IMPACT Study Could Make Financial Sense for Hospitals

There is significant financial incentive for hospitals to implement an Improving Addiction Care Team, or Project IMPACT, according to a new study. The program unites physicians, social workers, peer recovery mentors, and community addiction providers to address addiction patients when they are admitted to the hospital.

Because addiction is often the root cause of serious medical and surgery problems, Honora Englander, MD, and researchers from Oregon Health & Science University decided to perform a needs assessment in 2015. Afterward, they assembled a team of academic and community partners, including a hospital, community substance use disorders organizations, and Medicaid accountable care organizations. With that team, they designed a care model for medically complex hospitalized patients suffering from substance use disorders.

The researchers learned that between 58% and 67% of substance use disorder patients were interested in either cutting back or quitting. There was additional interest in medication for addiction treatment, the study authors learned. Englander explained in a YouTube video that although people don’t come to the hospital for substance use treatment, they often find the reality of facing death jarring and cutting back or abstaining from substances can become a wake-up call.

“Our findings highlight that hospitalization can be a reachable moment to initiate care for addiction, and show a path forward, both in terms of defining a care model and a business case to sustain it,” Englander told MD Magazine® in an email. “Models such as ours are critical to addressing the opioid epidemic.”

The study participants had high rates of costly readmissions, the study authors wrote, on top of longer than expected lengths of stay. The researchers found that some of the key barriers to caring for these patients included long wait times and lack of resources for these medically complex patients, according to community stakeholders.

Project IMPACT was created by the researchers to bring together an inpatient medicine consultation service, rapid access pathways to substance use disorder treatment after hospital discharge, and a medically enhanced residential care model (which includes antibiotic infusion and residential addiction care). Furthermore, the researchers were able to design a business case and secure funding for this program from Medicaid and hospital payers. They believe that the project allows one pathway for hospitals, payers, and communities to collaboratively address the substance use disorder epidemic.

The researchers believe that their model addresses a widespread need, and could be adapted to other hospitals, substance use disorder treatment organizations, and Medicaid payers. The team’s next step will be to measure clinical and cost outcomes achieved through use of the program.

“Addressing addiction in the hospital setting allows us to reach patients who wouldn’t otherwise access care,” Englander concluded in a press release. “And it is one of those key opportunities where doing the right thing can lead to better quality and cost savings.”

The study, titled “Planning and designing the Improving Addiction Care Team (IMPACT) for hospitalized adults with substance use disorder,” was published in the Journal of Hospital Medicine.

The press release was called “New study outlines financial incentive for in-hospital opioid intervention program.”

There is also a YouTube video called Project IMPACT at OHSU where the researchers further discuss the program’s focus.

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