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Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter?
Psychiatr Serv. 2017 Aug 01; 68(8):810-818.PS

Abstract

OBJECTIVE

Individuals with substance use disorders are at high risk of hospital readmission. This study examined whether follow-up services received within 14 days of discharge from an inpatient hospital stay or residential detoxification reduced 90-day readmissions among Medicaid enrollees whose index admission included a substance use disorder diagnosis.

METHODS

Claims data were analyzed for Medicaid enrollees ages 18-64 with a substance use disorder diagnosis coded in any position for an inpatient hospital stay or residential detoxification in 2008 (N=30,439). Follow-up behavioral health services included residential, intensive outpatient, outpatient, and medication-assisted treatment (MAT). Analyses included data from ten states or fewer, based on a minimum number of index admissions and the availability of follow-up services or MAT. Survival analyses with time-varying independent variables were used to test the association of receipt of follow-up services and MAT with behavioral health readmissions.

RESULTS

Two-thirds (67.7%) of these enrollees received no follow-up services within 14 days. Twenty-nine percent were admitted with a primary behavioral health diagnosis within 90 days of discharge. Survival analyses showed that MAT and residential treatment were associated with reduced risk of 90-day behavioral health admission. Receipt of outpatient treatment was associated with increased readmission risk, and, in only one model, receipt of intensive outpatient services was also associated with increased risk.

CONCLUSIONS

Provision of MAT or residential treatment for substance use disorders after an inpatient or detoxification stay may help prevent readmissions. Medicaid programs should be encouraged to reduce barriers to MAT and residential treatment in order to prevent behavioral health admissions.

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Authors+Show Affiliations

Reif S
Dr. Reif, Dr. Acevedo, and Dr. Garnick are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. At the time of the study, Dr. Fullerton was with Truven Health Analytics, Cambridge, Massachusetts.
Acevedo A
Dr. Reif, Dr. Acevedo, and Dr. Garnick are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. At the time of the study, Dr. Fullerton was with Truven Health Analytics, Cambridge, Massachusetts.
Garnick DW
Dr. Reif, Dr. Acevedo, and Dr. Garnick are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. At the time of the study, Dr. Fullerton was with Truven Health Analytics, Cambridge, Massachusetts.
Fullerton CA
Dr. Reif, Dr. Acevedo, and Dr. Garnick are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. At the time of the study, Dr. Fullerton was with Truven Health Analytics, Cambridge, Massachusetts.

MeSH

AdolescentAdultAftercareAmbulatory CareFemaleHumansMaleMedicaidMental Health ServicesMiddle AgedPatient ReadmissionResidential TreatmentSubstance-Related DisordersUnited StatesYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28412900

Citation

Reif, Sharon, et al. "Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter?" Psychiatric Services (Washington, D.C.), vol. 68, no. 8, 2017, pp. 810-818.
Reif S, Acevedo A, Garnick DW, et al. Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter? Psychiatr Serv. 2017;68(8):810-818.
Reif, S., Acevedo, A., Garnick, D. W., & Fullerton, C. A. (2017). Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter? Psychiatric Services (Washington, D.C.), 68(8), 810-818. https://doi.org/10.1176/appi.ps.201600339
Reif S, et al. Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter. Psychiatr Serv. 2017 Aug 1;68(8):810-818. PubMed PMID: 28412900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter? AU - Reif,Sharon, AU - Acevedo,Andrea, AU - Garnick,Deborah W, AU - Fullerton,Catherine A, Y1 - 2017/04/17/ PY - 2017/4/18/pubmed PY - 2018/4/27/medline PY - 2017/4/18/entrez KW - Admissions &amp KW - readmissions, addiction, Outpatient treatment, Residential programs, medication-assisted treatment SP - 810 EP - 818 JF - Psychiatric services (Washington, D.C.) JO - Psychiatr Serv VL - 68 IS - 8 N2 - OBJECTIVE: Individuals with substance use disorders are at high risk of hospital readmission. This study examined whether follow-up services received within 14 days of discharge from an inpatient hospital stay or residential detoxification reduced 90-day readmissions among Medicaid enrollees whose index admission included a substance use disorder diagnosis. METHODS: Claims data were analyzed for Medicaid enrollees ages 18-64 with a substance use disorder diagnosis coded in any position for an inpatient hospital stay or residential detoxification in 2008 (N=30,439). Follow-up behavioral health services included residential, intensive outpatient, outpatient, and medication-assisted treatment (MAT). Analyses included data from ten states or fewer, based on a minimum number of index admissions and the availability of follow-up services or MAT. Survival analyses with time-varying independent variables were used to test the association of receipt of follow-up services and MAT with behavioral health readmissions. RESULTS: Two-thirds (67.7%) of these enrollees received no follow-up services within 14 days. Twenty-nine percent were admitted with a primary behavioral health diagnosis within 90 days of discharge. Survival analyses showed that MAT and residential treatment were associated with reduced risk of 90-day behavioral health admission. Receipt of outpatient treatment was associated with increased readmission risk, and, in only one model, receipt of intensive outpatient services was also associated with increased risk. CONCLUSIONS: Provision of MAT or residential treatment for substance use disorders after an inpatient or detoxification stay may help prevent readmissions. Medicaid programs should be encouraged to reduce barriers to MAT and residential treatment in order to prevent behavioral health admissions. SN - 1557-9700 UR - https://www.unboundmedicine.com/medline/citation/28412900/Reducing_Behavioral_Health_Inpatient_Readmissions_for_People_With_Substance_Use_Disorders:_Do_Follow_Up_Services_Matter L2 - https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201600339?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -