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Inpatient Addiction Medicine Consultation Service Impact on Post-discharge Patient Mortality: a Propensity-Matched Analysis.
J Gen Intern Med. 2022 08; 37(10):2521-2525.JG

Abstract

BACKGROUND

Inpatient addiction medicine consultation services (AMCS) have grown rapidly, but there is limited research of their impact on patient outcomes.

OBJECTIVE

To examine whether AMCS is associated with all-cause mortality and hospital utilization post-discharge.

DESIGN

This was a propensity-score-matchedcase-control study from 2018 to 2020.

PARTICIPANTS

The intervention group included patients referred to the AMCS from October 2018 to March 2020. Matched control participants included patients hospitalized from October 2017 to September 2018 at an urban academic hospital with a large suburban and rural catchment area.

MAIN MEASURES

The effect of treatment was estimated as the difference between the proportion of subjects experiencing the event (7-day and 30-day readmission, emergency department visits, and mortality within 90 days) for each group in the matched sample.

KEY RESULTS

There were 711 patients in the intervention group and 2172 patients in the control group. The most common substance use disorders among the intervention group were primary alcohol use disorder (n=181; 25.5%) and primary opioid use disorder (n=175, 24.6%) with over a third with polysubstance use (n=257, 36.1%). Intervention patients showed a reduction in 90-day mortality post-hospital discharge (average treatment effect [ATE]: -2.35%, 95% CI: -3.57, -1.13; p-value <0.001) compared to propensity-matched controls. We found a statistically significant reduction in 7-day hospital readmission by 2.15% (95% CI: -3.65, -0.65; p=0.005) and a nonsignificant reduction in 30-day readmission (ATE: -2.38%, 95% CI: -5.20, 0.45; p=0.099). There was a statistically significant increase in 30-day emergency department visits (ATE: 5.32%, 95% CI: 2.19, 8.46; 0.001) compared to matched controls.

CONCLUSIONS

There was a reduction in 90-day all-cause mortality for the AMCS intervention group compared to matched controls, although the impact on hospital utilization was mixed. AMCS are systems interventions that are effective tools to improve patient health and reduce all-cause mortality.

Authors+Show Affiliations

Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. wilsonjd@pitt.edu. Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. wilsonjd@pitt.edu.The Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Pittsburgh Harm Reduction Coalition, Pittsburgh, PA, USA.Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

35076857

Citation

Wilson, J Deanna, et al. "Inpatient Addiction Medicine Consultation Service Impact On Post-discharge Patient Mortality: a Propensity-Matched Analysis." Journal of General Internal Medicine, vol. 37, no. 10, 2022, pp. 2521-2525.
Wilson JD, Altieri Dunn SC, Roy P, et al. Inpatient Addiction Medicine Consultation Service Impact on Post-discharge Patient Mortality: a Propensity-Matched Analysis. J Gen Intern Med. 2022;37(10):2521-2525.
Wilson, J. D., Altieri Dunn, S. C., Roy, P., Joseph, E., Klipp, S., & Liebschutz, J. (2022). Inpatient Addiction Medicine Consultation Service Impact on Post-discharge Patient Mortality: a Propensity-Matched Analysis. Journal of General Internal Medicine, 37(10), 2521-2525. https://doi.org/10.1007/s11606-021-07362-8
Wilson JD, et al. Inpatient Addiction Medicine Consultation Service Impact On Post-discharge Patient Mortality: a Propensity-Matched Analysis. J Gen Intern Med. 2022;37(10):2521-2525. PubMed PMID: 35076857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inpatient Addiction Medicine Consultation Service Impact on Post-discharge Patient Mortality: a Propensity-Matched Analysis. AU - Wilson,J Deanna, AU - Altieri Dunn,Stefanie C, AU - Roy,Payel, AU - Joseph,Emily, AU - Klipp,Stephanie, AU - Liebschutz,Jane, Y1 - 2022/01/25/ PY - 2021/06/10/received PY - 2021/12/16/accepted PY - 2023/08/01/pmc-release PY - 2022/1/26/pubmed PY - 2022/8/11/medline PY - 2022/1/25/entrez KW - Alcohol use disorder KW - Hospitals KW - Opioid-related disorders SP - 2521 EP - 2525 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 37 IS - 10 N2 - BACKGROUND: Inpatient addiction medicine consultation services (AMCS) have grown rapidly, but there is limited research of their impact on patient outcomes. OBJECTIVE: To examine whether AMCS is associated with all-cause mortality and hospital utilization post-discharge. DESIGN: This was a propensity-score-matchedcase-control study from 2018 to 2020. PARTICIPANTS: The intervention group included patients referred to the AMCS from October 2018 to March 2020. Matched control participants included patients hospitalized from October 2017 to September 2018 at an urban academic hospital with a large suburban and rural catchment area. MAIN MEASURES: The effect of treatment was estimated as the difference between the proportion of subjects experiencing the event (7-day and 30-day readmission, emergency department visits, and mortality within 90 days) for each group in the matched sample. KEY RESULTS: There were 711 patients in the intervention group and 2172 patients in the control group. The most common substance use disorders among the intervention group were primary alcohol use disorder (n=181; 25.5%) and primary opioid use disorder (n=175, 24.6%) with over a third with polysubstance use (n=257, 36.1%). Intervention patients showed a reduction in 90-day mortality post-hospital discharge (average treatment effect [ATE]: -2.35%, 95% CI: -3.57, -1.13; p-value <0.001) compared to propensity-matched controls. We found a statistically significant reduction in 7-day hospital readmission by 2.15% (95% CI: -3.65, -0.65; p=0.005) and a nonsignificant reduction in 30-day readmission (ATE: -2.38%, 95% CI: -5.20, 0.45; p=0.099). There was a statistically significant increase in 30-day emergency department visits (ATE: 5.32%, 95% CI: 2.19, 8.46; 0.001) compared to matched controls. CONCLUSIONS: There was a reduction in 90-day all-cause mortality for the AMCS intervention group compared to matched controls, although the impact on hospital utilization was mixed. AMCS are systems interventions that are effective tools to improve patient health and reduce all-cause mortality. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/35076857/Inpatient_Addiction_Medicine_Consultation_Service_Impact_on_Post_discharge_Patient_Mortality:_a_Propensity_Matched_Analysis_ DB - PRIME DP - Unbound Medicine ER -