National trends and characteristics of inpatient detoxification for drug use disorders in the United States

Zhu, He; Wu, Li‐Tzy

doi:10.1186/s12889-018-5982-8

Cited by 29 publications

(19 citation statements)

References 49 publications

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“…Transition to ICD-10-CM occurred October 1, 2015. These codes are consistent with recent studies on OUD, overdoses, and drug detoxification and rehabilitation (counselling and pharmacotherapy) services (Heslin et al, 2017; Peterson et al, 2018; Tedesco et al, 2017; Zhu & Wu, 2018). This study followed physician coding guidance (Providers Clinical Support System, 2018) indicating the use of ICD-CM codes for both opioid dependence and opioid use disorder to identify problematic opioid use, and assumed that these codes would not appear on inpatient records for patients with acceptable opioid use.…”

Section: Methodssupporting

confidence: 86%

Opioid-related US hospital discharges by type, 1993–2016

Peterson

Florence

et al. 2019

Journal of Substance Abuse Treatment

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Objective: To classify and compare US nationwide opioid-related hospital inpatient discharges over time by discharge type: 1) opioid use disorder (OUD) diagnosis without opioid overdose, detoxification, or rehabilitation services, 2) opioid overdose, 3) OUD diagnosis or opioid overdose with detoxification services, and 4) OUD diagnosis or opioid overdose with rehabilitation services. Methods: Survey-weighted national analysis of hospital discharges in the Healthcare Cost and Utilization Project National Inpatient Sample yielded age-adjusted annual rates per 100,000 population. Annual percentage change (APC) in the rate of opioid-related discharges by type during 1993–2016 was assessed. Results: The annual rate of hospital discharges documenting OUD without opioid overdose, detoxification, or rehabilitation services quadrupled during 1993–2016, and at an increased rate (8% annually) during 2003–2016. The discharge rate for all types of opioid overdose increased an average 5–9% annually during 1993–2010; discharges for non-heroin overdoses declined 2010–2016 (3–12% annually) while heroin overdose discharges increased sharply (23% annually). The rate of discharges including detoxification services among OUD and overdose patients declined (−4% annually) during 2008–2016 and rehabilitation services (e.g., counselling, pharmacotherapy) among those discharges decreased (−2% annually) during 1993–2016. Conclusions: Over the past two decades, the rate of both OUD diagnoses and opioid overdoses increased substantially in US hospitals while rates of inpatient detoxification and rehabilitation services identified by diagnosis codes declined. It is critical that inpatients diagnosed with OUD or treated for opioid overdose are linked effectively to substance use disorder treatment at discharge.

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Section: Methodssupporting

confidence: 86%

Opioid-related US hospital discharges by type, 1993–2016

Peterson

Florence

et al. 2019

Journal of Substance Abuse Treatment

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“…Substance and alcohol use disorders are among the conditions most strongly associated with DAMA (34,35) and it is conceivable that untreated drug withdrawal is a contributing factor (36). OUD has been associated with an increased odds of DAMA from detoxification admission (37). One study of persons who inject drugs reported that receipt of methadone was associated was linked with a reduced odds of DAMA (38), a finding that suggests that, for opioid-tolerant patients, opioid substitution may be beneficial in curtailing DAMA.…”

Section: Discussionmentioning

confidence: 99%

“…DUA-IE is a critical emerging public health issue that is affecting the lives of young persons, burdening health systems and public insurance payers, and fundamentally reshaping the epidemiology and management of endocarditis. Enhancing the multidisciplinary infrastructure to address treatment and prevention of DUA-IE should be an urgent priority, including improved provision of addiction care in the inpatient and outpatient setting (37,57). Further studies are needed to characterize long-term outcomes for DUA-IE after discharge, such as reinfection, reoperation and mortality, and to understand the role of addiction treatment, harm reduction and other interventions in improving DUA-IE outcomes.…”

