Background Evidence for community-based strategies to reduce inpatient detoxification readmission for opioid use disorder (OUD) is scant. A pilot program was designed to provide individualized structured treatment plans, including addressing prolonged withdrawal symptoms, family/systems assessment, and contingency management, to reduce readmission after the index inpatient detoxification. Methods A non-randomized quasi-experimental design was used to compare the pilot facilities (treatment) and comparison facilities before and after the program started, i.e., a simple difference-in-differences (DID) strategy. Adults 18 years and older who met the Diagnostic and Statistical Manual of Mental Disorders version 5 criteria for OUD and had an inpatient detoxification admission at any OUD treatment facility in two study periods between 7/2016 and 3/2020 were included. Readmission for inpatient detoxification in 90-days after the index stay was the primary outcome, and partial hospitalization, intensive outpatient care, outpatient services, and medications for OUD were the secondary outcomes. Six statistical estimation methods were used to triangulate evidence and adjust for potential confounding factors between treatment and comparison groups. Results A total of 2,320 unique patients in the pilot and comparison facilities with 2,443 index inpatient detoxification admissions in the pre- and post-periods were included. Compared with patients in comparison facilities, patients in the C.L.I.M.B. facilities had higher readmission in the pre-period (unadjusted readmission 17.0% vs. 10.6%), but similar rates in the post-period (12.3% vs. 10.6%) after the implementation of the pilot program. For 90-day readmission, all DID estimates were not statistically significant (adjusted estimates ranged from 6 to 9 percentage points difference favoring the C.L.I.M.B. program). There was no significant improvement in the secondary outcomes of utilizations in lower level of care and medications for OUD in C.L.I.M.B. facilities. Conclusions We found a reduction in readmission in the pilot facilities between the two periods, but the results were not statistically significant compared with the comparison facilities and the utilization of lower level of care services remained low. Even though providers in the pilot OUD treatment facilities actively worked with health plans to standardize care for patients with OUD, more strategies are needed to improve treatment engagement and retention after an inpatient detoxification.

Background: Evidence for community-based detox readmission prevention strategies for opioid use disorder (OUD) is scant. We evaluated a pilot program designed to provide individualized and structured treatment plan, including addressing prolonged withdrawal symptoms, family/systems assessment, contingency management, and medically assisted treatment. Methods: A non-randomized quasi-experimental design was used to compare the pilot sites (treatment) and comparison sites before and after the program started, i.e., a simple difference-in-differences (DID) strategy. Adults 18 years and older who meet the Diagnostic and Statistical Manual of Mental Disorders version 5 criteria for OUD and had a detox admission at any OUD treatment facility in two study periods between 5/2018 and 12/2019 are included. Readmission for detox in 90-days after the initial detox was the primary outcome. Multiple statistical estimation methods were used to adjust for potential confounding factors between treatment and comparison groups. Results: A total of 2,320 unique patients with 2,443 initial detox admissions in the pre- and post-periods were compared. Compared with the comparison patients, the C.L.I.M.B. patients had higher readmission in the pre-period (unadjusted readmission rates16.4% vs. 10.0%), but similar rates in the post-period (11.8% vs. 10.1%) after the implementation of the pilot program. For the primary outcome 90-day readmission, all DID estimates were not statistically significant (adjusted estimates ranged from 6.0 to 17.3 percentage points difference favoring the C.L.I.M.B. program). For the secondary outcomes of service utilization, the C.L.I.M.B. program had reduced the proportion of patients using the intensive outpatient treatment compared to the comparison group and the statistically significant DID estimates ranged from 13 to 18 percentage point differences for the intensive outpatient treatment.Conclusions: Treating OUD as a chronic condition instead of an acute episodic condition for patients in the community is feasible and has a potential to reduce intensive outpatient services. Although the small sample size of the pilot program precluded us to draw a definitive conclusion, we believe more OUD treatment facilities should work with health plans to standardize care for patients with OUD and promote lowering readmission for inpatient withdrawal management.

Background: Evidence for community-based detox readmission prevention strategies for opioid use disorder (OUD) is scant. We evaluated a pilot program designed to provide individualized and structured treatment plan, including addressing prolonged withdrawal symptoms, family/systems assessment, contingency management, and medically assisted treatment. Methods: A non-randomized quasi-experimental design was used to compare the pilot sites (treatment) and comparison sites before and after the program started, i.e., a simple difference-in-differences (DID) strategy. Adults 18 years and older who meet the Diagnostic and Statistical Manual of Mental Disorders version 5 criteria for OUD and had a detox admission at any facility in two study periods between 5/2018 and 12/2019 are included. Readmission in 90-days after an inpatient detox was the primary outcome. Multiple statistical estimation methods were used to adjust for potential confounding factors between treatment and control groups.Results: A total of 2,320 unique patients with 2,443 index detox admission in the pre- and post-periods were compared. The C.L.I.M.B. patients had higher readmission compared with the controls in the pre-period (unadjusted readmission rates16.4% vs. 10.0%) and similar rates in the post-period (11.8% vs. 10.1%). All DID estimates were not statistically significant (adjusted estimates ranged from 6.0 to 9.2 percentage points difference favoring the C.L.I.M.B. program). Conclusions: While not statistically significant, wrap-around services reduced detox readmission. It may be that the added services helped to inform people that inpatient detox is not necessary for OUD and withdrawal can be managed with a structured treatment plan.