Care Transformation Center Blog

Massachusetts General's 3-step approach that cut readmission risk for substance use disorders by 25%

by Clare Wirth and Tomi Ogundimu

Of the 20 million Americans with a substance use disorder (SUD), only about 2.1 million suffer from opioid use disorder (OUD) specifically. In contrast, nearly 15 million have alcohol use disorder, which kills around 16,000 more people each year than opioids and is at least three times more expensive to treat. These statistics do not argue that providers should stop focusing on opioids. However, with only 12% of patients with a SUD receiving treatment, providers need a comprehensive strategy to increase access to a broader suite of services.

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Massachusetts General Hospital (MGH) has been an early innovator in this space, starting well before the opioid epidemic hit major headlines. In fact, their market all but demanded it. About 60-75% of patients surveyed in 2012 said substance use was the most important issue in the community. Not only did this result clearly underscore the need for their SUD Initiative, it also secured immediate leadership buy-in.

How MGH fills 3 critical gaps in SUD treatment

1. Multi-disciplinary addiction consult team treats underlying SUDs during inpatient stays

Inpatient treatment of patients with SUD tend to focus on the presenting medical issue rather than the underlying problem. To address that oversight, MGH established an inpatient addiction consult team to assess and address SUD needs for their 1,000+ beds. The team includes specialized nurse practitioners, psychiatrists, social workers, internists, and a peer recovery coach.

Together, the group conducts a comprehensive evaluation and makes treatment recommendations. They craft a tailored 3- to 12-month care plan adapted to fit the patient's readiness, including linkage to appropriate community resources. MGH estimates the addiction consult team lowers odds of readmission by 25%.

2. ED-based, walk-in care provides immediate treatment and connections to ongoing care via outpatient clinic

Even with a patient-centered treatment plan, many patients face so many challenges related to SUD that they are unable to access traditional outpatient care. The Bridge Clinic, located near MGH's ED, serves as a low-barrier option for transitional care. More than half of visits are walk-in or scheduled on the same day.

The Bridge Clinic's goal is harm reduction and medical wellness. Services include addiction pharmacotherapy, peer support, brief psychotherapy, psychiatric evaluation and medication treatment, medication education, and connections to social services with longer-term care. And the result? Only 10% of recently discharged Bridge Clinic patients are readmitted within 30 days.

3. Community health centers offer long-term support, such as peer recovery coaches 

MGH has a robust partnership with their community health centers, offering rapid access to psychiatrists and cross-training existing mental health staff. Peer recovery coaches have been key to the community health center's effectiveness. These coaches help patients overcome barriers to treatment, provide motivational support, and serve as part of the care team. MGH's retrospective cohort study revealed that integrating addiction treatment into primary care significantly reduced inpatient days by 9% and ED visits by 16%.

The 3 foundational pillars to the SUD Initiative's success: Cross-continuum collaboration, evidence-based treatment, and culture change

SUD is not siloed to any single part of health care. To create a cross-continuum strategy, MGH engaged leaders across medical, psychiatry, and community providers. Together, this team took immediate steps to educate staff about SUD and provide evidence-based treatment.

Since evidence-based SUD care combines medication and therapy, MGH ensured patients have same-day access to SUD drugs (e.g., suboxone for OUD, vivitrol for AUD). Leadership also cross-trained mental health staff and hired SUD-specific team members.

Lastly, recognizing staff experience unconscious bias like anyone else, the SUD Initiative leaders educated physicians, security, nurses, and janitors alike about SUDs, debunking any misconceptions and emphasizing SUDs are chronic, treatable diseases.

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