US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015

Abstract

Background Understanding more about circumstances in which patients receive an opioid use disorder (OUD) diagnosis might illuminate opportunities for intervention and ultimately prevent opioid overdoses. This study aimed to describe patient and clinical characteristics of hospital discharges documenting OUD among patients not being treated for opioid overdose, detoxification, or rehabilitation. Methods We assessed patient, payer, and clinical characteristics of nationally-representative 2011–2015 National Inpatient Sample discharges documenting OUD, excluding opioid overdose, detoxification, and rehabilitation. Discharges were clinically classified by Diagnostic Related Group (DRG) for analysis. Results Annual discharges grew 38%, from 347,137 (2011) to 478,260 (2015), totaling 2 million discharges during the study period. The annual discharge rate increased among all racial/ethnic groups, but was highest among the non-Hispanic black population until 2015, when non-Hispanic whites had a slightly higher rate (164 versus 162 per 100,000 population). Female patients and Medicaid and Medicare as primary payer accounted for an increasing annual proportion of discharges. Just 14 DRGs accounted for nearly 50% of discharges over the study period. The most prevalent primary treatment received during OUD inpatient stays was for psychoses (DRG 885; 16% of discharges) and drug and alcohol abuse or dependence symptoms (including withdrawal) or (non-opioid) poisoning (DRG 894, 897, 917, 918; 12% of discharges). Conclusions Now nearly half a million yearly US hospital discharges for a range of primary treatment include patients’ diagnosis of OUD without opioid overdose, detoxification, or rehabilitation services. Inpatient stays present an important opportunity to link OUD patients to treatment to reduce opioid-related morbidity and mortality.

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

“…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.…”

“…Opioid overdose discharges are a measure of the epidemic’s direct impact on hospitals, while data on hospital-based inpatients diagnosed with OUD in the absence of overdose—that is, inpatients whose presenting symptom is not opioid overdose—can illustrate how hospitals services are more widely affected (Peterson, Xu, Mikosz, Florence, & Mack, 2018). Although regulatory, insurance reimbursement, and other issues mean that drug detoxification and rehabilitation are most commonly provided outside of hospitals, documenting the prevalence of such inpatient services is relevant as policymakers, clinicians, and public health officials identify ways to reduce epidemic levels of drug overdose deaths in the United States (D’Onofrio, McCormack, & Hawk, 2018; Hedegaard, Minino, & Warner, 2018; Sharma et al, 2017; Substance Abuse and Mental Health Services Administration, 2018; Suzuki et al, 2015).…”

U.S. National 90-Day Readmissions After Opioid Overdose Discharge

“…14 Opioid overdose stays were classified by ICD-10-CM and other administrative codes (Figure 1), including whether patients received inpatient drug detoxification or rehabilitation services (e.g., counseling or pharmacotherapy). 3,15,16 Comorbidities were classified by Elixhauser Comorbidity Software for ICD-10-CM. 17 Patient age, sex, primary payer, and discharge status were reported in the data source.…”

National U.S. time-trends in opioid use disorder hospitalizations and associated healthcare utilization and mortality

“…In addition to examining opioid use disorder (OUD)-related mortality, hospitalizations associated with OUD can help us better understand the opioid epidemic. A recent study of U. S. national inpatient sample (NIS) documented that nearly half a million hospitalizations yearly included a diagnosis of OUD (in any position, primary or secondary) [7]. Regional and demographic differences exist in prescription opioid and heroin-related overdose hospitalizations [8].…”