Lijian He

Evaluation of the Washington State Screening, Brief Intervention, and Referral to Treatment Project: Cost Outcomes for Medicaid Patients Screened in Hospital Emergency Departments

Background:Substance abuse is a major determinant of morbidity, mortality, and health care resource consumption. We evaluated a screening, brief intervention, and referral to treatment (SBIRT) program, implemented in 9 hospital emergency departments (ED) in Washington State. Methods:Working-age, disabled Medicaid patients who were screened and received a brief intervention (BI) from April 12, 2004 through September 30, 2006 were included in the studys intervention group (N = 1557). The comparison group (N = 1557), constructed using (one-to-one) propensity score matching, consisted of Medicaid patients who received care in one of the counties in which an intervention hospital ED was located but who did not receive a BI. We estimated difference-in-difference (DiD) regression models to assess the effects of the SBIRT program for different patient groups. Results:The SBIRT program was associated with an estimated reduction in Medicaid costs per member per month of

Predicting readmission to substance abuse treatment using state information systems. The impact of client and treatment characteristics.

366 (P = 0.05) for all patients, including patients who received a referral for chemical dependency (CD) treatment. For patients who received a BI only and had no CD treatment in the year before or the year after the ED visit, the estimated reduction in Medicaid per member per month costs was

Impact of brief interventions and brief treatment on admissions to chemical dependency treatment

542 (P = 0.06). The SBIRT program was also associated with decreased inpatient utilization (P = 0.04). Conclusion:SBIRT programs have potential to limit resource consumption among working-age, disabled Medicaid patients. The hospital ED seems especially well suited for SBIRT programs given the large number of injured patients treated in the ED and the fact that many conditions treated are related to substance abuse.

The use of administrative data as a substitute for individual screening scores in observational studies related to problematic alcohol or drug use

The purpose of this study was to use administrative records of admissions to substance abuse treatment to construct episodes of care for publicly funded clients in Washington State, and then to analyze readmissions to treatment after an index episode. The study population was those clients who began and ended an index episode in 1995 (N = 10,284). The population was divided into two groups, which were separately analyzed based on programs run by the Washington State Division of Alcohol and Substance Abuse (DASA) [Alcohol and Drug Abuse Treatment and Support Act (ADATSA) and Non-ADATSA, named for legislation defining these programs]. Clients in each program were followed for 13 months, and proportional hazards regression was used to estimate the relationship between our treatment measures and readmission, controlling for several covariates. We compared clients based on several aspects of treatment, but our primary interest was in comparing clients that completed the index episode with those that did not complete it. For both ADATSA and Non-ADATSA clients, those completing their episode of treatment had significantly lower risks for readmission. Females and those arrested in the year prior to treatment had increased risks of readmission, while males and those receiving a combination of inpatient and outpatient treatments had lower risks of readmission. The discussion concludes with suggestions for improving statewide systems of care.

Treatment Readmissions and Criminal Recidivism in Youth Following Participation in Chemical Dependency Treatment

This study examined two issues. One, whether individuals with possible substance use disorders were more likely to be admitted to specialized chemical dependency (CD) treatment after receiving a brief intervention (BI) - either alone or in combination with other services - than similar individuals who did not receive a BI. Two, whether participation in brief treatment (BT) following a BI was helpful in facilitating admission to CD treatment. The study took place in the emergency department (ED) of a large urban safety-net hospital where CD professionals screened patients for alcohol/drug problems and provided BI, BT, and referral to specialized CD treatment when appropriate (SBIRT). Substance use disorders were indicated by alcohol/drug problems noted in administrative records. Hospital records were used to match patients with likely substance use disorders who received BI with similar ED patients who had not been screened. Admission to publicly funded CD treatment was determined by matching patient identifiers to state administrative records of CD treatment. Results indicated that individuals with a likely substance use disorder who received a BI (regardless of subsequent participation in BT) were significantly more likely to enter specialized CD treatment in the subsequent year than similar individuals who did not receive a BI. This result was particularly pronounced for patients with no CD treatment in the past two years. Results also indicated that participation in BT facilitated admission into CD treatment. The results suggest that SBIRT programs could serve an important role in increasing entry to specialized treatment for individuals with substance use disorders.

