Acute Care Utilization After Recovery Coaching Linkage During Substance-Related Inpatient Admission: Results of Two Randomized Controlled Trials

Julia A Cupp, Kaileigh A Byrne, Kristin Herbert, Prerana J Roth, Julia A Cupp, Kaileigh A Byrne, Kristin Herbert, Prerana J Roth

Abstract

Background: For patients with substance use disorder (SUD), a peer recovery coach (PRC) intervention increases engagement in recovery services; effective support services interventions have occasionally demonstrated cost savings through decreased acute care utilization.

Objective: Examine effect of PRCs on acute care utilization.

Design: Combined results of 2 parallel 1:1 randomized controlled trials.

Participants: Inpatient adults with substance use disorder INTERVENTIONS: Inpatient PRC linkage and follow-up contact for 6 months vs usual care (providing contact information for SUD resources and PRCs) MAIN MEASURES: Acute care encounters (emergency and inpatient) 6 months before and after enrollment; encounter type by primary diagnosis code category (mental/behavioral vs medical); 30-day readmissions with Lace+ readmission risk scores.

Key results: A total of 193 patients were randomized: 95 PRC; 98 control. In the PRC intervention, 66 patients had a pre-enrollment acute care encounter and 56 had an encounter post-enrollment, compared to the control group with 59 pre- and 62 post-enrollment (odds ratio [OR] = -0.79, P = 0.11); there was no significant effect for sub-groups by encounter location (emergency vs inpatient). There was a significant decrease in mental/behavioral ED visits (PRC: pre-enrollment 17 vs post-enrollment 10; control: pre-enrollment 13 vs post-enrollment 16 (OR = -2.62, P = 0.02)) but not mental/behavioral inpatient encounters or medical emergency or inpatient encounters. There was no significant difference in 30-day readmissions corrected for Lace+ scores (15.8% PRC vs 17.3% control, OR = 0.19, P = 0.65).

Conclusions: PRCs did not decrease overall acute care utilization but may decrease emergency encounters related to substance use.

Trial registration: ClinicalTrials.gov (NCT04098601, NCT04098614).

Keywords: admissions; peer recovery coaching; randomized controlled trial; substance use disorders.

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.

Figures

Fig. 1
Fig. 1
Participant flow diagram. Numbers are reported as n = number for combined studies (n for study 1 + n for study 2). PRC able to maintain relationship refers to the PRC documenting a phone call, text, or post-initial visit face-to-face interaction during the specified time window (30 days and 6 months, respectively). Patient-reported engagement refers to the patient endorsing involvement in recovery support services outside of PRC services through the self-report follow-up surveys. *Only study 2 tracked number of patients assessed for eligibility but excluded by eligibility criteria (n = 32) or eligible but declined study participation (n = 79). †The study team member had to leave the patient room to enter their information into REDCap for randomization and then return to the patient room to complete enrollment; patients who ended their hospitalization during this window were randomized but did not complete enrollment nor receive their assigned study condition
Fig. 2
Fig. 2
Percentage of patients with an MBD-related ED visit by condition and time (6 months pre-consent vs. 6 months post-consent)

