Medication Initiation, Patient-directed Discharges, and Hospital Readmissions Before and After Implementing...

Area of Science:

• Internal Medicine
• Addiction Medicine
• Hospital Administration

Background:

• Rising hospitalizations for opioid use disorder (OUD) lead to high patient-directed discharge (PDD) and readmission rates.
• Interdisciplinary addiction consult services improve OUD care but are resource-intensive.
• Guidelines were developed to aid generalists in managing opioid withdrawal without specialized consult services.

Purpose of the Study:

• To evaluate the impact of newly implemented opioid withdrawal guidelines on patient outcomes.
• To assess changes in patient-directed discharge (PDD) and 30-day readmissions.
• To determine the effect on the utilization of opioid agonist therapy (OAT) and psychiatry consults.

Main Methods:

• Retrospective chart review of hospitalized patients with OUD.
• Comparison of data from before (July 2017–March 2018) and after (January–July 2019) guideline implementation.
• Analysis of PDD rates, 30-day readmissions, psychiatry consults, and OAT provision.

Main Results:

• Opioid agonist therapy (OAT) use significantly increased from 23.3% to 64.8% post-guidelines (P < 0.001).
• Patient-directed discharge (PDD) rates remained unchanged at 14%.
• Thirty-day readmissions slightly increased from 12.4% to 15.7% (P = 0.05065).

Conclusions:

• The guidelines improved the process of care by increasing OAT use and reducing psychiatry consult workload.
• Despite increased OAT, PDD and readmission rates did not improve.
• Guidelines alone may be insufficient to impact key patient outcomes like PDD and readmissions.