Evaluation of the Medicaid Buy-In Program in Washington State Outcomes for Workers With Disabilities Who Purchase Medicaid Coverage

Administrative data provide a rich resource for improving our understanding of individuals with substance use disorders. The validation of administrative proxies for moderate or high risk alcohol or drug (AOD) use could enhance the ability to carry out rigorous observational research (for example, for use in the construction of comparison groups). This study used receiver operating characteristic (ROC) curve techniques to assess how well AOD-related administrative indicators predicted self-reported AOD use obtained from AUDIT/DAST screening scores. An administrative AOD indicator, derived from a combination of medical encounter and billing data, arrest records, and publicly funded AOD-related services data, demonstrated discrimination in the acceptable range (AUC: 0.72-0.78) for identifying self-reported AOD use consistent with potential need for either (1) any AOD-related intervention, or (2) intensive AOD-related intervention or treatment. These findings held up in two distinct samples: a statewide Medicaid-only sample and a single-site mixed-payer sample that included the uninsured. Our findings suggest that indicators of AOD-related problems derived from administrative data can be useful for identifying moderate or high risk AOD use in a research context. The findings further suggest that proxies for substance use disorders, such as those evaluated here, can enhance future observational studies intended to improve health care for this population.

Self-reported alcohol and drug use six months after brief intervention: do changes in reported use vary by mental-health status?

Abstract The purpose of this study was to use administrative records of admissions to substance abuse treatment to construct episodes of care for publicly funded adolescent clients in Washington State, and then to analyze two important outcomes after an index episode: readmissions to treatment and criminal convictions (including felony convictions and any conviction). The study population was youth, ages 14 to 17, who began and ended an index episode in 1997 and 1998 (n = 5903). The youth were followed for 18 months after the end of their episode, and survival analysis techniques were used to determine the treatment correlates of the outcomes. Clients who completed treatment, compared to those who did not, had significantly lower risks of each outcome, while those with treatment episodes longer than 90 days had lower risks of readmission and felony convictions.

Self-reported drug use six months after a brief intervention: do changes in reported use vary by mental health status?

This study examines the effectiveness of Washington State’s Medicaid Buy-In (MBI) program—Healthcare for Workers With Disabilities (HWD)—which gives workers with disabilities who earn too much for conventional Medicaid the opportunity to purchase full Medicaid coverage by paying a monthly premium based on a sliding income scale. The authors compare HWD enrollees who recently had conventional Medicaid coverage to a statistically matched group of individuals who had conventional Medicaid coverage in recent history and at baseline. Their findings suggest that MBI in Washington State is encouraging work, increasing earnings, and decreasing reliance on food stamps while providing medical coverage to a vulnerable population for whom continuous health insurance is particularly important.

Medicaid Costs Declined Among Emergency Department Patients who Received Brief Interventions for Substance Use Disorders through WASBIRT

BackgroundAlthough brief intervention (BI) for alcohol and other drug problems has been associated with subsequent decreased levels of self-reported substance use, there is little information in the extant literature as to whether individuals with co-occurring hazardous substance use and mental illness would benefit from BI to the same extent as those without mental illness. This is an important question, as mental illness is estimated to co-occur in 37% of individuals with an alcohol use disorder and in more than 50% of individuals with a drug use disorder. The goal of this study was to explore differences in self-reported alcohol and/or drug use in patients with and without mental illness diagnoses six months after receiving BI in a hospital emergency department (ED).MethodsThis study took advantage of a naturalistic situation where a screening, brief intervention, and referral to treatment (SBIRT) program had been implemented in nine large EDs in the US state of Washington as part of a national SBIRT initiative. A subset of patients who received BI was interviewed six months later about current alcohol and drug use. Linear regression was used to assess whether change in substance use measures differed among patients with a mental illness diagnosis compared with those without. Data were analyzed for both a statewide (n = 828) and single-hospital (n = 536) sample.ResultsNo significant differences were found between mentally ill and non-mentally ill subgroups in either sample with regard to self-reported hazardous substance use at six-month follow-up.ConclusionThese results suggest that BI may not have a differing impact based on the presence of a mental illness diagnosis. Given the high prevalence of mental illness among individuals with alcohol and other drug problems, this finding may have important public health implications.

Service Costs for Persons with Developmental Disabilities Living in Residential and Community-Based Settings

Although brief intervention (BI) for alcohol and other drug problems has been associated with decreased levels of self-reported substance use, there is little information in the literature as to whether individuals with co-occurring hazardous substance use and mental illness would benefit from BI to the same extent as those without mental illness, despite high estimates comorbidity. This study took advantage of a naturalistic situation where a screening, brief intervention, and referral to treatment (SBIRT) program had been implemented in a large hospital emergency department in Seattle, WA. A subset of patients who received BI was interviewed six months following the intervention about current alcohol/drug use. A search of the patients’ medical records allowed us to divide the sample into those with and without evidence of mental illness and to analyze their self-reported drug use. Although unadjusted means indicated a possible decrease in illegal drug use between baseline and follow-up interviews for both groups, there was no significant difference between mentally ill and non-mentally ill subgroups with regard to self-reported changes in substance use. Changes in self-reported alcohol and binge drinking days showed a similar pattern. Although the lack of a comparison group prevented us from attributing change in reported use to BI alone, these data suggest the impact of BI on subsequent drug and alcohol use may not differ among patients with mental-health diagnoses.