Differences in length of stay and discharge destination among patients with substance use disorders: The effect of Substance Use Intervention Team (SUIT) consultation service

Thompson, Hale M.; Faig, Walter; VanKim, Nicole A.; Sharma, Brihat; Afshar, Majid; Karnik, Niranjan S.

doi:10.1371/journal.pone.0239761

Cited by 31 publications

(29 citation statements)

References 40 publications

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“…To date, a few studies have evaluated various strategies to prevent irregular discharge, although they have primarily focused on patients with SUD. 30,32,33 For example, using retrospective data from over 35 000 hospital-related treatment encounters for SUD, Thompson et al found that compared with usual care, a substance use intervention team (SUIT) was associated with a significantly greater probability that patients would leave with a regular discharge (HR = 1.16, 95% CI 1.03–1.3). 32 The SUIT intervention focuses on harm reduction and includes interventions such as medication initiation, motivational interviewing, treatment education and processes to facilitate post-discharge care.…”

Section: Discussionmentioning

confidence: 99%

“…30,32,33 For example, using retrospective data from over 35 000 hospital-related treatment encounters for SUD, Thompson et al found that compared with usual care, a substance use intervention team (SUIT) was associated with a significantly greater probability that patients would leave with a regular discharge (HR = 1.16, 95% CI 1.03–1.3). 32 The SUIT intervention focuses on harm reduction and includes interventions such as medication initiation, motivational interviewing, treatment education and processes to facilitate post-discharge care. 32 In a study of veterans discharged from an in-patient mental health recovery and rehabilitation programme, Decker et al also found that small group, patient-centred therapy interventions were associated with significant improvements in successful treatment completion and better treatment retention.…”

Section: Discussionmentioning

confidence: 99%

“…32 The SUIT intervention focuses on harm reduction and includes interventions such as medication initiation, motivational interviewing, treatment education and processes to facilitate post-discharge care. 32 In a study of veterans discharged from an in-patient mental health recovery and rehabilitation programme, Decker et al also found that small group, patient-centred therapy interventions were associated with significant improvements in successful treatment completion and better treatment retention. 33…”

Section: Discussionmentioning

confidence: 99%

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Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

et al. 2021

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Background Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

et al. 2021

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“…Rush launched a multidisciplinary Substance Use Intervention Team (SUIT) to address the opioid epidemic through a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program with an inpatient Addiction Consult Service in October 2017. 22 , 23 Part of the SUIT initiative included the following single question universal drug screen: “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?” (≥ 1 is positive). The single-question screen was administered by nursing staff as a part of the admission battery of questions to patients admitted to Rush’s 18 inpatient medical and surgical wards.…”

Section: Methodsmentioning

confidence: 99%

Bias and fairness assessment of a natural language processing opioid misuse classifier: detection and mitigation of electronic health record data disadvantages across racial subgroups

Thompson

Sharma

Bhalla

et al. 2021

Journal of the American Medical Informatics Association

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Objectives To assess fairness and bias of a previously validated machine learning opioid misuse classifier. Materials & Methods Two experiments were conducted with the classifier’s original (n = 1000) and external validation (n = 53 974) datasets from 2 health systems. Bias was assessed via testing for differences in type II error rates across racial/ethnic subgroups (Black, Hispanic/Latinx, White, Other) using bootstrapped 95% confidence intervals. A local surrogate model was estimated to interpret the classifier’s predictions by race and averaged globally from the datasets. Subgroup analyses and post-hoc recalibrations were conducted to attempt to mitigate biased metrics. Results We identified bias in the false negative rate (FNR = 0.32) of the Black subgroup compared to the FNR (0.17) of the White subgroup. Top features included “heroin” and “substance abuse” across subgroups. Post-hoc recalibrations eliminated bias in FNR with minimal changes in other subgroup error metrics. The Black FNR subgroup had higher risk scores for readmission and mortality than the White FNR subgroup, and a higher mortality risk score than the Black true positive subgroup (P < .05). Discussion The Black FNR subgroup had the greatest severity of disease and risk for poor outcomes. Similar features were present between subgroups for predicting opioid misuse, but inequities were present. Post-hoc mitigation techniques mitigated bias in type II error rate without creating substantial type I error rates. From model design through deployment, bias and data disadvantages should be systematically addressed. Conclusion Standardized, transparent bias assessments are needed to improve trustworthiness in clinical machine learning models.

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“…2 Given that people with OUD tend to have high utilization of emergency room and inpatient services, efforts at initiating treatment (eg, MOUD) and improving access to overdose-reversing medications (eg, naloxone) via acute care initiatives are increasing. [4][5][6] In the outpatient setting, pharmacists have made many efforts to collaborate with waivered prescribers to increase OUD treatment access and prescribing. [6][7][8] These collaborative models have demonstrated similar levels of care for MOUD management, improved adherence and retention to MOUD, and extended the care of waivered physicians.…”

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confidence: 99%

Role of the pharmacist in acute care interventions for opioid use disorder: A scoping review

Irwin

Walkerly

2021

J Am Coll Clin Pharm

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Opioid use disorder (OUD) is associated with significant morbidity and mortality in the United States. In recent years, interest in initiatives to increase access to medication for OUD (MOUD) and overdose-reversing medications (naloxone) in acute care has grown. While well positioned to intervene, the role of acute care pharmacists in these interventions is not known. The objective for this scoping review was to better understand what is presently known about the role of pharmacists in acute care OUD interventions. These were defined as initiatives implemented in either inpatient or emergency department (ED) settings aimed at treatment of OUD (eg, initiation or management of MOUD) or harm reduction in individuals with OUD (eg, education or targeted naloxone dispensing). PubMed/MEDLINE and Embase databases were searched for articles pertaining to the research question from inception to 19 May 2021. Pearling was performed after the identification of eligible articles. Articles had to explicitly describe the pharmacist's role in planning, implementing, or evaluating an OUD intervention in the inpatient or ED setting.Data charting was performed by both authors using a predefined template, and data synthesis was performed via discussion between authors. The initial title search yielded 101 references which were screened and resulted in four articles that met inclusion criteria. Three additional articles were identified in the pearling process, yielding a total of seven articles. Four described initiatives aimed at point-ofcare dispensing of naloxone, and three described initiatives for provision or management of MOUD. Pharmacist roles primarily consisted of medication use process management, hospital staff and patient education, and dispensing activities. Literature describing the role of pharmacists in acute care OUD interventions is limited.Given the burden of OUD, there are many opportunities for further exploration of the roles acute care pharmacists can play in OUD harm reduction and treatment.

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Differences in length of stay and discharge destination among patients with substance use disorders: The effect of Substance Use Intervention Team (SUIT) consultation service

Cited by 31 publications

References 40 publications

Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

Bias and fairness assessment of a natural language processing opioid misuse classifier: detection and mitigation of electronic health record data disadvantages across racial subgroups

Role of the pharmacist in acute care interventions for opioid use disorder: A scoping review

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