(168) Impact of Resource Linkage on Rehospitalization in People With Substance Use Disorders

Background & Introduction: Peer recovery coaches (PRCs) are increasingly deployed in the acute-care (emergency department and medical hospital inpatient) setting, and are often responsible for assessing patients’ needs and linking them to appropriate resources (1). The resources offered vary from patient-to-patient and may include recommendations for medical treatment, harm reduction, mutual support and recovery groups, sober living, and placement in detoxification and residential treatment centers (2,3). Program evaluations frequently focus on rehospitalization as a metric of success, however there is limited literature analyzing how the type of linkage(s) provided by PRCs, or the timing of their consultation during patients’ hospitalization, might affect this outcome. We sought to evaluate the effect that the timeliness of consultation, as well as different resources linked, have on subsequent hospital utilization to better inform our deployment of PRCs in acute-care settings.

Methods: This is a single-center, retrospective cohort study of adults aged 18 and over with SUD-related concerns who were first seen by PRCs during an acute care visit between 6/1/2023 and 6/30/2024. We reviewed charts to determine linkages provided and rates of rehospitalization. We conducted negative binomial regression analyses to assess the effect of referral type on rehospitalization within one year.

Results: Three hundred and twenty-four unique patients were included, with a total of 469 hospital encounters. The median age was 46 years (IQR: 36-58.5), and 70% of patients were male. Among all patients, the average number of rehospitalizations within one year was 0.45 (95% CI: 0.35 – 0.55). Of patients that received resources beyond PRC contact information, patients were most commonly linked to residential treatment (N=74, 15.8% of patients) or given a list of community resources (N=52, 11.1%). Fewer patients were referred to crisis centers (N=20, 4.3%), sober living (N=12, 2.6%), or detoxification centers (N=16, 3.4%). We observed fewer rehospitalizations among patients linked to crisis centers (Rate Ratio [RR]: 0.23, 95% CI: 0.06-0.95, p=0.04) and those provided a list of community resources (RR: 0.33, 95% CI: 0.15-0.71, p=0.005), but did not observe a change in rehospitalizations among patients linked to residential treatment (RR: 0.76, 95% CI: 0.47-1.21, p=0.25), sober living (RR: 1.13, 95% CI 0.49-2.56, p=0.78), or detoxification centers (RR: 0.70, 95% CI: 0.17-2.85, p=0.62).

Conclusion & Discussion: We observed no change in rehospitalization among patients placed in residential treatment, possibly reflecting higher acuity among this group. Another explanation may be insufficient aftercare for patients discharged from those programs. Patients without an established treatment plan may be more likely to return to the ED for additional linkages to care. PRC referrals may mitigate rehospitalization when patients are linked to crisis centers and community resources. Given the high time burden of residential treatment linkage compared to other referrals, further study is needed to identify optimal resource utilization by hospital-based PRCs.

References: [1] Stack, Erin, Christi Hildebran, Gillian Leichtling, Elizabeth Needham Waddell, Judith M. Leahy, Eric Martin, and Phillip Todd Korthuis. 2021. “Peer Recovery Support Services Across the Continuum: In Community, Hospital, Corrections, and Treatment and Recovery Agency Settings – a Narrative Review.” Journal of Addiction Medicine 16 (1): 93–100. https://doi.org/10.1097/adm.0000000000000810. [2] Bassuk, Ellen L., Justine Hanson, R. Neil Greene, Molly Richard, and Alexandre Laudet. 2016. “Peer-Delivered Recovery Support Services for Addictions in the United States: A Systematic Review.” Journal of Substance Abuse Treatment 63 (January): 1–9. https://doi.org/10.1016/j.jsat.2016.01.003. [3] Tracy, Kathlene, and Samantha Wallace. 2016. “Benefits of Peer Support Groups in the Treatment of Addiction.” Substance Abuse and Rehabilitation Volume 7 (September): 143–54. https://doi.org/10.2147/sar.s81535.