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. 2023 Mar 3;4(3):e230245.
doi: 10.1001/jamahealthforum.2023.0245.

Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge

Keisha T Solomon  1 , Jason O'Connor  2 , Jason B Gibbons  3 , Austin S Kilaru  4 , Kenneth A Feder  5 , Lingshu Xue  2 , Brendan Saloner  3 , Elizabeth A Stuart  3 , Evan S Cole  2 , Eric Hulsey  6 , Zachary Meisel  4 , Esita Patel  7 , Julie M Donohue  2
Affiliations

Association Between Hospital Adoption of an Emergency Department Treatment Pathway for Opioid Use Disorder and Patient Initiation of Buprenorphine After Discharge

Keisha T Solomon et al. JAMA Health Forum. .

Abstract

Importance: Emergency department (ED)-based initiation of buprenorphine has been shown to increase engagement in outpatient treatment and reduce the risk of subsequent opioid overdose; however, rates of buprenorphine treatment in the ED and follow-up care for opioid use disorder (OUD) remain low in the US. The Opioid Hospital Quality Improvement Program (O-HQIP), a statewide financial incentive program designed to increase engagement in OUD treatment for Medicaid-enrolled patients who have ED encounters, has the potential to increase ED-initiated buprenorphine treatment.

Objective: To evaluate the association between hospitals attesting to an ED buprenorphine treatment O-HQIP pathway and patients' subsequent initiation of buprenorphine treatment.

Design, setting, and participants: This cohort study included Pennsylvania patients aged 18 to 64 years with continuous Medicaid enrollment 6 months before their OUD ED encounter and at least 30 days after discharge between January 1, 2016, and December 31, 2020. Patients with a claim for medication for OUD 6 months before their index encounter were excluded.

Exposures: Hospital implementation of an ED buprenorphine treatment O-HQIP pathway.

Main outcomes and measures: The main outcome was patients' receipt of buprenorphine within 30 days of their index OUD ED visit. Between August 2021 and January 2023, data were analyzed using a difference-in-differences method to evaluate the association between hospitals' O-HQIP attestation status and patients' treatment with buprenorphine after ED discharge.

Results: The analysis included 17 428 Medicaid-enrolled patients (female, 43.4%; male, 56.6%; mean [SD] age, 37.4 [10.8] years; Black, 17.5%; Hispanic, 7.9%; White, 71.6%; other race or ethnicity, 3.0%) with OUD seen at O-HQIP-attesting or non-O-HQIP-attesting hospital EDs. The rate of prescription fills for buprenorphine within 30 days of an OUD ED discharge in the O-HQIP attestation hospitals before the O-HQIP intervention was 5%. The O-HQIP attestation was associated with a statistically significant increase (2.6 percentage points) in prescription fills for buprenorphine within 30 days of an OUD ED discharge (β, 0.026; 95% CI, 0.005-0.047).

Conclusions and relevance: In this cohort study, the O-HQIP was associated with an increased initiation of buprenorphine in patients with OUD presenting to the ED. These findings suggest that statewide incentive programs may effectively improve outcomes for patients with OUD.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cole reported receiving funding/support from a Pennsylvania Department of Human Services intergovernmental agreement during the conduct of the study and consulting fees from AcademyHealth outside the submitted work. Dr Donohue reported receiving funding/support from a Pennsylvania Department of Human Services contract during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Selection of the Study Population
Selection criteria were applied to Pennsylvania Medicaid enrollees who visited an emergency department (ED) for an opioid-related cause between January 1, 2017, and December 31, 2020. MOUD indicates medication for opioid use disorder; O-HQIP, Opioid Hospital Quality Improvement Program; and OUD, opioid use disorder.
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