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. 2021 Sep 10;16(9):e0256793.
doi: 10.1371/journal.pone.0256793. eCollection 2021.

Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality

Caroline A King  1 , Honora Englander  2 , P Todd Korthuis  2 , Joshua A Barocas  3 , K John McConnell  4 , Cynthia D Morris  5 , Ryan Cook  2
Affiliations

Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality

Caroline A King et al. PLoS One. .

Abstract

Introduction: Addiction consult services (ACS) engage hospitalized patients with opioid use disorder (OUD) in care and help meet their goals for substance use treatment. Little is known about how ACS affect mortality for patients with OUD. The objective of this study was to design and validate a model that estimates the impact of ACS care on 12-month mortality among hospitalized patients with OUD.

Methods: We developed a Markov model of referral to an ACS, post-discharge engagement in SUD care, and 12-month drug-related and non-drug related mortality among hospitalized patients with OUD. We populated our model using Oregon Medicaid data and validated it using international modeling standards.

Results: There were 6,654 patients with OUD hospitalized from April 2015 through December 2017. There were 114 (1.7%) drug-related deaths and 408 (6.1%) non-drug related deaths at 12 months. Bayesian logistic regression models estimated four percent (4%, 95% CI = 2%, 6%) of patients were referred to an ACS. Of those, 47% (95% CI = 37%, 57%) engaged in post-discharge OUD care, versus 20% not referred to an ACS (95% CI = 16%, 24%). The risk of drug-related death at 12 months among patients in post-discharge OUD care was 3% (95% CI = 0%, 7%) versus 6% not in care (95% CI = 2%, 10%). The risk of non-drug related death was 7% (95% CI = 1%, 13%) among patients in post-discharge OUD treatment, versus 9% not in care (95% CI = 5%, 13%). We validated our model by evaluating its predictive, external, internal, face and cross validity.

Discussion: Our novel Markov model reflects trajectories of care and survival for patients hospitalized with OUD. This model can be used to evaluate the impact of other clinical and policy changes to improve patient survival.

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Conflict of interest statement

Dr. Korthuis serves as principal investigator for NIH-funded studies that accept donated study medication from Alkermes (extended-release naltrexone) and Indivior (buprenorphine). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Markov model of hospital-based addiction care in Oregon, 2015–2018.
Fig 2
Fig 2. Markov model with estimated transition probabilities for hospital-based addiction care in Oregon, 2015–2018.
See this image and copyright information in PMC

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