Evaluation of an Opioid Use Disorder Consult Service on Success of Non-Home Discharge Recommendations

Background: Patients with opioid use disorder (OUD) are frequently hospitalized and often need post-acute care, but face high rates of rejection from post-acute and long-term care (PALTC) facilities. This study aimed to assess the impact of an OUD consult service on referral success. Methods: Between 2021 and 2022, 381 hospitalized patients with OUD at a Midwestern academic medical center who were recommended for post-acute care were identified. The primary outcome was referral success (patient’s discharge location matching the recommended form of post-acute care). Secondary outcomes included length of stay (LOS), medication for OUD (MOUD) initiation, and naloxone prescription on discharge. Regression analyses were conducted to compare patients who received an OUD consult (n = 207) and those who did not (n = 174). Results: Rates of referral success for the consult and non-consult groups were 49.3% and 55.2%, respectively. When controlled for active OUD, insurance, housing, and prior-to-admission MOUD, receiving a consult did not predict referral success ( P = .44). Admission to the hospital from a PALTC facility was a positive predictor of referral success ( P < .001). Negative predictors included having active OUD ( P < .001), being uninsured ( P = .001), or having Medicaid ( P = .008) or Medicare ( P = .006). LOS was similar between groups ( P = .18). Patients in the consult group were more likely to have started MOUD during admission (adjusted odds ratio [aOR] = 2.20, P < .001) and to discharge with naloxone (aOR = 1.48, P < .001). Conclusions: Receipt of an OUD consult did not improve rates of referral success, though this may be due to the non-random nature of the consult population. The low overall referral success rate highlights the need for a multifaceted approach to improve referral success.