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Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge

IMPORTANCE: Emergency department (ED)–based initiation of buprenorphine has been shown to increase engagement in outpatient treatment and reduce the risk of subsequent opioid overdose; however, rates of buprenorphine treatment in the ED and follow-up care for opioid use disorder (OUD) remain low in...

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Autores principales: Solomon, Keisha T., O’Connor, Jason, Gibbons, Jason B., Kilaru, Austin S., Feder, Kenneth A., Xue, Lingshu, Saloner, Brendan, Stuart, Elizabeth A., Cole, Evan S., Hulsey, Eric, Meisel, Zachary, Patel, Esita, Donohue, Julie M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313142/
https://www.ncbi.nlm.nih.gov/pubmed/36961457
http://dx.doi.org/10.1001/jamahealthforum.2023.0245
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author Solomon, Keisha T.
O’Connor, Jason
Gibbons, Jason B.
Kilaru, Austin S.
Feder, Kenneth A.
Xue, Lingshu
Saloner, Brendan
Stuart, Elizabeth A.
Cole, Evan S.
Hulsey, Eric
Meisel, Zachary
Patel, Esita
Donohue, Julie M.
author_facet Solomon, Keisha T.
O’Connor, Jason
Gibbons, Jason B.
Kilaru, Austin S.
Feder, Kenneth A.
Xue, Lingshu
Saloner, Brendan
Stuart, Elizabeth A.
Cole, Evan S.
Hulsey, Eric
Meisel, Zachary
Patel, Esita
Donohue, Julie M.
author_sort Solomon, Keisha T.
collection PubMed
description IMPORTANCE: Emergency department (ED)–based initiation of buprenorphine has been shown to increase engagement in outpatient treatment and reduce the risk of subsequent opioid overdose; however, rates of buprenorphine treatment in the ED and follow-up care for opioid use disorder (OUD) remain low in the US. The Opioid Hospital Quality Improvement Program (O-HQIP), a statewide financial incentive program designed to increase engagement in OUD treatment for Medicaid-enrolled patients who have ED encounters, has the potential to increase ED-initiated buprenorphine treatment. OBJECTIVE: To evaluate the association between hospitals attesting to an ED buprenorphine treatment O-HQIP pathway and patients’ subsequent initiation of buprenorphine treatment. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Pennsylvania patients aged 18 to 64 years with continuous Medicaid enrollment 6 months before their OUD ED encounter and at least 30 days after discharge between January 1, 2016, and December 31, 2020. Patients with a claim for medication for OUD 6 months before their index encounter were excluded. EXPOSURES: Hospital implementation of an ED buprenorphine treatment O-HQIP pathway. MAIN OUTCOMES AND MEASURES: The main outcome was patients’ receipt of buprenorphine within 30 days of their index OUD ED visit. Between August 2021 and January 2023, data were analyzed using a difference-in-differences method to evaluate the association between hospitals’ O-HQIP attestation status and patients’ treatment with buprenorphine after ED discharge. RESULTS: The analysis included 17 428 Medicaid-enrolled patients (female, 43.4%; male, 56.6%; mean [SD] age, 37.4 [10.8] years; Black, 17.5%; Hispanic, 7.9%; White, 71.6%; other race or ethnicity, 3.0%) with OUD seen at O-HQIP–attesting or non–O-HQIP–attesting hospital EDs. The rate of prescription fills for buprenorphine within 30 days of an OUD ED discharge in the O-HQIP attestation hospitals before the O-HQIP intervention was 5%. The O-HQIP attestation was associated with a statistically significant increase (2.6 percentage points) in prescription fills for buprenorphine within 30 days of an OUD ED discharge (β, 0.026; 95% CI, 0.005-0.047). CONCLUSIONS AND RELEVANCE: In this cohort study, the O-HQIP was associated with an increased initiation of buprenorphine in patients with OUD presenting to the ED. These findings suggest that statewide incentive programs may effectively improve outcomes for patients with OUD.
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spelling pubmed-103131422023-07-01 Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge Solomon, Keisha T. O’Connor, Jason Gibbons, Jason B. Kilaru, Austin S. Feder, Kenneth A. Xue, Lingshu Saloner, Brendan Stuart, Elizabeth A. Cole, Evan S. Hulsey, Eric Meisel, Zachary Patel, Esita Donohue, Julie M. JAMA Health Forum Original Investigation IMPORTANCE: Emergency department (ED)–based initiation of buprenorphine has been shown to increase engagement in outpatient treatment and reduce the risk of subsequent opioid overdose; however, rates of buprenorphine treatment in the ED and follow-up care for opioid use disorder (OUD) remain low in the US. The Opioid Hospital Quality Improvement Program (O-HQIP), a statewide financial incentive program designed to increase engagement in OUD treatment for Medicaid-enrolled patients who have ED encounters, has the potential to increase ED-initiated buprenorphine treatment. OBJECTIVE: To evaluate the association between hospitals attesting to an ED buprenorphine treatment O-HQIP pathway and patients’ subsequent initiation of buprenorphine treatment. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Pennsylvania patients aged 18 to 64 years with continuous Medicaid enrollment 6 months before their OUD ED encounter and at least 30 days after discharge between January 1, 2016, and December 31, 2020. Patients with a claim for medication for OUD 6 months before their index encounter were excluded. EXPOSURES: Hospital implementation of an ED buprenorphine treatment O-HQIP pathway. MAIN OUTCOMES AND MEASURES: The main outcome was patients’ receipt of buprenorphine within 30 days of their index OUD ED visit. Between August 2021 and January 2023, data were analyzed using a difference-in-differences method to evaluate the association between hospitals’ O-HQIP attestation status and patients’ treatment with buprenorphine after ED discharge. RESULTS: The analysis included 17 428 Medicaid-enrolled patients (female, 43.4%; male, 56.6%; mean [SD] age, 37.4 [10.8] years; Black, 17.5%; Hispanic, 7.9%; White, 71.6%; other race or ethnicity, 3.0%) with OUD seen at O-HQIP–attesting or non–O-HQIP–attesting hospital EDs. The rate of prescription fills for buprenorphine within 30 days of an OUD ED discharge in the O-HQIP attestation hospitals before the O-HQIP intervention was 5%. The O-HQIP attestation was associated with a statistically significant increase (2.6 percentage points) in prescription fills for buprenorphine within 30 days of an OUD ED discharge (β, 0.026; 95% CI, 0.005-0.047). CONCLUSIONS AND RELEVANCE: In this cohort study, the O-HQIP was associated with an increased initiation of buprenorphine in patients with OUD presenting to the ED. These findings suggest that statewide incentive programs may effectively improve outcomes for patients with OUD. American Medical Association 2023-03-24 /pmc/articles/PMC10313142/ /pubmed/36961457 http://dx.doi.org/10.1001/jamahealthforum.2023.0245 Text en Copyright 2023 Solomon KT et al. JAMA Health Forum. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Solomon, Keisha T.
O’Connor, Jason
Gibbons, Jason B.
Kilaru, Austin S.
Feder, Kenneth A.
Xue, Lingshu
Saloner, Brendan
Stuart, Elizabeth A.
Cole, Evan S.
Hulsey, Eric
Meisel, Zachary
Patel, Esita
Donohue, Julie M.
Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge
title Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge
title_full Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge
title_fullStr Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge
title_full_unstemmed Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge
title_short Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge
title_sort association between hospital adoption of an emergency department treatment pathway for opioid use disorder and patient initiation of buprenorphine after discharge
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313142/
https://www.ncbi.nlm.nih.gov/pubmed/36961457
http://dx.doi.org/10.1001/jamahealthforum.2023.0245
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