Inpatient Link to Addiction Recovery: A Pilot Program

From the 2019 HVPAA National Conference

Ms. Krupa Merchant (University of South Carolina School of Medicine – Greenville), Ms. Francesca Tocci (University of South Carolina School of Medicine – Greenville), Ms. Bryana Baginski (University of South Carolina School of Medicine – Greenville), Ms. Katy Dumas (University of South Carolina School of Medicine – Greenville), Ms. Katie Robinson (University of South Carolina School of Medicine – Greenville), Mr. James Collie (University of South Carolina School of Medicine – Greenville), Ms. Jen Cull (University of South Carolina School of Medicine – Greenville), Mr. Benjamin Ramsey (University of South Carolina School of Medicine – Greenville), Ms. Leah Cooper (University of South Carolina School of Medicine – Greenville), Dr. Lauren Demosthenes (University of South Carolina School of Medicine – Greenville), Mr. Rich Jones (FAVOR Greenville), Dr. Kaileigh Byrne (Clemson University), Dr. Prerana Roth (Prisma Health – Upstate Greenville Memorial Hospital)

Background

Substance use disorder (SUD) is a national health epidemic. Only 10% of patients with SUD receive treatment. Current standard of care (SOC) for SUD is an outpatient referral for future services following hospital discharge. However, research shows that only 32% of SUD patients who receive a referral actually complete a treatment plan at two-month follow-up. There is no infrastructure in place to assist navigating these patients to outpatient services, creating a significant lapse in treatment. Recovery coaching represents a new model of care tailored to a patient’s specific needs and stage of recovery. It provides a unique patient-centered approach to devise a long-term, customized plan for recovery success. Preliminary research suggests that peer-based recovery services are associated with reduced rates of relapse and increased retention in treatment programs.

Objective

To assess the efficacy of linking a hospitalized inpatient admitted with SUD to a recovery coach on (1) recovery services, (2) substance use severity, (3) quality of life, and (4) hospital utilization.

Methods

This study is a prospective randomized controlled trial that compares outcomes of patients linked with a peer coach in the hospital to patients given the current SOC. After the medical team identifies inpatients that have SUD, the research team obtains informed consent and randomizes them to either an outpatient referral or a recovery coach using a REDCap algorithm. The primary outcome is the patient’s engagement in recovery services. Secondary outcomes include substance use severity (DAST-10, ASI-Lite), quality of life (SF-12), depression (PHQ-9), and hospital utilization. Outcomes are assessed through phone surveys and chart review at 30, 60, 90 days and 6 months.

Results

Those in the intervention arm report significantly greater engagement in recovery services, better physical health compared to baseline, and significantly less substance use at 60-days post-discharge. In contrast, those in the control condition show the contrary—a linear increase in drug use from 30 to 60 days post-baseline and subsequently poorer physical health. All patients in the intervention arm report active involvement in recovery services, while only 4% of the control individuals are involved in a recovery program at 30 days post-baseline. Paired sample t-tests within each arm demonstrate the intervention group reporting significantly improved physical health (M=2.75, SD=1.04) at 30-days post-baseline on the SF-12 Health Survey (1 = Poor, 5 = Excellent, p = 0.01), whereas the control group (M=2.22, SD=1.06) did not (p = 0.10).

Conclusions

Initiating peer recovery coaching in the hospital is a feasible, effective way to link patients to care and decrease substance use severity at 60-days post-discharge.

Clinical Implications

The major clinical implication of this project is the improvement of the quality of patient care provided to individuals with SUD. This patient-centered approach and partnership between the certified coach and patient is a unique treatment option that helps develop and implement a long-term recovery plan, taking into consideration physical, social, psychological, and familial goals. Future studies are in progress and will investigate risk factors for relapse during recovery that peer coaching may help to mitigate.

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPAA on Health Affairs Blog