Outcomes of a Hospitalist-Led Consult Service for Patients with Opioid Use Disorder: A Propensity Score Weighted Study.

BACKGROUND

Medication for opioid use disorder (MOUD) reduces mortality and is the standard of care yet use remains low. Hospitalist-led treatment can fill important gaps in care for patients with OUD.

OBJECTIVE

Evaluate effectiveness of a hospitalist-led OUD consult service, Project Caring for patients with Opioid Misuse through Evidence-based Treatment (COMET).

DESIGN

Retrospective cohort study with quasi-experimental design, using propensity score weighting with historical and concurrent control groups.

PATIENTS: Adult patients with an OUD diagnosis during hospitalization.

EXPOSURE: COMET consult MAIN MEASURES: Primary outcomes included MOUD receipt during hospitalization and 90-day all-cause mortality, with 30-day all-cause mortality subsequently added. Secondary outcomes included buprenorphine and naloxone prescriptions, length of stay (LOS), 30-day readmission, and 30-day emergency department (ED) visit.

KEY

RESULTS

There were 5098 encounters for patients with OUD. Inpatient MOUD administration was higher for COMET patients (concurrent control RR = 1.86, 97.5% CI: 1.69-2.04; historical control RR = 2.68, 97.5% CI: 2.36-3.06). Mortality within 30 days of discharge was less likely in COMET patients (concurrent control RR = 0.47, 97.5% CI: 0.17-0.96; historical control RR = 0.55, 97.5% CI: 0.22-1.22). Association of COMET with post-discharge mortality lessened at 90 days (concurrent control RR = 0.81, 97.5% CI: 0.49-1.31; historical control RR = 0.74, 97.5% CI: 0.44-1.23). COMET patients had fewer 30-day readmissions (concurrent control RR = 0.76, 95% CI: 0.61-0.92; historical control RR = 0.84, 95% CI: 0.68-1.04). COMET was not associated with ED visits within 30 days of discharge but was associated with longer LOS.

CONCLUSIONS

COMET patients were more likely to receive inpatient MOUD with evidence of a lower risk of all-cause mortality and readmission within 30 days of discharge. A hospitalist-led consult service can improve care for inpatients with OUD.