Austin S. Kilaru, MD; Jeanmarie Perrone, MD; David Kelley, MD; Sari Siegel, PhD; Su Fen Lubitz, MPH; Nandita Mitra, PhD; Zachary F. Meisel, MD

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.2,3 The 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 2019.4 We obtained publicly reported data on hospital characteristics from the Pennsylvania Department of Health and county-level data from the Pennsylvania Open Data Portal.5,6 We 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.

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