What was the research about?
Having support after a hospital stay can help patients recover and keep them from having to go back to the hospital. Many hospitals offer patients follow-up help using community disease management, or CDM, programs. After patients leave the hospital, they get phone calls from nurses, help getting to doctor’s visits, and other kinds of support.
In this study, the research team created a new CDM program for patients with both
- Substance use disorders, or SUDs
- Long-term health problems, such as heart disease or diabetes
In the new CDM program, care teams received special training in treating SUDs. The research team compared patients in the new program with those in a standard CDM program.
What were the results?
Compared with the three months before their hospital stay, patients in both CDM programs reported decreases in substance use three months after leaving the hospital. Changes didn’t differ between the groups. Neither group reported changes in hospital and emergency room visits or substance use treatment attendance.
Who was in the study?
The study included 97 patients with SUDs and another long-term health problem. Of these patients, 69 percent were African American, 14 percent were white, 16 percent were other races, and 19 percent were Hispanic or Latino. The average age was 50, and 59 percent were men. All received care at a hospital in Philadelphia.
What did the research team do?
The research team assigned patients by chance to one of the two 90-day CDM programs. In the new CDM program, before leaving the hospital, patients had one or two sessions with a counselor who encouraged them to seek SUD treatment. Patients also set goals on reducing substance use and avoiding risky situations. After leaving the hospital, patients received follow-up calls from counselors twice a week for four weeks, and then once a week for the next eight weeks. Patients also received home visits from a peer support worker who offered emotional support and went with patients to treatment visits.
In the standard CDM program, care teams didn’t receive special training on treating SUDs. Before leaving the hospital, patients had a session with the counselor without setting goals. After patients left the hospital, they received check-in calls from nurses once a week. Patients who needed extra help received home visits and aid getting to healthcare visits.
Patients completed surveys at the start of the study and three months after leaving the hospital.
Patients, clinicians, and counselors for SUDs helped design the new CDM program and provided input throughout the study.
What were the limits of the study?
Fewer patients took part in the study than planned. Results may have differed if more patients had enrolled in the study.
Future research could continue to explore ways to support patients with SUDs after they leave the hospital.
How can people use the results?
Hospitals can use these results when considering ways to support patients with SUDs after they go home.
To compare the effectiveness of specialized community disease management (CDM) versus standard CDM in reducing postdischarge substance use and acute care service use among patients with a substance use disorder (SUD)
|Design||Randomized controlled trial|
|Population||97 patients with SUDs and another chronic disease|
Primary: change in number of days of substance use
Secondary: change in substance use treatment attendance, acute care service use (medical visits, hospitalizations, emergency department visits)
|Timeframe||3-month follow-up for primary outcome|
This randomized controlled trial compared the effectiveness of specialized CDM with standard CDM in providing postdischarge care to patients who were hospitalized with a chronic health condition and who also have a SUD.
Researchers randomly assigned patients to specialized or standard CDM for 90 days. In specialized CDM, care teams received training on treating SUDs. Prior to discharge, patients had one or two sessions with a behavioral health consultant focused on building motivation for seeking SUD treatment and setting goals and plans to reduce substance use and avoid risky situations. After discharge, patients received follow-up calls from the behavioral health consultant twice a week for four weeks, and then once a week for the next eight weeks. Also, at least once a month, patients received home visits from a peer support specialist, who followed up on medication adherence and looked for safety concerns. The care team also accompanied patients to medical and SUD treatment visits and offered support for patient decisions and goals related to treatment engagement and harm reduction.
In standard CDM, care teams could provide referrals for substance abuse treatment but did not receive special training in treating SUDs. Prior to discharge, patients completed a postdischarge needs assessment with a nurse navigator and had one session with a behavioral health consultant but did not set risk reduction goals. After discharge, patients received weekly calls from the nurse navigator about discharge needs and home visits from a community health worker as needed. The care team accompanied patients to medical visits only.
The study included 97 patients with SUDs who received care at a hospital in Philadelphia. All patients had another chronic disease, such as heart disease or diabetes. Of these patients, 69% were African American, 14% were white, 16% were other races, and 19% were Hispanic or Latino. The average age was 50, and 59% were male.
Patients completed assessments on study outcomes at enrollment and three months after hospital discharge.
Patients, clinicians, researchers, and health insurers helped design specialized CDM and provided feedback throughout the study.
Compared with the three months before their hospital stay, patients in both specialized and standard CDM reported reduced rates of substance use three months after hospital discharge (p<0.001); the change did not differ between the two groups. Acute care service use and substance use treatment attendance did not change significantly or differ between the two groups.
The study did not reach its sample target of 222 patients, which limited the ability to detect differences between groups.
Conclusions and Relevance
In this study, specialized CDM was not more effective than standard CDM in reducing substance use and acute care service use or in increasing substance use treatment attendance among patients with SUDs.
Future Research Needs
Future research could continue to explore ways to support patients with SUDs after hospital discharge.
Final Research Report
View this project's final research report.
Stories and Videos
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers questioned the report’s conclusions that the Specialized Community Disease Management (SCDM) did not show any improvements in health service use or health outcomes over treatment as usual in a sample of high-risk patients with substance abuse. The reviewers stated that because the researchers were able to recruit less than 50 percent of their needed sample to test the intervention, there was not enough power to make any conclusions about SCDM compared to usual care. The researchers revised the report to acknowledge their low recruitment and high attrition, which hampered their ability to get longer follow-ups for study participants and make any conclusions regarding the effectiveness of the novel disease management program.
- The reviewers questioned the decision to not try to follow up patients beyond six months, since longer follow-up could potentially better capture the breadth of individuals’ mental well-being and how they experienced the interventions. The researchers agreed that longer follow-ups would be useful but could not be attempted within the three-year scope of this project. The researchers said they also expected that any positive effects of the intervention would be apparent within three months. They had also planned to follow up at six months to see whether any observed effects were maintained after discontinuation of the intervention.
- The reviewers expressed disappointment that the researchers excluded the homeless population from the study. The researchers agreed that the homeless are an important group, but they were not included because of the difficulty of maintaining contact with homeless people and retaining them in studies.
- The reviewers asked about the structure and function of the community advisory board (CAB), since the report indicated that at least one former study participant was a member, and that the CAB helped develop study materials even though it was only formed after the investigators received study funding. The researchers explained that the CAB had rolling membership and this former study participant joined well after he or she had participated in the study. Also, the researchers explained that although the CAB was not established until after funding, it did contribute ideas and recommendations for the study design.
Conflict of Interest Disclosures
Study Registration Information
This project's organization was originally Treatment Research Institute, Inc.
- Has Results