Medical Inpatients with Substance Use Disorders Are More Likely to Have Acute Care Readmission than Those without Substance Use Disorders

Patients with substance use disorders (SUDs) are frequent users of acute medical care services (AMCS) (emergency department visits or hospitalizations). Hospital discharge provides an opportunity to reduce hospital readmission through linkage to specialized care, especially for patients with SUDs. This study assessed whether the diagnosis of an SUD during medical hospitalization was associated with recurrent AMCS use. The authors examined data from Project RED, a randomized trial of reengineered discharge services among 738 general medical inpatients at a single institution. The discharge intervention did not contain services specifically tailored to patients with SUDs. The main outcomes were rate and risk of AMCS use within 30 days of discharge as assessed by medical record review and self-report.

• Seventeen percent of patients had an SUD.

• Patients with an SUD had higher rate of AMCS use at 30 days (0.63 versus 0.32 events per patient) and had an increased risk of AMCS use (33% versus 22%).

• Subgroup analysis revealed that drug use disorders or a combination of drug and alcohol use disorders resulted in higher AMCS use than alcohol diagnoses alone.

Comments:

Despite the inherent limitations of reliance on self-report, International Classification of Diseases (ICD-9) coding, and single institution data, these results support the hypothesis that SUDs place medical inpatients at higher risk for recurrent AMCS use. A discharge plan tailored to patients with SUDs may help reduce readmission rates.

Jeanette M. Tetrault, MD

Reference:

Walley AY, Paasche-Orlow M, Lee EC, et al. Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med. 2012;6(1):50–56.