Hospitalized patients with substance use disorder benefit from navigation services

1. Patients who received navigation services had significantly fewer inpatient readmissions and emergency department visits compared to those who received standard care.

2. Those who received navigation services were faster to enter treatment for substance use disorder compared to those who received standard care.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Repeated use of acute care and other hospital services contributes heavily to health care costs and is often indicative of suboptimal care. Navigation services aim to help patients traverse the complex landscape of healthcare by offering individualized support and coordinating care across multiple systems. As such, this study investigated whether patient navigation services reduce hospital readmissions.  While mortality was consistent between these groups at 12 months, both inpatient readmissions and emergency department visits were significantly less frequent in the group that was enrolled in the navigation services. Furthermore, patients in the navigation service group were significantly faster to enter treatment for substance use disorders (SUD) and medication treatment for opioid use disorder (OUD) compared to those in the control group. This study employed a randomized design with fairly broad inclusion criteria but was conducted at a single site and had a relatively small sample size that limited generalizability. Nonetheless, these results contribute to the body of evidence pointing toward patient-centered navigation services as an effective method for improving clinical outcomes and ameliorating the issue of escalating national healthcare costs.

Click here to read the study in Annals of Internal Medicine

Relevant Reading: History and principles of patient navigation

In-Depth [randomized controlled trial]: This parallel-group study was conducted at the University of Maryland Medical Center and involved 400 adult hospital patients. Patients included in the study met current criteria for opioid, cocaine, or alcohol use disorder and had not enrolled in SUD treatment within 30 days before hospitalization. Patients who were pregnant or had a planned discharge to a long-term or terminal inpatient facility were excluded from the study. The primary outcome was hospital inpatient readmission over 12 months. The patients were randomized in a 1:1 ratio to either receive treatment as usual (TAU) or navigation services (NavSTAR), respectively. Patients in the NavSTAR group (15.5%) were roughly half as likely to have an inpatient readmission within 30 days of discharge compared to those receiving TAU (30.0%) (odds ratio, 0.43; 95% CI, 0.26 to 0.70; P < 0.001). At 12 months, the NavSTAR group had 136 fewer inpatient readmission events than those receiving TAU (incidence rate per 1000 person-days at risk: NavSTAR, 6.05; TAU, 8.13); this corresponded to a hazard ratio (HR) of 0.74 (95% CI, 0.58 to 0.96; P = 0.020). Additionally, the NavSTAR group had significantly fewer ED visits than those receiving TAU (HR, 0.66; 95% CI, 0.49 to 0.89; P = 0.006). Lastly, those who received navigation services reported faster entry into SUD treatment than those who received usual care (50.3% vs. 35.3%; HR, 1.43; 95% CI, 1.07 to 1.91; P = 0.014). Overall, navigation services significantly lowered inpatient readmissions and emergency department visits compared to standard care treatment in patients with substance use disorders.

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