Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals: 2015-2021

Area of Science:

• Public Health
• Health Services Research
• Addiction Medicine

Background:

• Hospitalizations present a critical juncture for addressing substance use disorders (SUDs).
• The prioritization and implementation of SUD services by nonprofit hospitals over time are not well understood.
• Understanding these trends is vital for improving community health and patient outcomes.

Purpose of the Study:

• To examine trends in nonprofit hospitals' prioritization of SUD as a community need.
• To assess trends in the implementation of SUD programs within nonprofit hospitals from 2015 to 2021.

Main Methods:

• Analysis of hospital community benefit reports from 2015-2021 (two waves: 2015-2018 and 2019-2021).
• Statistical tests (t or χ2) to compare prioritization and implementation across waves.
• Multilevel logistic regression to identify factors associated with SUD program prioritization and implementation.

Main Results:

• Nonprofit hospitals were less likely to prioritize SUD as a top community need in the later period (2019-2021) compared to the earlier period (2015-2018).
• Implementation of SUD programs increased in the later period, even after adjusting for overdose rates and hospital/community factors.
• Despite an overall rise in overdose rates, 11% of hospitals reduced SUD services, and 15% never adopted them.

Conclusions:

• Significant gaps exist in hospital-based SUD infrastructure, particularly during a period of increasing need.
• These gaps represent missed opportunities to connect vulnerable populations with essential treatment and care.
• Addressing these infrastructure deficits is crucial for mitigating the impact of substance use disorders.