State variation in opioid treatment policies and opioid-related hospital readmissions

Blanchard, Janice; Weiss, Audrey J.; Barrett, Marguerite L.; McDermott, Kimberly W.; Heslin, Kevin C.

doi:10.1186/s12913-018-3703-8

BMC Health Services Research

Table 1 Characteristics of opioid-related index hospitalizations by state policy category

From: State variation in opioid treatment policies and opioid-related hospital readmissions

Characteristic	Naloxone Standing Orders		Good Samaritan Laws		Methadone Coverage by Medicaid		MAT Coverage Generosity by Medicaid^a
Characteristic	Yes	No	Yes	No	Yes	No	More Generous	Less Generous
Number of stays	145,262	238,072	307,369	75,965	353,335	29,999	237,221	146,113
Patient Sociodemographic Characteristics
Age (mean)	47.7**	46.3	47.0**	46.0	46.9**	45.8	45.0**	49.7
Female (%)	48.1**	49.4	47.7**	53.7	48.2**	57.4	46.5**	52.8
Race/ethnicity (%)
White	68.6 **	70.1	68.6**	73.2	68.2**	85.5	67.9**	72.2
Black	12.4**	14.2	12.8**	16.5	14.2**	5.9	15.3**	10.7
Hispanic	13.0**	9.3	12.7**	2.7	11.4 **	2.4	10.0**	12.0
Other	5.5**	4.1	5.3**	1.9	4.9**	0.6	5.3**	3.5
Missing	0.5**	2.3	0.6**	5.7	1.3**	5.5	1.6	1.6
Expected primary payer (%)
Medicare	31.5**	30.1	30.5**	31.4	30.2**	36.1	27.0**	36.5
Medicaid	42.4**	34.7	38.9**	32.5	38.6**	26.1	42.3**	30.0
Private insurance	18.0**	17.5	17.7*	17.4	17.5**	17.5	16.6**	19.3
Uninsured/self-pay	5.1**	13.2	8.8**	15.5	9.7**	14.7	10.9**	8.8
Other	3.0**	4.4	4.1**	2.8	4.0**	2.0	3.1**	5.1
Median community-level income (%)
Quartile 1 (lowest)	31.7**	34.9	32.4**	38.9	34.0**	29.9	35.9**	30.1
Quartile 2	24.6**	23.8	23.9**	25.0	23.7**	28.8	22.6**	26.5
Quartile 3	21.1*	20.8	21.1**	20.2	20.6**	24.2	19.9**	22.5
Quartile 4 (highest)	17.6**	16.4	17.5**	14.3	16.9**	15.7	16.5**	17.4
Missing	5.0**	4.1	5.2**	1.6	4.7**	1.4	5.1**	3.4
Patient location (%)
Urban	89.7**	90.7	92.4**	82.0	92.0**	70.9	93.1**	85.8
Rural	8.9**	8.2	6.2**	17.7	6.7**	28.9	5.9**	12.6
Patient Clinical Factors
Opioid-related diagnosis (%)
Principal	13.3**	13.8	13.7*	13.4	13.3**	17.0	14.4**	12.2
Secondary only	86.7**	86.2	86.3*	86.6	86.7**	83.0	85.6**	87.8
Any opioid abuse or dependence (%)	83.0	82.9	83.6**	80.0	83.4**	77.4	85.4**	78.8
Continuous opioid abuse or dependence (%)	29.9*	29.6	30.8**	25.2	30.4**	21.4	32.6**	24.9
Mental health co-occurring diagnosis (%)	54.1**	55.7	54.2**	58.9	54.6**	61.3	55.7**	54.2
Alcohol abuse co-occurring diagnosis (%)	19.5	19.5	19.7**	18.6	19.9**	14.5	21.3**	16.5
Number of co-occurring physical conditions (mean)^b	2.1**	2.0	2.0**	2.1	2.0**	1.9	1.8**	2.3
Initial Hospital Stay Characteristics
Hospital stay began in ED (mean %)	75.0**	76.7	77.4**	70.9	77.2 **	63.5	76.4**	75.5
Length of index stay (mean days)	5.3**	5.1	5.3**	4.6	5.2**	4.5	5.2**	5.1
Receipt of rehabilitation during index stay (%)	16.9**	16.1	16.9**	14.7	16.5	16.3	21.2**	8.8
Hospital Characteristics^c
Percentage of annual opioid-related discharges in index year (mean)	3.9	3.9	3.9	3.9	3.9**	3.2	4.7**	2.5
Alcohol/substance use disorder (SUD) detoxification unit (%)
No	56.8**	59.3	57.5**	61.8	58.0**	62.1	53.0**	67.0
Yes	26.7 **	24.3	25.9**	22.3	25.7**	19.4	32.8**	12.8
Not reported	16.6	16.4	16.6**	15.9	16.3**	18.5	14.2**	20.1
Psychiatric acute care unit (%)
No	35.9**	30.9	32.9*	32.5*	32.7**	34.7	25.7**	44.4
Yes	47.5**	52.8	50.6**	51.6	51.1**	46.8	60.1**	35.7
Not reported	16.6*	16.3	16.5**	15.9	16.2**	18.5	14.2**	19.9
State Factors
Medicaid coverage of ASAM recommended treatment services (mean)	87.1**	58.7	72.0**	59.1	69.2**	72.6	65.0**	76.6
Newly certified provider capacity for buprenorphine/naloxone per 100,000 state population during year of index stay (mean)	86.2**	76.4	79.9**	80.9	78.8**	96.1	95.6**	55.0
Number of opioid treatment programs per 100,000 state population during year of index stay (mean)	0.6*	0.6	0.6**	0.5	0.6**	0.1	0.7**	0.3
SUD treatment capacity per 100,000 state population during year of index stay (mean)	43.4**	42.2	45.2**	32.4	43.7**	30.5	48.6**	33.0
Opioid overdose death rate during year of index stay (mean)	9.1**	9.3	8.7**	11.4	9.1**	11.0	10.7**	6.9

ASAM American Society of Addiction Medicine, MAT medication-assisted treatment, OTP opioid treatment program, SUD substance use disorder
*p < 0.05; **p < 0.001
^aThis is a composite variable of preauthorization requirements for buprenorphine/naloxone, preauthorization for naltrexone, dosing limits for buprenorphine/naltrexone, and SUD counseling requirements
^bCo-occurring conditions were formulated from 25 Elixhauser comorbidities (excluding mental health and SUD variables, which are reported as separate variables)
^cHospital characteristics describe the hospital at which the index visit occurred

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ISSN: 1472-6963

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