TY - JOUR
KW - Academic Medical Centers
KW - Adult
KW - Aftercare
KW - Alcohol-Related Disorders/complications/therapy
KW - Baltimore
KW - Cocaine-Related Disorders/complications/therapy
KW - Emergency Service, Hospital/statistics & numerical data
KW - Facilities and Services Utilization
KW - Female
KW - Follow-Up Studies
KW - Hospitals, Urban
KW - Humans
KW - Male
KW - Middle Aged
KW - Motivation
KW - Opioid-Related Disorders/complications/therapy
KW - Patient Navigation/organization & administration
KW - Patient Readmission
KW - Psychosocial Support Systems
KW - Substance-Related Disorders/therapy
KW - Treatment Outcome
AU - J. Gryczynski
AU - C. D. Nordeck
AU - C. Welsh
AU - S. G. Mitchell
AU - K. E. O'Grady
AU - R. P. Schwartz
A1 - 
AB - BACKGROUND: Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use. OBJECTIVE: To determine whether patient navigation services reduce hospital readmissions. DESIGN: Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818). SETTING: Urban academic hospital in Baltimore, Maryland, with an SUD consultation service. PARTICIPANTS: 400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol). INTERVENTION: NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge. MEASUREMENTS: Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up. RESULTS: Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU). LIMITATION: Single-site trial, which limits generalizability. CONCLUSION: Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs. PRIMARY FUNDING SOURCE: National Institute on Drug Abuse.
AD - Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.).; Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.).; University of Maryland School of Medicine, Baltimore, Maryland (C.W.).; Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.).; University of Maryland, College Park, Maryland (K.E.O.).; Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.).
BT - Annals of Internal Medicine
C5 - Financing & Sustainability; Opioids & Substance Use
CP - 7
CY - United States
DO - 10.7326/M20-5475
IS - 7
JF - Annals of Internal Medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use. OBJECTIVE: To determine whether patient navigation services reduce hospital readmissions. DESIGN: Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818). SETTING: Urban academic hospital in Baltimore, Maryland, with an SUD consultation service. PARTICIPANTS: 400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol). INTERVENTION: NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge. MEASUREMENTS: Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up. RESULTS: Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU). LIMITATION: Single-site trial, which limits generalizability. CONCLUSION: Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs. PRIMARY FUNDING SOURCE: National Institute on Drug Abuse.
PP - United States
PY - 2021
SN - 1539-3704; 0003-4819
SP - 899
EP - 909
EP - 
T1 - Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial
T2 - Annals of Internal Medicine
TI - Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial
U1 - Financing & Sustainability; Opioids & Substance Use
U2 - 33819055
U3 - 10.7326/M20-5475
VL - 174
VO - 1539-3704; 0003-4819
Y1 - 2021
Y2 - Jul
ER -