UMass Medical School report identifies effective practices, common barriers for coordinating care for patients with substance use disorders

July 28, 2016

UMass Medical School researchers studied how three Worcester community health providers integrate care for patients with substance use disorders to understand what practices work and where the challenges remain.  The study, funded by the Blue Cross Blue Shield of Massachusetts (BCBSMA) Foundation, indicates primary care teams that provide SUD treatment could improve quality and manage costs.

Coordinating Care for Patients with Alcohol or Drug Use Disorders: Effective Practices and Common Barriers in Three Centers, released July 21, examines the care coordination practices at Edward M. Kennedy Community Health Center (EMK), Family Health Center of Worcester (FHC), and Community Healthlink (CHL). Researchers used enrollment records and medical claims from MassHealth, the Massachusetts Medicaid program, for adult patients served at the centers during 2013. They also conducted interviews with center staff and patients.

The study was led by Robin Clark, PhD, a professor of Family Medicine and Community Health, and of Quantitative Health Sciences at UMass Medical School, and Deborah Gurewich, PhD, associate director of the Research and Evaluation unit within UMass Medical School’s Commonwealth Medicine division. Additional Commonwealth Medicine co-authors include Linda Cabral, MM, senior project director of Research and Evaluation; and Kathleen Muhr, MEd, project director of the Work Without Limits program. UMass Medical School student Gillian Griffith contributed to the report.

Researchers learned that flexibility and delivering quick responses to patients is essential to delivering good care. They also noted that payment systems must support this this type of patient communication. The study discovered that patients with SUD often have a wide range of social needs that must be considered.

Key findings of the study include:

  • Co-occurring conditions: Patients with SUD had higher rates of many mental and physical illness diagnoses than patients without SUD;
  • Service use: Patients with SUD at all centers had higher rates of hospital admissions, ED use, and ambulatory care visits than patients without SUD. Fewer than 10% of admissions were classified as potentially avoidable;
  • MassHealth expenditures: Higher utilization led to higher expenditures for patients with SUD than for patients without SUD;
  • Quality of care: Patients with SUD generally had lower scores on quality indicators, but had higher scores for cervical cancer screening and treatment for depression;
  • SUD treatment: Rates of SUD treatment initiation were similar across the three centers and lower than national averages, but once patients began treatment, they were somewhat more likely to follow through with treatment than national averages;
  • Flexibility and responsiveness: Sporadic health care use among patients with SUD demands flexible and responsive service strategies;
  • Support services: Patients with SUD often have many needs beyond health care, including housing, employment, and legal issues;
  • Leadership: Care integration at all centers benefited from one or more staff leaders who showed particular dedication to serving patients with SUD;
  • Service co-location: All centers adopted some form of a co-located service model; and
  • Coordinating care: Each center invested a significant amount of effort in coordinating care within the center and with external providers.

The authors conclude that primary care teams with a focus on serving patients with addiction disorders appeared to contribute to higher-quality care for a range of conditions and to reduce rates of potentially avoidable hospitalization.

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