Exploring factors that contribute to successful patient well-being and/or recovery from Substance Use Disorders Gautam Nayyar, MS21; Laura Harrison, MPH2; Linda DeMasi, MBA2 ; Kate O’Neill, RN2; Dana Cortapasso, RN2; Jay Enden, MD, MS1; 1,2 1,2 1,4 1,2 Jon Morgenstern, PhD ; Nancy Kwon, MD, MPA ; John D’Angelo, MD ; Sandeep Kapoor, MD, MS-HPPL 1Zucker
School of Medicine at Hofstra/Northwell; 2Emergency Medicine, Northwell Health; 3Center on Addiction; 4Addiction Services, Northwell Health
Abstract
Methods
Discussion
• Substance use is a prevalent public health issue in the U.S.
• Retrospective cohort study of 590 ED patients with moderate to high risk substance use, identified by SBIRT and enrolled in Project Connect from April 2018 to April 2020
• Though only statistically significant at 60 and 90 days, the lack of reported substance use among patients in AA/NA and/or outpatient SUD treatment is clinically significant and highlights the importance of providing patients with multiple resources to address their substance use over time
• There is minimal discharge planning and longitudinal support for patients with substance use following an emergency department (ED) visit • To fill this gap, PROJECT CONNECT was developed and is an external care navigation program for patients with substance use and/or a Substance Use Disorder (SUD) • This study uses PROJECT CONNECT data from 6 EDs to analyze the association of supportive factors and longitudinal self-reported substance use status of patients • SUD outpatient treatment and AA/NA are not mutually exclusive resources and are both associated with successful patient recovery • Inconsistent cell phone access presents a challenge in supporting patients with substance use over time
Background • In the U.S., 60% of the population reports use of tobacco, alcohol, or drugs in the past month; 20.3 million Americans had a substance use disorder (SUD) in the past year1 • Discharge planning and care management are minimal for patients reporting substance use, typically consisting of a few contacts months after initial discharge2-4 • Screening, Brief Intervention, and Referral to Treatment (SBIRT) is the framework at Northwell Health for humanizing and addressing substance use as part of usual care in all 18 emergency departments (EDs) • PROJECT CONNECT is a program developed in collaboration with a community-based organization (Central Nassau Guidance and Counselling) to provide external navigation for patients struggling with substance use for 120 days following an ED visit • Objective: To examine factors associated with successful longitudinal outcomes for Project Connect patients to identify actionable, system-level steps to increase the likelihood of successful recovery for patients with an SUD
Hypothesis Individuals engaged with community support or who have family members engaged in their recovery are less likely to report substance use at 60, 90, and 120 days compared to those who are not engaged with community or family support
• Patients from 6 EDs in Nassau and Suffolk Counties, within New York State • Data from baseline and 7/30/60/90/120 days entered into REDCap at point of service by Project Connect team; exported to IBM SPSS Statistics v26 for analysis • Descriptive Statistics used to identify patient and site demographics, as well as outreach results • Odds Ratios and Pearson’s Chi-Square were used to analyze association between engagement in treatment and support, and self-reported substance use at 60, 90, and 120 days
Results Table 3:
Table 1:
Patient Demographics Patient Age Groups (n=590) 18-29 30-49 50-69 70-80+ Missing
126
Southside Hospital Peconic Bay Medical Center LIJ Medical Center Other
248 (42.0%)
166 (42.6%)
17 (2.9%)
33 (5.6%)
220 (37.3%)
235 (39.8%)
34 (5.8%)
92 (15.6%)
9 (1.5%)
Table 2:
Successful Outreach Timepoint Baseline 7 Days 30 Days 60 Days
90 Days 120 Days
Type of Engagement
(21.4%)
Patients per ED (n=590)
Huntington Hospital
Odds of Self-Reported Substance Use Among Patients Engaged vs. Not Engaged in Treatment and/or Supportive Care for Substance Use
# (%) 397 (67.3%)
133 (22.5%)
159 (20.0%)
118 (17.6%)
97 (16.4%)
92 (16.0%)
Outpatient SUD Treatment Program Community Support AA: Alcoholics Anonymous NA: Narcotics Anonymous
Project Connect Staff Contact with Family Member Community Support and/or Outpatient SUD Treatment
