A personalized patient navigation service reduced readmissions among medical and surgical patients with comorbid substance use disorder, according to a recent randomized trial.
The trial included 400 inpatients with substance use disorder (opioids, cocaine, or alcohol) who were seen by the addiction consult service at an urban academic hospital. Half got usual care, and half were randomized to an intervention called Navigation Services to Avoid Rehospitalization (NavSTAR). NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address substance use disorder, medical, and basic needs for three months after discharge. Results were published by Annals of Internal Medicine on April 6.
Overall, there was high use of acute care by the study population: 69% had an inpatient readmission, and 79% visited the ED during the 12-month observation period. However, rates of these events were lower in patients who received NavSTAR rather than usual care. Readmissions were 6.05 versus 8.13 per 1,000 person-days (hazard ratio [HR], 0.74; 95% CI, 0.58 to 0.96; P=0.020) and ED visits were 17.66 versus 27.85 per 1,000 person-days (HR, 0.66; 95% CI, 0.49 to 0.89; P=0.006). The NavSTAR group also showed better outcomes on 30-day readmissions (15.5% vs. 30.0%; P<0.001) and entry into community substance use treatment within three months of discharge (50.3% vs. 35.3%).
The observed benefits of the program are “important because this is a clinically complex population characterized by significant levels of illness and recurrent use of hospital services,” the study authors said. It's significant that the intervention and usual care groups did not differ on most substance use measures, suggesting that this multifactorial intervention can provide stabilizing benefits even if it doesn't lead to complete cessation of substance use, they noted. “An important aspect of the study is that services were layered atop those of an experienced hospital addiction consultation service,” they said. “Providers, administrators, and payers should consider these findings in configuring services for patients with comorbid [substance use disorder].”