Health Care Utilization After Paraprofessional-administered Substance Use Screening, Brief Intervention, and Referral...

Area of Science:

• Health Services Research
• Public Health
• Behavioral Health Integration

Background:

• Universal substance use screening, brief intervention, and referral to treatment (SBIRT) is recommended for all adult primary care patients.
• Paraprofessionals can deliver SBIRT in primary care settings.

Purpose of the Study:

• To examine long-term health care utilization and cost changes after universal SBIRT implementation.
• To assess the cost-effectiveness of paraprofessional-delivered SBIRT in primary care.

Main Methods:

• Difference-in-differences design using Medicaid administrative data.
• Monte Carlo simulation to estimate cost offsets.
• Analysis of outpatient days, inpatient length of stay, inpatient admissions, and emergency department admissions.

Main Results:

• An annual increase of 1.68 outpatient days per patient was observed (P=0.027).
• A nonsignificant annual decrease of 0.67 inpatient days per patient was found (P=0.087).
• Estimated annual net cost savings of $782 per patient due to reduced inpatient utilization.

Conclusions:

• Paraprofessional-delivered universal SBIRT is likely to generate healthcare cost savings.
• SBIRT is a cost-effective strategy for integrating behavioral health services into primary care.