Section: Discussionmentioning

confidence: 99%

Trends in Drug Use–Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017

et al. 2018

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Background: Drug use-associated infective endocarditis (DUA-IE) is rising during the opioid epidemic. Infective endocarditis (IE) can require valve surgery, but surgical treatment of DUA-IE has invoked controversy and the extent of its use is unknown. Objective: To examine hospitalization trends for DUA-IE, the proportion with surgery, patient characteristics, length of stay and charges. Design: Ten-year analysis of a statewide hospital discharge database. Setting: North Carolina hospitals, 2007–2017. Patients: All patients hospitalized for IE aged ≥ 18 years. Measurements: Annual trends in all IE hospitalizations and those with valve surgery, stratified by patients’ drug use. Characteristics of DUA-IE surgical hospitalizations including demographics, length of stay, disposition and charges. Results: Of 22,825 IE hospitalizations, 2,602 (11%) were for DUA-IE. Valve surgery was performed in 1,655 (7%) IE hospitalizations, including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 per 100,000, and DUA-IE hospitalizations with surgery rose from 0.10 per 100,000 to 1.38 per 100,000. In the final year, surgeries for DUA-IE comprised 42% of IE valve surgeries. Compared to other IE surgical patients, DUA-IE patients were younger (median age 33 vs. 56), more commonly female (47% vs. 33%) and White (89% vs. 63%), and primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median 27 vs. 17 days) with higher median charges ($250,994 vs. $198,764). Charges for 282 DUA-IE hospitalizations exceeded $78,000,000. Limitations: Reliance on administrative data and billing codes. Conclusions: DUA-IE hospitalizations and valve surgeries increased over twelve-fold and DUA-IE approached half of all IE valve surgeries. The swell of DUA-IE patients is reshaping the scope, type, and financing of healthcare resources needed for effective IE treatment.

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“…This phenomenon is frequently referred to as dropout or against medical advice (AMA) discharge [1]. Rates of early discharge in inpatient withdrawal management settings vary widely, ranging from 14% [2] to 63% [3]. These numbers are troubling, considering that patients who experience early discharge often have high rates of readmission [1,4] and subsequent early discharges [5], which are costly to the healthcare system [6].…”

Section: Introductionmentioning

confidence: 99%

Predictors of and reasons for early discharge from inpatient withdrawal management settings: A scoping review

Ling

Davies

Sproule

et al. 2021

Drug and Alcohol Review

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Issues Early discharges, also known as ‘against medical advice’ discharges, frequently occur in inpatient withdrawal management settings and can result in negative outcomes for patients. The purpose of this scoping review is to identify what is known about predictors of and reasons for the early discharge among adults accessing inpatient withdrawal management settings. Approach MEDLINE, CINAHL, PsycINFO, ASSIA and EMBASE were searched, resulting in 2587 articles for screening. Title and abstract screening and full‐text review were completed by two independent reviewers. Results were synthesised in quantitative and qualitative formats. Key Findings Sixty‐two studies were included in this scoping review. All studies focused on predictors of early discharge, except one which only described reasons for the early discharge. Forty‐eight percent of studies involved retrospective review of health records data. The most frequently examined variables were demographics. Variables related to the treatment setting, such as referral source and treatment received, were examined less frequently but were more consistently associated with early discharge compared to demographics. Only six studies described patient reasons for the early discharge, which were retrieved via clinical documentation. The most common reasons for early discharge were dissatisfaction with treatment and family issues. Implications and Conclusions Most demographic variables do not consistently predict early discharge, and reasons for early discharge are not well understood. Future studies should focus on the predictive value of non‐patient‐level variables, or conduct analyses to account for predictors of early discharge among different subgroups of people (e.g. by gender or ethnicity). Qualitative research exploring patient perspectives is needed.

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National trends and characteristics of inpatient detoxification for drug use disorders in the United States

Cited by 29 publications

References 49 publications

Opioid-related US hospital discharges by type, 1993–2016

Opioid-related US hospital discharges by type, 1993–2016

Trends in Drug Use–Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017

Predictors of and reasons for early discharge from inpatient withdrawal management settings: A scoping review

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