(26) Health Care Utilization Outcomes of a Comprehensive Program for Perinatal Substance Use

Introduction: The prevalence of opioid use disorder (OUD) in the perinatal population directly reflects the pervasive nature of the U.S. opioid epidemic. Between 1999 and 2014, the rate of OUD documented at hospital deliveries across 28 states more than quadrupled (1). Barriers to optimal care in this population contribute to adverse maternal and neonatal outcomes (2). A low-threshold comprehensive shared medical appointment (SMA) program for pregnant and postpartum women with substance use that combined medications for opioid use disorder (MOUD), behavioral health, care coordination, wraparound services to address unmet social determinants of health, and group-based counseling resulted in high retention rates, increased medication prescribing, and high rates of opioid-negative urine toxicology (3). The purpose of this study was to assess healthcare utilization before and after enrolling in our SMA program.

Methods: We conducted a retrospective cohort study between 11/1/16 and 3/31/20 that compared emergency department (ED) visits, hospital admissions, and hospital length of stay (LOS) 6 months before and after participants’ SMA program enrollment date. Healthcare utilization was further categorized as related to substance use or not. Data was obtained from our institution’s electronic medical record and from regional health systems using the Camden Coalition Health Information Exchange. The Wilcoxon Signed Rank Test was used to compare healthcare utilization pre- and post-program enrollment. Multivariable logistic regression models were used to evaluate demographic, clinical, and substance use-related factors associated with a decrease in healthcare utilization after program enrollment.

Results: Of the 99 women included, 69% identified as non-Hispanic white, 85% were insured by Medicaid, and 87% had OUD. We found that median hospital admissions [Pre - 0 (0 - 1) vs. Post - 0 (0 - 0), p=0.02)] significantly decreased in the 6 months after program enrollment. Percent of hospital admissions related to substance use [Pre - 100 (37.5 - 100) vs. Post - 58.3 (0 - 100), p=0.17] did not reach statistical significance. We did not find any statistically significant differences in median ED visits [Pre - 1 (0 - 2) vs. Post - 1 (0 - 2), p=0.88], percent of ED visits related to substance use [Pre - 8.5 (0 - 50) vs. Post - 0 (0 - 37.3), p=0.25], or median hospital LOS [Pre - 2 (2 - 6.1) vs. Post - 2 (1.4 - 3.1), p=0.45). Women enrolled after initiation of wraparound services had greater odds of having a decrease in ED visits post-enrollment (OR 4.14, 95% CI 1.23-13.98).

Conclusion: A low-threshold comprehensive SMA model for underserved pregnant and postpartum women that combined MOUD, group-based counseling, and recovery supports led to significant reductions in overall hospital admissions in the 6 months after program enrollment. Comprehensive programs for perinatal substance use may reduce the use of costly health care services.

References: 1. Haight SC, Ko JY, Tong VT, et al. Opioid use disorder documented at delivery hospitalization – United States, 1999-2014. MMWR Morb Mortal Wkly Rep. 2018;67(31):845–849.
2. Ecker J, Abuhamad A, Hill W, et al. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. Am J Obstet and Gynecol. 2019;221(1):B5–B28.
3. Ganetsky VS, Heil J, Yates B, et al. A low-threshold comprehensive shared medical appointment program for perinatal substance use in an underserved population. Journal of Addiction Medicine. 2021 Sep 10. doi: 10.1097/ADM.0000000000000912. Online ahead of print.