Assessing Outcomes with Utilization of LADC Consults for Patients Hospitalized with SUD

Introduction
Substance use disorders (SUDs) are characterized as “maladaptive patterns of substance use leading to clinically severe impairment or distress” potentially affecting physical or psychological functioning; personal safety; social relations, roles, and obligations; work; and other areas1. Unfortunately, patients with substance use disorders and substance use have been well documented to have significant morbidity and mortality & elevated risk for hospital readmissions2. With this realization, coupled with the recent effects of the COVID-19 pandemic, came an increase in use of telemedicine services. The purpose of this study was to assess patient outcomes with the institution of a telemedicine-delivered consult service.

Methods
An SUD Optimization project was initiated at an academic tertiary referral hospital. It was designed to have patients hospitalized with substance use disorder undergo consultation with Case Managers/Social Workers who would then arrange virtual or face-to-face chemical dependency assessments by Licensed Alcohol and Drug Counselors (LADCs) prior to the patient being discharged. Assessments were done using either Standard Assessments for insured patients or Rule 25 - a Minnesota based program that provides public funding for chemical dependency treatment - Assessments for those with no insurance or state insurance. Flyers were emailed to providers in the Hospital Internal Medicine Division (HIM) outlining the process to have patients enrolled. Patients were enrolled from May 1, 2020 until September 30, 2020.
Results
A total number of 117 patients were referred for LADC consultation. A total of 76 patients completed the consultation and underwent either Standard or Rule 25 assessment. At completion of the enrollment period, retrospective chart review was performed. Preliminary data shows that the 30 day hospital readmission rate for patients that completed the inpatient LADC consultation was found to be 19.39%. This is in comparison to the 30 day readmission rate of 25.8% for patients admitted to HIM in 2019.
Conclusion
The psychiatric population can be particularly challenging when considering increased risk for readmission within 30 days. Measures should be taken to ensure that readmission rates decrease to promote better patient outcomes as well as cost-savings. Although many variables may contribute to the risk for 30-day readmission rates including medication noncompliance, lack of proper follow-up, as well as seasonal trends, the postal appointment reminder letters may further decrease 30-day readmission rates. A SUD Optimization project was designed to address many of these variables. By increasing access to LADC for chemical dependency assessments, we were able to decrease 30 day hospital readmission rates from 25.8% to 19.39%. This demonstrates the importance and utilization of care processes centered on this special population. For future work, continued evaluation of this intervention on readmission rates, but also on relapse rates, subsequent Emergency Department visits, successful completion of a chemical dependency program, and several other factors should be done. Hopefully this will lead to the widespread use of this intervention, or a similar process, in addition to other care management strategies as a means to further address barriers that may exist to not only improve patient outcomes, but also to further reduce readmission rates.

References: 1. Laudet AB. The case for considering quality of life in addiction research and clinical practice. Addict Sci Clin Pract. 2011;6(1):44-55.
2. Larson SA, Caroline Burton M, Kashiwagi DT, Hugo ZP, Cha SS, Lapid MI, Alcohol Withdrawal Admissions. J. Hosp. Med 2012;8;617-621. doi:10.1002/jhm.1953
3. Bose J, Hedden SL, Lipari RN, et al. Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Available online at: https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report. Accessed on September 16, 2020.