Navigation Services to Avoid Rehospitalization (NavSTAR) among substance abusers

描述（由申请人提供）：近年来，再住院问题作为可预防的发病率和不断上升的医疗费用的主要原因受到高度关注。物质使用障碍与不良的健康结果和对医疗服务的高度低效利用（包括重复住院）密切相关。干预措施 增加对门诊医疗护理和物质滥用治疗建议的依从性可能潜在地帮助最近住院的物质使用障碍患者避免不必要的再住院、相关的发病率和医疗费用。本研究是一项随机对照试验，比较了导航服务避免再住院（NavSTAR）与治疗性治疗（TAU）对合并医疗问题和物质使用障碍的住院患者的有效性。应用Andersen的卫生服务利用理论模型，NavSTAR将采用患者导航和动机干预的有前途的策略，以促进参与门诊医疗和药物滥用治疗，从而降低再住院的可能性。在一家大型城市医院的药物滥用咨询联络服务中嵌入的患者导航员将在住院期间提供以患者为中心的主动导航和激励服务，并在出院后持续3个月。随机分配至TAU的受试者将接受医院和药物滥用咨询联络服务的常规护理，其中包括转介药物滥用治疗，但出院后不再继续联系。参与者将在进入研究时进行评估，并在3个月、6个月和12个月随访时再次评估各种医疗保健利用、物质使用和功能指标。关注的主要结局是12个月内的再住院时间。此外，还将评估医疗和药物滥用服务领域的一系列次要成果。该研究将包括从服务提供商的角度对NavSTAR的成本、增量成本效益和成本效益进行经济评估。这项研究涉及一个具有全国意义的问题。在美国，可以避免的再住院的程度，特别是在患有药物使用障碍的个人中，这表明存在公共卫生风险，并构成医疗保健支出的主要驱动因素。本研究在患者导航和动机干预策略的应用方面具有创新性，其特定目的是避免患有共同发生的医疗问题和物质使用障碍的个体再次住院。如果NavSTAR被证明在减少这一高风险患者群体的再住院方面是有效和具有成本效益的，那么它将对设计出院计划服务、通知国家成本控制计划和改善公共卫生产生重要影响。

DESCRIPTION (provided by applicant): In recent years, the problem of rehospitalization has come under intense focus as a major contributor to preventable morbidity and escalating healthcare costs. Substance use disorders are strongly associated with poor health outcomes and highly inefficient use of healthcare services, including repeat hospitalizations. Interventions that increase adherence to recommendations for outpatient medical care and substance abuse treatment could potentially help recently-hospitalized individuals with substance use disorders to avoid unnecessary rehospitalization, associated morbidity, and medical expenses. The current study is a randomized controlled trial comparing the effectiveness of Navigation Services to Avoid Rehospitalization (NavSTAR) vs. Treatment-as-Usual (TAU) for hospital patients with co-occurring medical problems and substance use disorders. Applying Andersen's theoretical model of health service utilization, NavSTAR will employ the promising strategies of Patient Navigation and motivational interventions to facilitate engagement in outpatient medical and substance abuse treatment, thereby lowering the likelihood of rehospitalization. Patient Navigators embedded within the substance abuse consultation liaison service at a large urban hospital will deliver patient- centered, proactive navigation and motivational services initiated during the hospital stay and continued for 3 months post-discharge. Participants randomized to TAU will receive usual care from the hospital and the substance abuse consultation liaison service, which includes referral to substance abuse treatment but no continued contact post-hospital discharge. Participants will be assessed at study entry and again at 3-, 6-, and 12-months follow-up on various measures of healthcare utilization, substance use, and functioning. The primary outcome of interest is time-to-rehospitalization through 12 months. In addition, a range of secondary outcomes spanning the medical and substance abuse service areas will be assessed. The study will include an economic evaluation of the cost, incremental cost-effectiveness, and cost-benefits of NavSTAR from the service provider perspective. This study addresses a problem of national significance. The extent of avoidable rehospitalizations in the U.S., and among individuals with substance use disorders specifically, is indicative of public health risks and constitutes a key driver of healthcare expenditures. This study is innovative in its application of Patient Navigation and motivational intervention strategies with the specific purpose of avoiding rehospitalization among individuals with co-occurring medical problems and substance use disorders. If NavSTAR proves to be effective and cost-effective in reducing rehospitalizations in this high risk patient group, it would have important implications for designing hospital discharge planning services, informing national cost containment initiatives, and improving public health.