• J Gen Intern Med · Aug 2022

    Randomized Controlled Trial

    Acute Care Utilization After Recovery Coaching Linkage During Substance-Related Inpatient Admission: Results of Two Randomized Controlled Trials.

    • Julia A Cupp, Kaileigh A Byrne, Kristin Herbert, and Prerana J Roth.
    • Prisma Health-Upstate, Greenville, USA. Julia.Cupp@Prismahealth.org.
    • J Gen Intern Med. 2022 Aug 1; 37 (11): 276827762768-2776.

    BackgroundFor patients with substance use disorder (SUD), a peer recovery coach (PRC) intervention increases engagement in recovery services; effective support services interventions have occasionally demonstrated cost savings through decreased acute care utilization.ObjectiveExamine effect of PRCs on acute care utilization.DesignCombined results of 2 parallel 1:1 randomized controlled trials.ParticipantsInpatient adults with substance use disorder INTERVENTIONS: Inpatient PRC linkage and follow-up contact for 6 months vs usual care (providing contact information for SUD resources and PRCs) MAIN MEASURES: Acute care encounters (emergency and inpatient) 6 months before and after enrollment; encounter type by primary diagnosis code category (mental/behavioral vs medical); 30-day readmissions with Lace+ readmission risk scores.Key ResultsA total of 193 patients were randomized: 95 PRC; 98 control. In the PRC intervention, 66 patients had a pre-enrollment acute care encounter and 56 had an encounter post-enrollment, compared to the control group with 59 pre- and 62 post-enrollment (odds ratio [OR] = -0.79, P = 0.11); there was no significant effect for sub-groups by encounter location (emergency vs inpatient). There was a significant decrease in mental/behavioral ED visits (PRC: pre-enrollment 17 vs post-enrollment 10; control: pre-enrollment 13 vs post-enrollment 16 (OR = -2.62, P = 0.02)) but not mental/behavioral inpatient encounters or medical emergency or inpatient encounters. There was no significant difference in 30-day readmissions corrected for Lace+ scores (15.8% PRC vs 17.3% control, OR = 0.19, P = 0.65).ConclusionsPRCs did not decrease overall acute care utilization but may decrease emergency encounters related to substance use.Trial RegistrationClinicalTrials.gov (NCT04098601, NCT04098614).© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.

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