Context Predicting hospital readmission risk is of great interest to identify which patients would benefit most from care transition interventions, as well as to risk-standardize readmission rates for purposes of hospital comparison. Objective To summarize validated readmission risk prediction models, describe their performance, and assess suitability for clinical or administrative use. Data Sources MEDLINE, CINAHL, and Cochrane Library through March 2011, EMBASE through August 2011, and hand search of reference lists. Study Selection Dual review to identify English language studies of prediction models tested with medical patients, with both derivation and validation cohorts. Data Extraction Data were extracted on the population, setting, sample size, follow-up interval, readmission rate, model discrimination and calibration, type of data used, and timing of data collection. Results Of 7,843 citations reviewed, 30 studies of 26 unique models met criteria. The most common outcome used was 30-day readmission; only one model specifically addressed preventable readmissions. Fourteen models relying on retrospective administrative data could be potentially used for standardization of readmission risk and hospital comparisons; of these, nine were tested in large US populations and had poor discriminative ability (c-statistics 0.55 – 0.65). Seven models could potentially be used to identify high-risk patients for intervention early during a hospitalization (c-statistics 0.56 – 0.72), and five could be used at hospital discharge (c-statistics 0.68 – 0.83). Six studies compared different models in the same population and two of these found that functional and social variables improved model discrimination. Though most models incorporated medical comorbidity and prior utilization variables, few examined variables associated with overall health and function, illness severity, or social determinants of health. Conclusions Most current readmission risk prediction models, whether designed for comparative or clinical purposes, perform poorly. Though in certain settings such models may prove useful, efforts to improve their performance are needed as use becomes more widespread.

Conclusions: Hospital-based addiction medicine consultation can improve SUD treatment engagement, which is associated with reduced substance use, mortality, and other important clinical outcomes. National expansion of such models represents an opportunity to address an enduring gap in the SUD treatment continuum.

People with substance use disorders (SUD) have high rates of hospitalization and readmission, long lengths of stay, and skyrocketing healthcare costs. Yet, models for improving care are extremely limited. We performed a needs assessment and then convened academic and community partners, including a hospital, community SUD organizations, and Medicaid accountable care organizations, to design a care model for medically complex hospitalized patients with SUD. Needs assessment showed that 58% to 67% of participants who reported active substance use said they were interested in cutting back or quitting. Many reported interest in medication for addiction treatment (MAT). Participants had high rates of costly readmissions and longer than expected length of stay. Community stakeholders identified long wait times and lack of resources for medically complex patients as key barriers. We developed the Improving Addiction Care Team (IMPACT), which includes an inpatient addiction medicine consultation service, rapid-access pathways to posthospital SUD treatment, and a medically enhanced residential care model that integrates antibiotic infusion and residential addiction care. We developed a business case and secured funding from Medicaid and hospital payers. IMPACT provides one pathway for hospitals, payers, and communities to collaboratively address the SUD epidemic.

BACKGROUND: Individuals with substance use disorders (SUD) have high rates of chronic illness and readmission, yet few are engaged in addiction treatment. Hospitalization may be a reachable moment for initiating and coordinating addiction care, but little is known about motivation for change in the inpatient setting. OBJECTIVE: To explore the experiences of hospitalized adults with SUD and to better understand patient and system level factors impacting readiness for change. DESIGN: We performed a qualitative study using individual interviews. The study was nested within a larger mixed-methods needs assessment. PARTICIPANTS AND SETTING: Hospitalized adults admitted to medical or surgical units at an urban academic medical center who reported high-risk alcohol or drug use on AUDIT-C or single-item drug use screener. APPROACH: We conducted a thematic analysis, using an inductive approach at a semantic level. KEY RESULTS: Thirty-two patients participated. The mean age was 43 years; 75% were men, and 68% identified as white. Participants reported moderate to high-risk alcohol (39%), amphetamine (46%), and opioid (65%) use. Emergent themes highlight the influence of hospitalization at the patient, provider, and health system levels. Many patients experienced hospitalization as a wake-up call, where mortality was motivation for change and hospitalization disrupted substance use. However, many participants voiced complex narratives of social chaos, trauma, homelessness, and chronic pain. Participants valued providers who understood SUD and the importance of treatment choice. Patient experience suggests the importance of peers in the hospital setting, access to medication-assisted treatment, and coordinated care post-discharge. CONCLUSIONS: This study supports that hospitalization offers an opportunity to initiate and coordinate addiction care, and provides insights into patient, provider, and health system factors which can leverage the reachability of this moment.