References

    1. Lewer D, Freer J, King E, et al. Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. Addiction. 2019;115:1011–1023. doi: 10.1111/add.14892.
    1. Walley A, Paasche-Orlow M, Lee E, et al. Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med. 2012;6(1):50–56. doi: 10.1097/ADM.0b013e318231de51.Acute.
    1. Moe J, Kirkland SW, Rawe E, et al. Effectiveness of interventions to decrease emergency department visits by adult frequent users: a systematic review. Acad Emerg Med. 2017;24(1):40–52. doi: 10.1111/acem.13060.
    1. Bodenheimer T.Strategies to reduce costs and improve care for high-utilizing Medicaid patients: reflections on pioneering programs.; 2013. .
    1. Hong CS, Siegel AL, Ferris TG. Caring for high-need, high-cost patients: what makes for a successful care management program? Commonw Fund. 2014;19(August):1–19. doi: 10.1016/j.trac.2015.07.006.
    1. Kirk TA, Di Leo P, Rehmer P, Moy S, Davidson L. A case and care management program to reduce use of acute care by clients with substance use disorders. Psychiatr Serv. 2013;64(5):491–493. doi: 10.1176/appi.ps.201200258.
    1. Chakravarty S, Cantor JC. Informing the design and evaluation of superuser care management initiatives. Med Care. 2016;54(9):860–867. doi: 10.1097/mlr.0000000000000568.
    1. Williams BC. Limited effects of care management for high utilizer on total healthcare costs. Am J Manag Care. 2015;21(4):244–246.
    1. Raven MC, Kushel M, Ko MJ, Penko J, Bindman AB. The effectiveness of emergency department visit reduction programs: a systematic review. Ann Emerg Med. 2016;68(4):467–483.e15. doi: 10.1016/j.annemergmed.2016.04.015.
    1. Edgren G, Anderson J, Dolk A, et al. A case management intervention targeted to reduce healthcare consumption for frequent Emergency Department visitors: results from an adaptive randomized trial. Eur J Emerg Med. 2016;23(5):344–350. doi: 10.1097/MEJ.0000000000000280.
    1. Lin MP, Blanchfield BB, Kakoza RM, et al. ED-based care coordination reduces costs for frequent ED users. Am J Manag Care. 2017;23(12):762–766.
    1. Bodenmann P, Velonaki VS, Griffin JL, et al. Case management may reduce emergency department frequent use in a universal health coverage system: a randomized controlled trial. J Gen Intern Med. 2017;32(5):508–515. doi: 10.1007/s11606-016-3789-9.
    1. Post B, Lapedis J, Singh K, et al. Predictive model-driven hotspotting to decrease emergency department visits: a randomized controlled trial. J Gen Intern Med. 2021;36(9):2563–2570. doi: 10.1007/s11606-021-06664-1.
    1. Tait RJ, Teoh L, Kelty E, Geelhoed E, Mountain D, Hulse GK. Emergency department based intervention with adolescent substance users: 10 year economic and health outcomes. Drug Alcohol Depend. 2016;165:168–174. doi: 10.1016/j.drugalcdep.2016.06.005.
    1. Stergiopoulos V, Gozdzik A, Cohen A, et al. The effect of brief case management on emergency department use of frequent users in mental health: Findings of a randomized controlled trial. PLoS One. 2017;12(8). 10.1371/journal.pone.0182157
    1. McLaughlin-Davis M. The practice of hospital case management: a white paper. Prof Case Manag. 2019;24(6):280–296. doi: 10.1097/NCM.0000000000000391.
    1. Hesse M, Vanderplasschen W, Rapp R, Broekaert E, Fridell M. Case management for persons with substance use disorders (Review). Cochrane Database Syst Rev. 2007;(4). 10.1002/
    1. Rapp RC, Van Den Noortgate W, Broekaert E, Vanderplasschen W. The efficacy of case management with persons who have substance abuse problems: a three-level meta-analysis of outcomes. J Consult Clin Psychol. 2014;82(4):605–618. doi: 10.1037/a0036750.
    1. Joo JY, Huber DL. Community-based case management effectiveness in populations that abuse substances. Int Nurs Rev. 2015;62(4):536–546. doi: 10.1111/inr.12201.
    1. Vanderplasschen W, Rapp RC, De Maeyer J, Van Den Noortgate W. A meta-analysis of the efficacy of case management for substance use disorders: a recovery perspective. Front Psychiatry. 2019;10(186). 10.3389/fpsyt.2019.00186
    1. Penzenstadler L, Machado A, Thorens G, Zullino D, Khazaal Y. Effect of case management interventions for patients with substance use disorders: a systematic review. Front Psychiatry. 2017;8(APR). 10.3389/fpsyt.2017.00051
    1. Comprehensive Case Management for Substance Abuse Treatment. Rockville (MD); 2000.
    1. Eddie D, Hoffman L, Vilsaint C, et al. Lived experience in new models of care for substance use disorder: a systematic review of peer recovery support services and recovery coaching. Front Psychol. 2019;10(JUN). 10.3389/fpsyg.2019.01052
    1. Liebling EJ, Perez JJS, Litterer MM, et al. Implementing hospital-based peer recovery support services for substance use disorder disorder. Am J Drug Alcohol Abuse. 2021;47(2):229–237. doi: 10.1080/00952990.2020.1841218.
    1. NAADAC. National Certified Peer Recovery Support Specialist (NCPRSS). . Published 2021. Accessed September 26, 2021.
    1. Bassuk EL, Hanson J, Greene RN, Richard M, Laudet A. peer-delivered recovery support services for addictions in the united states: a systematic review. J Subst Abuse Treat. 2016;63:1–9. doi: 10.1016/j.jsat.2016.01.003.
    1. Byrne KA, Roth PJ, Merchant K, et al. Inpatient link to peer recovery coaching: results from a pilot randomized control trial. Drug Alcohol Depend. 2020;215(June):108234. doi: 10.1016/j.drugalcdep.2020.108234.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi: 10.1016/J.JBI.2008.08.010.
    1. van Walraven C, Wong J, Forster AJ. LACE+ index: extension of a validated index to predict early death or urgent readmission after hospital discharge using administrative data. Open Med. 2012;6(2):1–11.
    1. Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. . Accessed March 28, 2021.
    1. Shumway M, Boccellari A, O’Brien K, Okin RL. Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial{star, open} Am J Emerg Med. 2008;26(2):155–164. doi: 10.1016/j.ajem.2007.04.021.
    1. Shah R, Chen C, O’Rourke S, Lee M, Mohanty SA, Abraham J. Evaluation of care management for the uninsured. Med Care. 2011;49(2):166–171. doi: 10.1007/sl0869-007-9037-x.
    1. Hartnett K, Kite-Powell A, Devies J, et al. Impact of the COVID-19 pandemic on emergency department visits — United States, January 1, 2019–May 30, 2020. Morb Mortal Wkly Rep. 2020;69(23):699–704. doi: 10.15585/mmwr.mm6923e1.
    1. Gryczynski J, Nordeck CD, Welsh C, Mitchell SG, O’Grady KE, Schwartz RP. Preventing hospital readmission for patients with comorbid substance use disorder. Ann Intern Med. 2021. 10.7326/m20-5475
    1. Finkelstein A, Zhou A, Taubman S, Doyle J. Health care hotspotting — a randomized, controlled trial. N Engl J Med. 2020;382(2):152–162. doi: 10.1056/NEJMsa1906848.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する