• Based on OR > 1 for family contact, family members of patients with substance use may have been more likely to reach out to the Project CONNECT team for support • Project Connect Staff contact with family may not fully represent family involvement in patient’s recovery process • Phone issues were prevalent among the patient population within the 120-day window, emphasizing importance of collecting multiple forms of contact information • High prevalence of “unable to contact” timepoints is a limitation in fully understanding the longitudinal impact of Project Connect support on patients’ substance use
Timepoint
n
P-Value
OR
95% CI
60 day*
79
0.002
-- *
---
90 day
76
0.055
0.14
0.02 – 1.17
120 day
64
1.000
0.74
0.13 – 4.16
Conclusion
60 day*
79
0.017
-- *
---
90 day*
76
0.109
-- *
---
120 day
64
1.000
0.70
0.08 – 6.40
• There are multiple pathways to successful recovery; AA/NA and formal SUD outpatient treatment are not mutually exclusive resources and are both associated with less reported substance use at 60, 90, and 120 days
60 day
79
0.194
2.31
0.71 – 7.52
90 day
78
0.763
1.20
0.36 – 3.98
120 day
66
0.415
1.89
0.40 – 8.91
60 day
79
<0.001
-- *
---
90 day
76
0.004
0.08
0.01 – 0.66
120 day
64
1.000
0.78
0.16 – 3.79
* No OR computed: meaning 0 patients in support/treatment reported substance use
• Odds Ratio (OR) < 1 shows patients engaged with support/treatment are less likely to have active substance use, based on self-report • No patients enrolled in AA/NA at 60 or 90 days reported substance use, and 1 patient (8%) reported substance use at 120 days • For patients enrolled in outpatient SUD treatment, 0 (0%) reported substance use at 60 days, 1 (5%) reported substance use at 90 days, and 2 (9%) reported substance use at 120 days
• No significant association between family contact and reported substance use at 60, 90, or 120-day timepoints • 133 (22.5%) of patients either did not have their own cell phone or had a phone out of service during the 120-day window.
• Inconsistent phone access is likely to limit access to SUD care for patients as both AA/NA and outpatient care have moved to virtual and TeleHealth models due to COVID-19
Future Directions • Merge Medicaid/insurance data with phone data to identify patients eligible for free/subsidized cell phones • Analyze relationship between hospital location, zip code, ED visit data, and longitudinal outcome data References 1. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Rockville, MD; 2018. https://www.samhsa.gov/data/. Accessed January 4, 2019. 2. Penzenstadler L, Machado A, Thorens G, Zullino D, Khazaal Y. Effect of case management interventions for patients with substance use disorders: A systematic review. Front Psychiatry. 2017;8(APR):51. doi:10.3389/fpsyt.2017.00051 3. Dalton M, Crowley KF, Crouch JWJ, Kelly SE. “Check in, check up”: an evaluation of the impact of post-treatment follow-ups on substance users’ recovery. J Subst Use. 2017;22(3):260-264. doi:10.1080/14659891.2016.1182593 4. Kelly P, Deane F, Baker A, et al. Correction to: Study protocol the Continuing Care Project: a randomised controlled trial of a continuing care telephone intervention following residential substance dependence treatment (BMC public health (2020) 20 1 (107)). BMC Public Health. 2020;20(1):258. doi:10.1186/s12889-020-8328-2 5. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010 6. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. doi:10.1016/j.jbi.2019.103208 About Northwell Health The nation’s third-largest non-profit secular healthcare system, Northwell Health delivers world-class clinical care throughout the New York metropolitan area, pioneering research at the Feinstein Institute for Medical Research and a visionary approach to medical education, highlighted by the Hofstra Northwell School of Medicine. The winner of the National Quality Forum’s 2010 National Quality Healthcare Award, Northwell Health cares for people at every stage of life at 21 hospitals, long-term care facilities and 450 ambulatory care centers throughout the region. Northwell Health’s owned hospitals and long-term care facilities house about 6,400 beds, employ more than 10,000 nurses and have affiliations with more than 12,000 physicians. Its workforce of over 61,000 is the largest on Long Island and the third-largest in New York City. For more information, go to www.northwell.edu