Participation in a Hospital Incentive Program for Follow-up Treatment for Opioid Use Disorder

This cross-sectional study examines hospital participation in an incentive program that aims to improve the rate of opioid use disorder follow-up treatment among Medicaid recipients in Pennsylvania.


Introduction
Pennsylvania experienced an 80% increase in emergency department (ED) visits for opioid overdose from 2016 to 2017. 1 The engagement of patients with opioid use disorder (OUD) in treatment after hospital discharge is a key strategy in preventing subsequent opioid overdose. 2,3The Pennsylvania Department of Human Services established an incentive program to improve the rate of OUD follow-up treatment among Medicaid recipients. 4 In the Opioid Hospital Quality Improvement Program, hospitals earned payment for designing and attesting to 4 distinct clinical pathways: (1) ED initiation of buprenorphine treatment, (2) warm handoff to community resources, (3) referral and treatment for pregnant patients, and (4) inpatient initiation of medication treatment.Payment of the full incentive ($193 000) was contingent on participation and attestation of all 4 pathways, with smaller incentives for partial participation.We evaluated participation in this program among hospitals.

Methods
This study was deemed to be exempt from review by the institutional review board at the University of Pennsylvania.Because this study was done with publicly reported data, no informed consent was required by the institutional review board.We conducted a cross-sectional analysis of all hospitals with an ED in Pennsylvania.We excluded pediatric, federal, and specialty hospitals.Participation in the program was publicly reported in January 2019. 4We obtained publicly reported data on hospital characteristics from the Pennsylvania Department of Health and county-level data from the Pennsylvania Open Data Portal. 5,6We used a multivariable logistic regression model with robust SEs to compare differences in characteristics of hospitals that fully participated with those that declined or partially participated.We report adjusted risk differences (ARDs) and corresponding 95% CIs.A 2-sided P < .05 was deemed to be statistically significant.Analyses were conducted using Stata, version 14 (StataCorp LLC).This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
In the adjusted model, larger hospitals were full participants more often than smaller hospitals (ARD, 5 percentage points; 95% CI, 0.2-10 percentage points; P = .04)(Table 2).Hospitals affiliated with health systems were full participants more often than independent hospitals (ARD, 22 percentage points; 95% CI, 4-42 percentage points; P = .02).Compared with hospitals in the southeast region of the state, hospitals in the northeast region were full participants less often (ARD, −34 percentage points; 95% CI, −56 to −12 percentage points; P = .01),and hospitals in the central and western   a Differences in outcomes were estimated using a multivariable logistic regression model with robust SEs.A multivariable logistic regression model that accounted for correlated data by health system using generalized estimating equations with an independent correlation structure with robust SEs demonstrated identical odds ratios and equivalent statistical significance.
b For continuous covariates, the adjusted risk difference shown in this table is the difference between the predicted probability of the outcome at the mean value of the covariate for fully participating hospitals and the predicted probability at the mean value for partial and nonparticipating hospitals.
Author affiliations and article information are listed at the end of this article.OpenAccess.This is an open access article distributed under the terms of the CC-BY License.JAMA Network Open.2020;3(1):e1918511.doi:10.1001/jamanetworkopen.2019.18511(Reprinted) January 3, 2020 1/4

Table 2 .
Differences in Characteristics Between 79 Fully Participating Hospitals and 76 Partially and Nonparticipating Hospitals