Hospital Costs of Injection Drug Use in Florida

Coye, Austin; Bornstein, Kasha; Bartholomew, Tyler S.; Li, Hua; Wong, Stanley; Janjua, Naveed Z.; Tookes, Hansel; Onge, Joan E. St.

doi:10.1093/cid/ciaa823

Cited by 21 publications

(26 citation statements)

References 15 publications

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“…Infectious complications of injection drug use have a severe financial impact on the health‐care system [ 17 , 18 ] and between 2002 and 2012, the cost of OUD‐related infections more than tripled [ 7 ]. Previous reports in the literature that have reviewed hospitalization outcomes have revealed this financial impact on county safety‐net health‐care systems and state‐wide impact [ 17 , 18 ] but none, to our knowledge, have investigated hospital outcomes in a multi‐state private, for‐profit health‐care system. High‐risk injection behaviors, such as sharing or re‐using injection equipment, can contribute to infectious complications [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of initiation of medications for opioid use disorder on hospitalization outcomes for endocarditis and osteomyelitis in a large private hospital system in the United States, 2014–18

Nosal

Vittori

et al. 2021

Addiction

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Background and Aims Opioid use disorder (OUD) has led to not only increases in overdose deaths, but also increases in endocarditis and osteomyelitis secondary to injection drug use (IDU). We studied the association between initiation of medications for opioid use disorder (MOUD) and treatment outcomes for people with infectious sequelae of IDU and OUD. Design and setting This is a retrospective cohort study reviewing encounters at 143 HCA Healthcare hospitals across 21 states of the United States from 2014 to 2018. Participants Adults aged 18–65 with the ICD diagnosis code for OUD and endocarditis or osteomyelitis (n = 1407). Measurements Main exposure was the initiation of MOUD, defined as either methadone or buprenorphine at any dosage started during hospitalization. Primary outcomes were defined as patient‐directed discharge (PDD), 30‐day re‐admission and days of intravenous antibiotic treatment. Covariates included biological sex, age, ethnicity, other co‐occurring substance use disorders, and insurance status. Findings MOUD was initiated among 269 (19.1%) patients during hospitalization. Initiation of MOUD was not associated with decreased odds of PDD. Initiation of MOUD did not impact 30‐day re‐admission. Patients who received MOUD, on average, had 5.7 additional days of gold‐standard intravenous antibiotic treatment compared with those who did not [β = 5.678, 95% confidence interval (CI) = 3.563, 7.794), P < 0.05]. Conclusion For people with opioid use disorder hospitalized with endocarditis or osteomyelitis, initiation of methadone or buprenorphine appears to be associated with improved receipt of gold‐standard therapy, as quantified by increased days on intravenous antibiotic treatment.

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Section: Introductionmentioning

confidence: 99%

Effect of initiation of medications for opioid use disorder on hospitalization outcomes for endocarditis and osteomyelitis in a large private hospital system in the United States, 2014–18

Nosal

Vittori

et al. 2021

Addiction

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“…Previous studies demonstrate that PWID admissions come at great social and economic cost to Florida and nationwide. 13,15 Limited billing for PCS-SAT modalities through analysis of billing and coding records in this statewide sample suggests major gaps exist during inpatient treatment of underlying SUD. 13,16 Other studies suggest similar de ciencies in implementation of best practices for hospitalized PWID.…”

Section: Discussionmentioning

confidence: 96%

“…13,15 Limited billing for PCS-SAT modalities through analysis of billing and coding records in this statewide sample suggests major gaps exist during inpatient treatment of underlying SUD. 13,16 Other studies suggest similar de ciencies in implementation of best practices for hospitalized PWID. A national survey of hospitalists indicated that while 84.5% reported "often or always" caring for patients with opioid use disorder (OUD), 88.9% "rarely or never" initiated buprenorphine in the inpatient setting.…”

Section: Discussionmentioning

confidence: 96%

“…A major limitation of this study is the structure of ICD-10 coding for drug use disorders and SAT. To date, the ICD-10 lacks speci c code(s) for PWID, complicating efforts to study the care of this patient population and necessitating algorithmic approaches to identi cation of hospitalized PWID 13,20,21 .While highly speci c, the statistical algorithm used in this study underestimates the real number of hospitalized PWID in Florida during the study period. In addition to built-in stigmatizing language such as "abuse", there is no speci c category for rst-line medications such as buprenorphine and it includes vague categories such as "psychoactive medication."…”

Section: Discussionmentioning

confidence: 99%

“…The algorithm was validated using British Columbia Hepatitis Testers Cohort data and noted to have a sensitivity of 63% and a speci city of 100%. 13 PWID admissions between 18-75 years of age and with length of stay (LOS) < 60 days were included.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

A Missed Opportunity: Underutilization of Inpatient Behavioral Health Services to Reduce Injection Drug Use Sequelae in Florida

Coye

Jones

Bornstein

et al. 2021

Preprint

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Background: People who inject drugs (PWID) suffer high morbidity and mortality from injection related infections (IRI). The inpatient setting is an ideal opportunity to treat underlying substance use disorder (SUD), but it is unclear how often this occurs.Objectives: To quantify the utilization of behavioral health services for PWID during inpatient admissions for IRI.Design: Data for all hospital admissions in Florida in FY2017 were obtained from the Agency for Healthcare Administration.Subjects: Hospitalization for IRI were obtained using a validated ICD-10 algorithm and treatment for substance use disorder was quantified using ICD-10-Procedure Coding System (ICD-10-PCS) codes.Main Measure: Behavior health services associated with IRI admissionsKey Results: Among the 20,001 IRI admissions, there were 230 patients who received behavioral health services as defined by ICD-10-PCS SAT codes for treatment for SUD.Conclusions: In a state with a large number of IRI, only a very small portion of admissions received behavioral health services. Increased efforts should be directed to studying referral patterns among physicians and other providers caring for this population and increasing utilization of behavioral health services.

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The impact of opioid agonist treatment on hospitalisations for injecting-related diseases among an opioid dependent population: A retrospective data linkage study

Colledge-Frisby

Jones

Larney

et al. 2022

Drug and Alcohol Dependence

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Hospital Costs of Injection Drug Use in Florida

Cited by 21 publications

References 15 publications

Effect of initiation of medications for opioid use disorder on hospitalization outcomes for endocarditis and osteomyelitis in a large private hospital system in the United States, 2014–18

Effect of initiation of medications for opioid use disorder on hospitalization outcomes for endocarditis and osteomyelitis in a large private hospital system in the United States, 2014–18

A Missed Opportunity: Underutilization of Inpatient Behavioral Health Services to Reduce Injection Drug Use Sequelae in Florida

The impact of opioid agonist treatment on hospitalisations for injecting-related diseases among an opioid dependent population: A retrospective data linkage study

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