Early data from Project Engage: A program to identify and transition medically hospitalized patients into addictions treatment.

Patients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalization. In partnership with the Delaware Valley Node of the National Drug Abuse Treatment Clinical Trials Network (CTN), Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients on admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients. Program-level data on treatment entry after discharge were examined retrospectively, providing descriptive information on health-care utilization and costs.

Between September 1, 2008 and December 30, 2010, 415 patients participated in Project Engage and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009 and November 30, 2009 (n=18), insurance claims demonstrated a 33% decrease in inpatient medical admissions, a 38% decrease in emergency department visits, a 42% increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% increase in outpatient BH/SA admissions for an overall decrease of $37,760. For a small cohort who participated between June 1, 2010 and November 30, 2010 (n=25), claims demonstrated a 58% decrease in inpatient medical admissions; a 13% decrease in emergency department visits; a 32% decrease in BH/SA inpatient admissions, and a 32% increase in outpatient BH/SA admissions, for an overall decrease of $88,886.

Conclusions: These findings demonstrate that a large percentage of patients entered SUD treatment after participating in Project Engage, a novel intervention with facilitated referral to treatment. Although the findings are limited by the retrospective nature of the data and the small sample sizes, they do suggest a potentially cost-effective addition to existing hospital services if replicated in prospective studies with larger samples and controls.