Rejection of Patients With Opioid Use Disorder Referred for Post-acute Medical Care Before and After an Anti-discrimination Settlement in Massachusetts.
Rejection of Patients With Opioid Use Disorder Referred for Post-acute Medical Care Before and After an Anti-discrimination Settlement in Massachusetts.
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在马萨诸塞州发生抗歧视定居之前和之后，拒绝接受阿片类药物使用障碍患者。
DOI：
10.1097/adm.0000000000000693
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发表时间：
2021-01-01
影响因子：
5.5
通讯作者：
Walley AY
中科院分区：
文献类型：
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作者：
Kimmel SD;Rosenmoss S;Bearnot B;Larochelle M;Walley AY
确定阿片类药物使用障碍（OUD）住院患者因药物使用或阿片类激动剂治疗（OAT）而被拒绝接受急性期后医疗护理的常见程度。此外，评估美国检察官于2018年5月与马萨诸塞州一家护理机构就此类拒绝违反反歧视法达成和解后拒绝率的变化。2018年，我们将电子转诊与波士顿医疗中心的私人马萨诸塞州急性期后医疗机构的临床数据联系起来。我们纳入了使用ICD-10诊断代码或OAT收据的OUD证据的转诊。我们确定了转介的频率，其中所述的拒绝原因是物质使用或OAT，并将其归类为歧视。我们使用分段回归来评估在和解之前和之后与物质使用和OAT相关的拒绝的转诊比例的变化。2018年，219例OUD相关住院导致1648例转诊至285家机构; 81.8%（1348例）被拒绝。在住院治疗中，37.4%（82人）至少受到一次歧视性拒绝。在拒绝中，15.1%（203）是歧视性的（105个OAT和98个物质使用）。在设施中，29.1%（83个）至少有一次歧视性拒绝。我们发现，在解决之前和之后，歧视性拒绝的比例没有差异。尽管有联邦和州的保护，但因OUD住院的患者在急性期后护理中经常受到明确的歧视。需要努力加强反歧视法律、法规和政策的执行，以确保OUD患者和持续医疗需求者获得急性后医疗护理。
To determine how commonly medical inpatients with opioid use disorder (OUD) referred for post-acute medical care were rejected due to substance use or treatment with opioid agonist therapy (OAT). Additionally, to assess for changes in rejection rates following the United States Attorney’s May 2018 settlement with a Massachusetts nursing facility for violating anti-discrimination laws for such rejections. We linked electronic referrals to private Massachusetts post-acute medical care facilities from Boston Medical Center in 2018 with clinical data. We included referrals with evidence of OUD using ICD-10 diagnosis codes or OAT receipt. We identified the frequency of referrals where the stated rejection reason was substance use or OAT and classified these as discriminatory. We used segmented regression to assess for changes in proportion of referrals with substance use and OAT-related rejections before and after the settlement. In 2018, 219 OUD-associated hospitalizations resulted in 1648 referrals to 285 facilities; 81.8% (1348) were rejected. Among hospitalizations, 37.4% (82) received at least one discriminatory rejection. Among rejections, 15.1% (203) were discriminatory (105 for OAT and 98 for substance use). Among facilities, 29.1% (83) had at least one discriminatory rejection. We found no differences in proportion of discriminatory rejections before and after the settlement. Individuals hospitalized with OUD frequently experience explicit discrimination when rejected from post-acute care despite federal and state protections. Efforts are needed to enhance enforcement of anti-discrimination laws, regulations, and policies to ensure access to post-acute medical care for people with OUD and ongoing medical needs.