Clinical question: Do inpatient addiction-medicine consultation services (AMCS) affect patient mortality and medical utilization post-discharge?
Background: AMCS are increasingly common in inpatient medical settings, but there is limited research on their impact on patient outcomes.
Study design: Propensity-score-matched case-control study
Setting: Large urban academic hospital with a large suburban and rural catchment area across Western Pennsylvania
Synopsis: Each patient with an addiction-medicine consult was paired with a control patient with a similar propensity score. The main outcome was readmission rates, emergency department visits, and mortality within 90 days.
Patients referred to AMCS had reduced 90-day mortality by 2.35%; sub-analysis showed a decrease of 4.08% with exclusively an alcohol use disorder (AUD) and 3.21% with exclusively an opioid use disorder (OUD). The authors identified the potential role of OUD medications as the likely cause of decreased post-discharge mortality; however, the mechanism by which mortality was decreased for AUD is unclear. There was a significant reduction in the seven-day readmission rate, but no reduction in readmissions at 30 days. Patients with polysubstance use disorder saw the least impact from AMCS.
Interestingly, there was an increase in emergency-department visits of 5.32%. The authors postulated that patients who previously avoided care due to poor experiences and stigma were now more open to seeking care due to positive interactions with the AMCS.
Bottom line: AMCS significantly reduced mortality at 90 days and short-term seven-day readmissions with the greatest impact on patients with only AUD or OUD.
Citation: Wilson J, et al. Inpatient addiction medicine consultation service impact on post-discharge patient mortality: a propensity-matched analysis. J Gen Intern Med. 2022 Jan 25. doi: 10.1007/s11606-021-07362-8.
Dr. Munoa is a hospitalist at Denver Health, Denver, and an assistant professor in the division of internal medicine, at the University of Colorado School of Medicine.