Impact of Substance Use Navigators on Initiation of Treatment for Substance Use Disorders and 30-Day Unplanned...

The prevalence of substance use disorders (SUDs) is high among hospitalized patients, yet adoption of evidence-based practices to address SUDs in this population is limited. Substance use navigators (SUNs) are a promising intervention for improving patient outcomes.

This study aimed to quantify the impact of SUN consultations on medications for opioid use disorder (MOUD) and medications for alcohol use disorder (MAUD) initiation and 30-day unplanned readmissions in hospitalized patients with SUDs.

A retrospective observational cohort study at a rural hospital in Northern California following adoption of the CA Bridge model of using SUNs to provide low-threshold, evidence-based treatment for SUDs. Patient data were extracted from electronic medical records.

Hospitalized patients with a primary or secondary diagnosis of alcohol use disorder or opioid use disorder in 2023.

The two outcomes of interest were MOUD and MAUD initiation and 30-day unplanned readmission. Propensity score matching was used to estimate risk ratios comparing outcomes for patients who did vs. did not receive SUN consultation.

Among 781 patients, 26.6% received a SUN consultation and the most common primary diagnosis was sepsis (9%). MOUD and MAUD were initiated among 15.7% of patients who had a SUN consultation and 7% who did not, and the 30-day unplanned readmission rate was 4% for patients who had a SUN consultation and 10.9% for those who did not. In the propensity score matched analysis, having a SUN consultation was associated with a twofold increase in MOUD/MAUD initiation (RR 2.29, 95%CI 1.27-4.11) and a 64% reduction in risk of 30-day unplanned readmission (RR 0.36, 95%CI 0.17-0.80).

Adoption of SUNs may be an effective strategy for improving quality of care for patients with SUDs and reducing costs associated with unplanned readmissions at community-based hospitals without addiction medicine consult services.