Planning and Designing the Improving Addiction Care Team (IMPACT) for Hospitalized Adults with Substance Use Disorder

TLDR

People with substance use disorders experience high hospitalization and readmission rates, prolonged stays, and escalating costs, yet effective care models remain scarce. The study aimed to design a care model for medically complex hospitalized patients with substance use disorder through a needs assessment and stakeholder collaboration. The authors developed the Improving Addiction Care Team (IMPACT), comprising an inpatient addiction medicine consult, rapid‑access post‑hospital SUD treatment pathways, and a medically enhanced residential care model, and secured Medicaid and hospital payer funding. The needs assessment revealed that most participants wanted to reduce or quit substance use, many sought medication for addiction treatment, and they faced high readmission rates and long stays, while stakeholders cited wait times and resource gaps; IMPACT offers a collaborative pathway to address these challenges. Journal of Hospital Medicine 2017;12:339‑342.

Abstract

People with substance use disorders (SUD) have high rates of hospitalization and readmission, long lengths of stay, and skyrocketing healthcare costs. Yet, models for improving care are extremely limited. We performed a needs assessment and then convened academic and community partners, including a hospital, community SUD organizations, and Medicaid accountable care organizations, to design a care model for medically complex hospitalized patients with SUD. Needs assessment showed that 58% to 67% of participants who reported active substance use said they were interested in cutting back or quitting. Many reported interest in medication for addiction treatment (MAT). Participants had high rates of costly readmissions and longer than expected length of stay. Community stakeholders identified long wait times and lack of resources for medically complex patients as key barriers. We developed the Improving Addiction Care Team (IMPACT), which includes an inpatient addiction medicine consultation service, rapid-access pathways to posthospital SUD treatment, and a medically enhanced residential care model that integrates antibiotic infusion and residential addiction care. We developed a business case and secured funding from Medicaid and hospital payers. IMPACT provides one pathway for hospitals, payers, and communities to collaboratively address the SUD epidemic. Journal of Hospital Medicine 2017;12:339-342.