Prevention of 90-day Detox Readmission for Opioid use Disorder by A Community-Based Life-Changing Individualized Medically Assisted Evidence-based Treatment (C.L.I.M.B.) Program: A Quasi-Experimental Design

Abstract

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.