Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.

Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.

<h4>Introduction</h4>Addiction consult services (ACS) engage hospitalized patients with opioid use disorder (OUD) in care and help meet their goals for substance use treatment. Little is known about how ACS affect mortality for patients with OUD. The objective of this study was to design...

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Autores principales: Caroline A King, Honora Englander, P Todd Korthuis, Joshua A Barocas, K John McConnell, Cynthia D Morris, Ryan Cook
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2021
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Acceso en línea:https://doaj.org/article/8bb92735eef24e0ebee815b169883242
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spelling oai:doaj.org-article:8bb92735eef24e0ebee815b1698832422021-12-02T20:14:44ZDesigning and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.1932-620310.1371/journal.pone.0256793https://doaj.org/article/8bb92735eef24e0ebee815b1698832422021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256793https://doaj.org/toc/1932-6203<h4>Introduction</h4>Addiction consult services (ACS) engage hospitalized patients with opioid use disorder (OUD) in care and help meet their goals for substance use treatment. Little is known about how ACS affect mortality for patients with OUD. The objective of this study was to design and validate a model that estimates the impact of ACS care on 12-month mortality among hospitalized patients with OUD.<h4>Methods</h4>We developed a Markov model of referral to an ACS, post-discharge engagement in SUD care, and 12-month drug-related and non-drug related mortality among hospitalized patients with OUD. We populated our model using Oregon Medicaid data and validated it using international modeling standards.<h4>Results</h4>There were 6,654 patients with OUD hospitalized from April 2015 through December 2017. There were 114 (1.7%) drug-related deaths and 408 (6.1%) non-drug related deaths at 12 months. Bayesian logistic regression models estimated four percent (4%, 95% CI = 2%, 6%) of patients were referred to an ACS. Of those, 47% (95% CI = 37%, 57%) engaged in post-discharge OUD care, versus 20% not referred to an ACS (95% CI = 16%, 24%). The risk of drug-related death at 12 months among patients in post-discharge OUD care was 3% (95% CI = 0%, 7%) versus 6% not in care (95% CI = 2%, 10%). The risk of non-drug related death was 7% (95% CI = 1%, 13%) among patients in post-discharge OUD treatment, versus 9% not in care (95% CI = 5%, 13%). We validated our model by evaluating its predictive, external, internal, face and cross validity.<h4>Discussion</h4>Our novel Markov model reflects trajectories of care and survival for patients hospitalized with OUD. This model can be used to evaluate the impact of other clinical and policy changes to improve patient survival.Caroline A KingHonora EnglanderP Todd KorthuisJoshua A BarocasK John McConnellCynthia D MorrisRyan CookPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0256793 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Caroline A King
Honora Englander
P Todd Korthuis
Joshua A Barocas
K John McConnell
Cynthia D Morris
Ryan Cook
Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.
description <h4>Introduction</h4>Addiction consult services (ACS) engage hospitalized patients with opioid use disorder (OUD) in care and help meet their goals for substance use treatment. Little is known about how ACS affect mortality for patients with OUD. The objective of this study was to design and validate a model that estimates the impact of ACS care on 12-month mortality among hospitalized patients with OUD.<h4>Methods</h4>We developed a Markov model of referral to an ACS, post-discharge engagement in SUD care, and 12-month drug-related and non-drug related mortality among hospitalized patients with OUD. We populated our model using Oregon Medicaid data and validated it using international modeling standards.<h4>Results</h4>There were 6,654 patients with OUD hospitalized from April 2015 through December 2017. There were 114 (1.7%) drug-related deaths and 408 (6.1%) non-drug related deaths at 12 months. Bayesian logistic regression models estimated four percent (4%, 95% CI = 2%, 6%) of patients were referred to an ACS. Of those, 47% (95% CI = 37%, 57%) engaged in post-discharge OUD care, versus 20% not referred to an ACS (95% CI = 16%, 24%). The risk of drug-related death at 12 months among patients in post-discharge OUD care was 3% (95% CI = 0%, 7%) versus 6% not in care (95% CI = 2%, 10%). The risk of non-drug related death was 7% (95% CI = 1%, 13%) among patients in post-discharge OUD treatment, versus 9% not in care (95% CI = 5%, 13%). We validated our model by evaluating its predictive, external, internal, face and cross validity.<h4>Discussion</h4>Our novel Markov model reflects trajectories of care and survival for patients hospitalized with OUD. This model can be used to evaluate the impact of other clinical and policy changes to improve patient survival.
format article
author Caroline A King
Honora Englander
P Todd Korthuis
Joshua A Barocas
K John McConnell
Cynthia D Morris
Ryan Cook
author_facet Caroline A King
Honora Englander
P Todd Korthuis
Joshua A Barocas
K John McConnell
Cynthia D Morris
Ryan Cook
author_sort Caroline A King
title Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.
title_short Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.
title_full Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.
title_fullStr Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.
title_full_unstemmed Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.
title_sort designing and validating a markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/8bb92735eef24e0ebee815b169883242
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AT ptoddkorthuis designingandvalidatingamarkovmodelforhospitalbasedaddictionconsultserviceimpacton12monthdrugandnondrugrelatedmortality
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