Planning and Designing the Improving Addiction Care Team (Impact) for Hospitalized Adults with Substance Use Disorder

Insights Results

Overview of article

• This study describes the authors experience using patient needs assessment to engage stakeholders and drive local systems change. The authors also describe the resulting care model, the Improving Addiction Care Team (IMPACT). This experience provides a potentially useful example to other hospitals and communities seeking to address the national SUD epidemic
• In 2012, Oregon transformed its Medicaid system by establishing 16 regional “coordinated care organizations” (CCOs) to improve outcomes and slow healthcare spending. In a CCO environment, hospitals assume increased financial risk, yet reforms have focused on the outpatient setting. Therefore, executive leadership at Oregon Health & Science University (OHSU), an urban academic medical center, asked clinician- leaders to design point-of-care improvements for Medicaid- funded adults and build on existing models to improve care for socioeconomically vulnerable adults. One priority that emerged was to make improvements for hospitalized adults with substance use disorders (SUD)
• As a result, in order to understand local needs and opportunities at OHSU, the authors surveyed hospitalized adults with SUD. The authors reviewed needs assessment findings and examples from the literature to develop strategies to address patient and system needs. They used patient narratives to foster alignment and prioritized areas in which integration could improve quality and costs in order to develop IMPACT, a model that includes an inpatient addiction medicine consultation service, rapid-access pathways to posthospital SUD treatment, and a medically enhanced residential care model that integrates antibiotic infusion and residential addiction care. The authors developed a business case and secured funding from Medicaid and hospital payers. IMPACT provides one pathway for hospitals, payers, and communities to collaboratively address the SUD epidemic

Results

• Surveys assessed social and demographic factors, healthcare utilization, substance use severity, and treatment experience. Participants who reported high-risk illicit drug or alcohol use were asked to indicate their readiness to change on a 3-point scale developed for this study
• 54% of participants with moderate- to high-risk opioid use and 16% with moderate- to high-risk alcohol use reported strong interest in medication for addiction treatment (MAT). In qualitative interviews, participants described inadequately treated withdrawal, the importance of trust and choice, and long wait times as a barriers to entering treatment after hospital discharge
• Using a process of broad stakeholder engagement, data-driven understanding of population needs, and analysis of financial incentives, the authors built consensus and secured funding for a multicomponent intervention across hospital and post–acute care settings. Other studies have demonstrated the feasibility and efficacy of starting a single medication for a specific indication (e.g., methadone for opioid use disorder), yet strategies for expanding SUD services in hospitals and facilitating posthospital treatment linkages remain scarce. Our model addresses a widespread need and could be adapted to other hospitals, SUD treatment organizations, and Medicaid payers
• This study developed the IMPACT model, which includes an inpatient addiction medicine consultation service, rapid-access pathways to posthospital SUD treatment, and a medically enhanced residential care model that integrates antibiotic infusion and residential addiction care. This team also developed a business case and secured funding from Medicaid and hospital payers. IMPACT provides one pathway for hospitals, payers, and communities to collaboratively address the SUD epidemic

Key takeaways/implications

• Key implications: 1) Diverse partners were vital at all stages of program design, suggesting hospitals should look beyond traditional healthcare partners to address the SUD epidemic; 2) An interprofessional team that includes physicians, social workers, and peers may better engage patients and address complex system needs; and 3) A planned IMPACT evaluation will assess effects on substance use, healthcare use, and costs