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

Abstract

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.

Keywords: Healthcare innovation; Hospital medicine; Models of care; Opioid use disorder.