Impact of an opioid use disorder medication implementation intervention on hospitalization and emergency department utilization in the Veterans Health Administration.

Abstract

Background: It is important to evaluate how medication for opioid use disorder (MOUD) implementation interventions impact downstream outcomes, however little is known about impact on hospitalization and emergency department (ED) utilization. Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) is a national United States Veterans Health Administration (VHA) effort initially implemented at 18 facilities that increased MOUD receipt in primary care, mental health, and pain clinics. This evaluation assessed SCOUTT's impact on hospitalization and ED utilization.

Methods: This evaluation used a controlled interrupted time series analysis. We extracted electronic health record data for patients with OUD and ≥ 1 visit in an intervention clinic (N = 35) or matched comparison clinic (N = 35) in the post-implementation year. We examined monthly measures of hospitalization and ED utilization in the pre-implementation (9/1/2017-8/31/2018) and post-implementation (9/1/2018-8/31/2019) years. Segmented regression models estimated pre-post immediate and trend changes in intervention relative to comparison clinics, adjusting for pre-implementation trends and patient characteristics. Sensitivity analyses were conducted among patients with ≥ 1 visit in both the pre-/post-implementation years, and post-hoc secondary analyses were conducted among patients with OUD and ≥ 1 other SUD vs. OUD only.

Results: Patients with OUD in both intervention (N = 7,488) and comparison (N = 7,558) clinics had a mean age of 53 years, and the majority were male, White, and not married. During the pre-implementation period, hospitalization and ED utilization increased over time in both intervention and comparison clinics; during the post-implementation period, hospitalization and ED utilization decreased over time in intervention clinics and remained stable in comparison clinics. There was no significant difference in pre-post changes between intervention and comparison clinics for most analyses. In sensitivity analyses the pre-to-post decrease in monthly trend for ED visits was larger in intervention clinics and, in secondary analyses, the pre-to-post decrease in monthly trend for hospitalizations was larger in intervention clinics among patients with OUD and ≥ 1 other SUD.

Conclusions: This evaluation did not find evidence that SCOUTT substantially impacted hospitalization or ED utilization relative to comparison clinics, though there may have been positive impacts for patients with longer engagement in SCOUTT clinics and patients with OUD and ≥ 1 other SUD.