Problem of substance use and rehospitalizations
Researchers have found that patients who are diagnosed with a substance use disorder are about twice as likely to be readmitted to the hospital as patients without this diagnosis. These findings suggest that hospitals could intervene with substance use screening and programs designed to reduce subsequent hospital utilization.1
"This paper shows that those who have substance use disorders are more likely to be readmitted to the hospital within 30 days," says Brian Jack, MD, professor and vice chair in the Department of Family Medicine at Boston University School of Medicine/Boston Medical Center. Jack is the principal investigator for the Project RED — Re-Engineered Discharge program.
"Reducing readmissions is a very high priority across the country," Jack says. "The amount of money that can be saved by reducing readmissions from Medicare is in the tens of billions of dollars, and there's a lot of interest in finding ways to do that."
The study finding a connection between substance use and readmissions is a secondary analysis, conducted on top of a Project RED study, says Alexander Walley, MD, MSc, assistant professor of medicine at the Boston University School of Medicine. The study controlled for other factors that can make someone at high risk of rehospitalization, including depressive symptoms, age, lack of insurance, and comorbidities, Walley says.
Their acute care utilization, which also included emergency department visits, was higher than the acute care utilization of patients who did not have the substance use disorder diagnosis, he adds. The study also found that 17% of the patients had a substance use disorder diagnosis. Substance use disorder diagnoses were based on discharge codes, and it's likely a portion of potential diagnoses were missed, he adds.
The 17% finding would suggest that close to one out of five patients likely have a substance use problem, says Steven M. Vincent, PhD, LP, Care Center director, behavioral health services at St. Cloud (MN) Hospital. The hospital is part of the CentraCare Health System.
"Anytime we're dealing with a healthcare concern that might impact one out of five inpatients deserves attention," Vincent says. "What we've done in our own hospital on this topic is use a set of protocols to observe for signs of alcohol or drug abuse and the potential for withdrawal [symptoms]."
Substance use is the latest in a series of identified risk factors for hospital readmission, Jack notes. It joins the more commonly known risk factors of low health literacy, long lengths of stay (LOS), having comorbidities, and being older.
"Other papers we've published show that people who have depressive symptoms are more likely to be readmitted within 30 days," Jack says. "Also, patients who have a low score on the patient activation measure, which is a measure of their motivation and ability to influence their care, are more likely to be readmitted."
Reference
- Walley A, Paasche-Orlow M, Lee E, et al. Acute care hospitalization utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med 2012; 6:50-56.
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