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Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial.
Ann Intern Med. 2021 07; 174(7):899-909.AIM

Abstract

BACKGROUND

Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use.

OBJECTIVE

To determine whether patient navigation services reduce hospital readmissions.

DESIGN

Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818).

SETTING

Urban academic hospital in Baltimore, Maryland, with an SUD consultation service.

PARTICIPANTS

400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol).

INTERVENTION

NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge.

MEASUREMENTS

Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up.

RESULTS

Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU).

LIMITATION

Single-site trial, which limits generalizability.

CONCLUSION

Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs.

PRIMARY FUNDING SOURCE

National Institute on Drug Abuse.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Gryczynski J
Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.).
Nordeck CD
Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.).
Welsh C
University of Maryland School of Medicine, Baltimore, Maryland (C.W.).
Mitchell SG
Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.).
O'Grady KE
University of Maryland, College Park, Maryland (K.E.O.).
Schwartz RP
Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.).

MeSH

Academic Medical CentersAdultAftercareAlcohol-Related DisordersBaltimoreCocaine-Related DisordersEmergency Service, HospitalFacilities and Services UtilizationFemaleFollow-Up StudiesHospitals, UrbanHumansMaleMiddle AgedMotivationOpioid-Related DisordersPatient NavigationPatient ReadmissionPsychosocial Support SystemsSubstance-Related DisordersTreatment Outcome

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

33819055

Clinical Trial Links

Clinical trial which this article describes

Citation

Gryczynski, Jan, et al. "Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : a Randomized Trial." Annals of Internal Medicine, vol. 174, no. 7, 2021, pp. 899-909.
Gryczynski J, Nordeck CD, Welsh C, et al. Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial. Ann Intern Med. 2021;174(7):899-909.
Gryczynski, J., Nordeck, C. D., Welsh, C., Mitchell, S. G., O'Grady, K. E., & Schwartz, R. P. (2021). Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial. Annals of Internal Medicine, 174(7), 899-909. https://doi.org/10.7326/M20-5475
Gryczynski J, et al. Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : a Randomized Trial. Ann Intern Med. 2021;174(7):899-909. PubMed PMID: 33819055.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial. AU - Gryczynski,Jan, AU - Nordeck,Courtney D, AU - Welsh,Christopher, AU - Mitchell,Shannon G, AU - O'Grady,Kevin E, AU - Schwartz,Robert P, Y1 - 2021/04/06/ PY - 2021/4/6/pubmed PY - 2021/9/9/medline PY - 2021/4/5/entrez SP - 899 EP - 909 JF - Annals of internal medicine JO - Ann Intern Med VL - 174 IS - 7 N2 - BACKGROUND: Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use. OBJECTIVE: To determine whether patient navigation services reduce hospital readmissions. DESIGN: Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818). SETTING: Urban academic hospital in Baltimore, Maryland, with an SUD consultation service. PARTICIPANTS: 400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol). INTERVENTION: NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge. MEASUREMENTS: Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up. RESULTS: Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU). LIMITATION: Single-site trial, which limits generalizability. CONCLUSION: Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs. PRIMARY FUNDING SOURCE: National Institute on Drug Abuse. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/33819055/Preventing_Hospital_Readmission_for_Patients_With_Comorbid_Substance_Use_Disorder_:_A_Randomized_Trial_ DB - PRIME DP - Unbound Medicine ER -