults with OUD only to receive certain services.
We conducted a retrospective longitudinal study using the IBM® MarketScan® Multi-State Medicaid Database. We used logistic regression to measure associations between clinical characteristics and service utilization. The sample included non-Medicare-eligible adults aged 18–64 years with at least one claim in 2016 with a primary diagnosis of OUD who were continuously enrolled in Medicaid in 2016 and 2017.
Of the 58,745 Medicaid enrollees with an initial OUD diagnosis in 2016, 29,267 had one or more additional SUD diagnoses. In the year following diagnosis, these adults were less likely than adults with OUD only to receive OUD medication treatment (OR = 0.88, p < .0001). This was true for all specifically diagnosed co-occurring SUDS. Adults with OUD and a co-occurring SUD, however, were more likely than those with OUD only to use any type of high-intensity services.
Adults with OUD and at least one co-occurring SUD received more intensive services, which may reflect severity and lack of OUD medication treatment before misuse escalation. Programs should account for barriers to connecting these individuals to appropriate OUD treatment.
Despite rural hospitals' central role in their communities, they are increasingly in financial distress and may merge with other hospitals or health systems, potentially reducing service lines that ...are less profitable or duplicative of services that the acquirer also offers. Using hospital discharge data from thirty-two Healthcare cost and Utilization Project State Inpatient Databases from the period 2007-18, we examined the influence of rural hospital mergers on changes to inpatient service lines at hospitals and within their catchment areas. We found that merged hospitals were more likely than independent hospitals to eliminate maternal/neonatal and surgical care. Whereas the number of mental/substance use disorder-related stays decreased or remained stable at merged hospitals and within their catchment areas, it increased for unaffiliated hospitals and their catchment areas, indicating a potential unmet need in the communities of rural hospitals postmerger. Although a merger could salvage a hospital's sustainability, it also could reduce service lines and responsiveness to community needs.
•Adults misusing both opioids and other drugs had higher risk of adverse events.•Risk for adverse events varied in magnitude by substance use disorder combination.•Those misusing opioids and other ...drugs were more likely to have a mental disorder.•Multisubstance use should be screened for and treated to prevent adverse events.
It is common for adults with opioid use disorder (OUD) to misuse additional substances, and these individuals may be particularly at risk for adverse events, including mortality. Less is known about how continued receipt of prescription opioids or risk of adverse events (e.g., suicidality, overdose, poisoning) differs for people with co-occurring OUD and additional substance use disorders (SUDs).
We conducted a retrospective study using IBM® MarketScan® Multi-State Medicaid Database enrollment/claims data. We used logistic regression to measure the association between sample characteristics and our dependent variables. The sample consisted of non-Medicare-eligible adults aged 18–64 years who were continuously enrolled in Medicaid in 2016–2017 with an OUD diagnosis on at least one claim in 2016.
Adults with OUD and a co-occurring SUD were more likely than adults with OUD only to have an opioid-related poisoning event (odds ratio OR = 1.488, p = .0052), all-cause poisoning (OR = 1.756, p < .0001), or suicidal ideation (OR = 1.796, p < .0001) but not to receive ongoing opioid prescriptions (OR = 0.973, p = .1626). Adverse events varied by OUD-SUD combination. For example, adults with OUD and cocaine use disorder had the highest odds of all-cause (OR = 2.393, p < .0001) or opioid-related (OR = 1.890, p = .0027) poisoning among those with a drug-specific diagnosis and were most likely to be diagnosed with suicidal ideation (OR = 2.465, p < .0001).
This study provides evidence that adults with OUD and a co-occurring additional SUD have increased risk for several adverse events. Multisubstance use should be screened for and identified to determine the most appropriate course of treatment.
•15–20% of ED visits resulted in opioid prescriptions filled.•Opioid ED prescription rates increased from 2005–2010 and then declined through 2016.•Average number of opioids dispensed from ED (18–20) ...remained steady.•Whites were more likely to be prescribed opioids in the ED compared to Blacks.
To examine opioid prescribing rates following emergency department (ED) discharge stratified by patient’s clinical and demographic characteristics over an 11-year period.
We used 3.9 million ED visits from commercially insured enrollees and 15.2 million ED visits from Medicaid enrollees aged 12 to 64 over 2005–2016 from the IBM® MarketScan® Research Databases. We calculated rates of opioid prescribing at discharge from the ED and the average number of pills per opioid prescription filled.
Approximately 15–20% of ED visits resulted in opioid prescriptions filled. Rates increased from 2005 into late 2009 and 2010 and then declined steadily through 2016. Prescribing rates were similar for commercially insured and Medicaid enrollees. Being aged 25–54 years was associated with the highest rates of opioid prescriptions being filled. Hydrocodone was the most commonly prescribed opioid, but rates for hydrocodone prescription filling also fell the most. Rates for oxycodone were stable, and rates for tramadol increased. The average number of pills dispensed from prescriptions filled remained steady over the study period at 18–20.
Opioid prescribing rates from the ED have declined steadily since 2010 in reversal of earlier trends; however, about 15% of ED patients still received opioid prescriptions in 2016 amidst a national opioid crisis.
Efforts to reduce opioid prescribing could consider focusing on the pain types, age groups, and regions with high prescription rates identified in this study.
OBJECTIVEThis qualitative study aimed to examine how states implemented COVID-19 public health emergency-related federal policy flexibilities for opioid use disorder treatment from the perspective of ...state-level behavioral health policy makers. Recommendations are given for applying lessons learned to improve the long-term impact of these flexibilities on opioid use disorder treatment.METHODSEleven semistructured interviews were conducted with 13 stakeholders from six state governments, and transcripts were qualitatively coded. Data were analyzed by grouping findings according to state-, institution-, and provider-level barriers and facilitators and were then compared to identify overarching themes.RESULTSPolicy makers expressed positive opinions about the opioid use disorder treatment flexibilities and described benefits regarding treatment access, continuity of care, and quality of care. No interviewees reported evidence of increased adverse events associated with the relaxed medication protocols. Challenges to state-level implementation included gaps in the federal flexibilities, competing state policies, facility and provider liability concerns, and persistent systemic stigma.CONCLUSIONSAs the federal government considers permanent adoption of COVID-19-related flexibilities regarding opioid use disorder treatment policies, the lessons learned from this study are crucial to consider in order to avoid continuing challenges with policy implementation and to effectively remove opioid use disorder treatment barriers.
Discharge Planning and Hospital Readmissions Henke, Rachel Mosher; Karaca, Zeynal; Jackson, Paige ...
Medical care research and review,
06/2017, Letnik:
74, Številka:
3
Journal Article
Recenzirano
This study examines the association between the quality of hospital discharge planning and all-cause 30-day readmissions and same-hospital readmissions. The sample included adults aged 18 years and ...older hospitalized in 16 states in 2010 or 2011 for acute myocardial infarction, heart failure, pneumonia, or total hip or joint arthroplasty. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems measured discharge-planning quality at the hospital level. A generalized linear mixed model was used to estimate the contribution of patient and hospital characteristics to 30-day all-cause and same-hospital readmissions. Discharge-planning quality was associated with (a) lower rates of 30-day hospital readmissions and (b) higher rates of same-hospital readmissions for heart failure, pneumonia, and total hip or joint replacement. These results suggest that by improving inpatient discharge planning, hospitals may be able to influence their 30-day readmissions and increase the likelihood that readmissions will be to the same hospital.
Objective:The authors examined whether timely treatment for serious mental illness and substance use disorder reduces overall health care costs in a 3-year period.Methods:Claims data from the IBM ...MarketScan Research Databases (2010–2017) were analyzed. The population studied included 2,997 Medicaid enrollees and 35,805 commercial insurance enrollees ages 18–64 years with an index event for a serious mental illness and 2,315 Medicaid enrollees and 28,419 commercial insurance enrollees with an index event for a substance use disorder. Health care costs in the 3 years after an index event were calculated for enrollees who received care that met a minimum threshold for treatment and for those who did not receive such care. The Toolkit for Weighting and Analysis of Nonequivalent Groups was used to control for statistically significant differences in pretreatment characteristics between the groups.Results:All health care spending for enrollees who were engaged in behavioral health treatment for substance use disorder or a serious mental illness increased from year 0 to year 1 but decreased faster than the spending of enrollees who were not engaged in treatment, with larger trends for those engaged in substance use disorder treatment. Expenses for inpatient and emergency department care decreased over the 3 follow-up years; however, spending on outpatient services was significantly higher in all 3 follow-up years for those engaged in treatment.Conclusions:Health care delivery and payment models that improve access to behavioral health treatment may reduce emergency department, inpatient, and overall health care costs for particular subpopulations.
Purpose:
To estimate the relationship between employees’ health risks and health-care costs to inform health promotion program design.
Design:
An observational study of person-level health-care ...claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs.
Setting:
United States.
Participants:
The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers.
Measures:
Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures.
Analysis:
After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping.
Results:
Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined.
Conclusion:
Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.
Using a novel approach, we provide a preliminary "snapshot" of how the comprehensiveness of workplace cardiovascular health initiatives is related to measures of employees' health risks, disease ...prevalence, and medical expenditures. We linked scores for the twenty large organizations that voluntarily completed the American Heart Association's newly launched Worksite Health Achievement Index (WHAI) for 2015 to individual-level MarketScan® data for 373,478 of their workers with employer benefits that year. Higher aggregate WHAI scores were associated with lower values for four of seven modifiable indicators of cardiovascular risk and a higher value for one. Although also associated with lower prevalence of cardiovascular disease, higher aggregate scores were associated with higher spending on the condition. These and other findings provide useful benchmarks and norms for employer practices related to cardiovascular disease prevention. As employers continue to complete the annual WHAI, we expect to gain further insights into the policies, programs, and environmental supports employers can implement to positively influence cardiovascular health and related spending.
Background
Despite being adopted by a large number of hospitals, the relationship between Lean management and hospital performance is mixed and not well understood.
Purpose
We examined the ...relationships between Lean and hospital financial performance, patient outcomes, and patient satisfaction in a large national sample of hospitals, controlling for relevant organizational and market factors.
Methodology/Approach
A mixed effects linear regression analysis was performed to assess the relationships between adoption of Lean and 10 measures of hospital performance using data from 1,152 hospitals that responded to the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals. Hospital performance, organizational, and market data over the period 2011–2015 come from the 2015 American Hospital Association Annual Hospital Survey and the respective annual Centers for Medicare & Medicaid Services (CMS) Medicare Cost Report, CMS Hospital Compare, CMS MEDPAR, and the CMS Hospital Service Area File.
Results
Lean adoption was significantly associated at alpha < .05, with lower Medicare spending per beneficiary (
b
= −.005,
p
= .027). None of the other nine associations were statistically significant, although eight of them were in the predicted direction.
Conclusion
Lean adoption is not associated with most measures of hospital performance. It is likely Lean implementation varies greatly across hospitals. Future research should examine the relationships among the various dimensions of Lean implementation and performance.
Practice Implications
If Lean management is to contribute to hospital performance improvement, leaders must be highly cognizant of what “adoption of Lean” actually means in their hospital. Although limited, single-unit Lean initiatives in an emergency room or other patient care unit may improve performance on some unit-specific measures, improvement on hospital-wide measures of performance requires a broad, sustained commitment to the implementation of Lean practices and tools.
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