Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality

King, Caroline; Englander, Honora; Korthuis, P Todd; Barocas, Joshua A.; McConnell, K. John; Morris, Cynthia D.; Cook, Ryan

doi:10.1101/2020.12.01.20242164

Cited by 2 publications

(6 citation statements)

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“…We identified drug-related deaths using criteria from Hser et al, and include primarily overdose-related deaths. 23 We populated our model with Oregon Medicaid data using Bayesian analyses; we accounted for covariates including age, gender, race, ethnicity, concurrent alcohol or stimulant use disorder, length of stay, rural residence, prior OUD treatment engagement, previous hospitalization, and Chronic Illness and Disability Payment System score (see model validation manuscript for additional details 22 ). Cohort simulation uses data from Medicaid admissions from April 2015 through December 2017.…”

Section: Methodsmentioning

confidence: 99%

“…Markov model with estimated transition probabilities and 95% confidence intervals for hospital-based addiction care in Oregon, 2015–2017. 22 Patients are hospitalized and have a diagnosis of at least OUD. In the hospital, patients can be seen by an ACS; engage in post-discharge OUD treatment within 30 days.…”

Section: Methodsmentioning

confidence: 99%

“…[31][32][33] Using this definition allows us to match the definition used in an ongoing national pragmatic trial of effectiveness of ACS on OUD treatment engagement. 32 In the 30 days after hospital discharge, engagement was defined as (1) at least 2 filled prescriptions for buprenorphine or extended-release naltrexone, (2) enrollment in an OTP for at least 2 days, or (3) a prescription for extended-release naltrexone or buprenorphine that covered 28 of the 30 days posthospital discharge 22,32…”

Section: Outcome Measurementioning

confidence: 99%

“…1), which we describe in detail in an earlier publication. 22 In our Markov model, patients are hospitalized and have a diagnosis of OUD. In the hospital, patients can be seen by an ACS; engage in post-discharge OUD treatment within 30 days; and die from a drug-related cause or die from a nondrug related cause, within 12 months after discharge.…”

Section: Model Structure and Datamentioning

confidence: 99%

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Expanding Inpatient Addiction Consult Services Through Accountable Care Organizations for Medicaid Enrollees: A Modeling Study

et al. 2022

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Introduction: Addiction consult services (ACS) care for hospitalized patients with substance use disorder, including opioid use disorder (OUD). Medicaid Accountable Care Organizations (ACOs) could enhance access to ACS. This study extends data from Oregon's only ACS to Oregon's 15 regional Medicaid Coordinated Care Organizations (CCOs) to illustrate the potential value of enhanced in-and out-patient care for hospitalized patients with OUD. The study objectives were to estimate the effects of (1) expanding ACS care through CCOs in Oregon, and (2) increasing community treatment access within CCOs, on post-discharge OUD treatment engagement. Methods: We used a validated Markov model, populated with Oregon Medicaid data from April 2015 to December 2017, to estimate study objectives.Results: Oregon Medicaid patients hospitalized with OUD with care billed to a CCO (n = 5878) included 1298 (22.1%) patients engaged in post-discharge OUD treatment. Simulation of referral to an ACS increased post-discharge OUD treatment engagement to 47.0% (95% confidence interval [CI] 45.7%, 48.3%), or 2684 patients (95% CI 2610, 2758). Ten of fifteen (66.7%) CCOs had fewer than 20% of patients engage in post-discharge OUD care. Without ACS, increasing outpatient treatment such that 20% of patients engage increased the patients engaging in post-discharge OUD care from 12.9% or 296 patients in care at baseline to 20% (95% CI 18.1%, 21.4%) or 453 (95% CI 416, 491). Discussion: ACOs can improve care for patients hospitalized with OUD. Implementing ACS in ACO networks can potentially improve post-discharge OUD treatment engagement, but community treatment systems must be prepared to accept more patients as inpatient addiction care improves.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Outcome Measurementioning

confidence: 99%

Section: Model Structure and Datamentioning

confidence: 99%

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Expanding Inpatient Addiction Consult Services Through Accountable Care Organizations for Medicaid Enrollees: A Modeling Study

et al. 2022

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“…This analysis is part of a larger project modeling care trajectories for hospitalized patients with OUD in Oregon. 5 We used data from all Oregon Medicaid patients who were admitted to one of 62 Oregon hospitals at least once between April 2015 and December 2017. Encrypted IDs from these patients were linked to encrypted Oregon Vital Statistics mortality data through December 2018 by Medicaid Health Service Delivery in Oregon.…”

Section: Methodsmentioning

confidence: 99%

Causes of Death in the 12 Months After Hospital Discharge Among Patients With Opioid Use Disorder

King

Cook

Korthuis

et al. 2021

Journal of Addiction Medicine

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BackgroundPatients with substance use disorders are seven times more likely hospitalized than the general population. However, causes of death for recently hospitalized patients with Opioid Use Disorder (OUD) are not well described. This study describes causes of death in the year post-discharge among hospitalized patients with OUD.MethodsWe analyzed data from participants who were at least 18 years old, with Medicaid insurance, and had a diagnosis of OUD during a general hospital admission in Oregon between April 2015 and December 2017.ResultsDuring the study window, 6,654 Oregon Medicaid patients with an OUD diagnosis were hospitalized. Patients were predominately female (56.7%) and White (72.2%), an average age of 44.2 years (SD = 15.4 years) and average hospital length of stay of 6.5 days (SD = 10.9 days). In the 12 months post-discharge, 522 patients died (7.8%); 301 patients from a drug or substance related cause (4.5%), including 71 from drug overdose (1.1%). Stated another way, of those who died within 12 months, 58% of deaths were attributed to drug-related causes, including 13.6% of deaths attributed to overdose; 42% died of non-drug related causes. Drug-related death was the most frequent cause of mortality.ConclusionsHospitalized patients with OUD are at high risk of death, from drug and non-drug related causes, in the year after discharge. Future research should consider not only overdose, but a more comprehensive definition of drug-related death in understanding post-discharge mortality among hospitalized patients with OUD, and care systems should work to mitigate the risk of death in this population.

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Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality

Cited by 2 publications

References 36 publications

Expanding Inpatient Addiction Consult Services Through Accountable Care Organizations for Medicaid Enrollees: A Modeling Study

Expanding Inpatient Addiction Consult Services Through Accountable Care Organizations for Medicaid Enrollees: A Modeling Study

Causes of Death in the 12 Months After Hospital Discharge Among Patients With Opioid Use Disorder

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