Northeast Postacute Medical Facilities Disproportionately Reject Referrals For Patients With Opioid Use Disorder

Area of Science:

• Health Services Research
• Addiction Medicine
• Health Equity

Background:

• Hospitalized patients with opioid use disorder (OUD) frequently encounter difficulties accessing postacute medical care.
• Referrals to postacute care facilities are often rejected for patients with OUD, posing a barrier to continued treatment and recovery.

Purpose of the Study:

• To investigate the association between an opioid use disorder (OUD) diagnosis and the rejection rates from postacute medical care.
• To identify potential disparities in postacute care access for hospitalized patients with OUD.

Main Methods:

• Utilized electronic referral data from a Boston safety-net hospital in 2018, linked with clinical data.
• Employed multivariable logistic regression to analyze the relationship between OUD diagnosis and postacute care rejection.
• Compared referral patterns and acceptance rates between patients with and without OUD.

Main Results:

• Hospitalized patients with OUD received more referrals per hospitalization (8.2 vs. 6.6) but had a higher rejection proportion (83.3% vs. 65.5%).
• Adjusted analyses revealed patients with OUD had significantly greater odds of rejection from postacute care (aOR, 2.2).
• Patients with OUD were disproportionately referred to a limited number of facilities with higher acceptance rates.

Conclusions:

• Findings demonstrate significant disparities in postacute care admissions for individuals with opioid use disorder (OUD).
• There is a critical need for interventions to ensure equitable access to medically necessary postacute care for people with OUD.
• Addressing these access barriers is crucial for improving continuity of care and recovery outcomes for OUD patients.