Hospitalized patients with substance use disorder (SUD) are at high risk for hospital readmission and emergency department use. Addiction consult services have emerged to improve inpatient management of SUD-related care and increase linkage to SUD treatment upon discharge. However, engagement of hospitalized individuals can be challenging and length of stay may be short. This single-site randomized controlled trial tested whether adding a patient navigator who engaged individuals during hospitalization and followed them for up to 90 days reduced readmissions and improved SUD treatment rates compared with treatment as usual that included an addiction consult service.
- Compared with treatment as usual, navigation reduced 12-month inpatient admission rates from 8 to 6 per 1000 person-days and emergency department visits from 28 to 18 per 1000 person-days.
- Community SUD treatment initiation within 3 months was higher among patients receiving navigation (50%), compared with treatment as usual (35%).
- Navigation was provided by masters-level social workers with an average caseload of 13 patients per week.
Comments: Hospitalization is often a missed—if challenging—opportunity to engage and link individuals with SUD to community treatment. This randomized controlled trial demonstrated that patient navigators improved SUD treatment engagement and reduced care utilization. Further work is needed to understand the reproducibility, scalability, and sustainability of this intervention.
Marc R. Larochelle, MD, MPH
Reference: Gryczynski J, Nordeck CD, Welsh C, et al. Preventing hospital readmission for patients with comorbid substance use disorder: a randomized trial. Ann Intern Med. 2021;174(7):899–909.