Problem Statement

Opioid prescriptions increased sharply reaching a peak of 2.7 million during the past decade. For example, between 1999 and 2011, the number of people using hydrocodone increased by more than two-fold while the number of people using oxycodone increased by more than five fold (Phillips, Ford, and Bonnie, 2017). The study also indicates mortality rates, as well as readmissions rates into the emergency department, are related to opioid overdose which has increased by approximately four-fold thus representing a significant portion of healthcare expenditures. Gesensway, 2016) established that these healthcare expenditures could be detrimental especially to providers in regions with high rates of addiction. Additionally, readmits create problems with increasing health concerns and length of stay which have come with recurring visits in the emergency departments, financial burdens on non-payments with insurance companies and an indigent patient, and medicated assisted treatment with its effect after discharge-continued use (Gesensway, 2016).

This research proposal is directed at the effect that readmissions have on hospitals/facilities that help people who have issues with the use/misuse of opiates drugs. The population usually are seeking intervention by force or after a fatal abuse of the drug. (Burrows, 2016). There is a gap in treatment and interventions that have provided low levels of outcome care that has caused continued misuse of medication and street drugs and have caused deaths/overdoses and readmissions into hospitals (Lester, 2018). Emergency department visit provides an opportunity for active engagement between healthcare providers and their patients when it comes to an acute change in health. As developed by Lester (2018) active participation is encompassed on both reflection and discussion that tends to motivate patients in changing their behaviors. In some cases, the connection is evident while the motivation concept is used by healthcare providers in drug opioid overdose intervention in the intention of engaging patients into positive behavior change.

Purpose of the Study

The purpose of this study is to challenge current practices that administrators have encountered that have not been effective in minimizing the readmission of opiate use/abuse/deaths. The research will also be based on quantitative and qualitative data that increases the relationship between patient hospital readmission and current drug use patterns. The relationship between the number of overdoses and hospital administering opiates while in the emergency department. (Enos, 2019) The measurements will be based on how the level of treatment is not met when the apparent need is treatment programs.

Significance

The impact of a drug opioid program/intervention on readmissions is my doctoral study topic. The program/intervention for opioid overdose death was selected in response to an increase in repeat visits in the emergency departments related to opioid overdoses. According to Vivolo Kantor et al. (2018) the impact of social change is implemented in having effective interventions (education) for mental health care for addicts and not dismissing the social implications of cost, crime, and physical health. The ability to allow people to stop the statistics of the increase in death rates related to opiate overdose is essential to creating a better social interaction (Boston University Medical Center, 2015). The Healthcare Cost and Utilization Project gave a clear indication that the increase in ED visits scored 99.4% from 2005 to 2014 measured across 30 states. (Weiss, et al., 2016)

The change that is seen will produce positive social change as the “analyses of ED utilization patterns and support public health professionals, administrators, policymakers, and clinicians in their decision making regarding this critical source of care” (Weiss et al., 2016). As the emergency department connects and partners with community agencies, the social change will be how a connection is made for treatment outside of the emergency department. People may not be able to quit abusing opiates as society would like so finding a way to meet patients where they are offering alternatives to care, and treatment will create positive social change (Peters, 2018).

Background

Articles and journals in regards to the impact of drug opioid overdose have on readmission rates into the emergency department. Keywords used for easy search include drug opioid overdose, opioid overdose, rates of readmission and opioid overdose, rates of readmission after discharge and problems of opioid misuse in the databases education sources, EBSCOhost, SAGE Journals, APHA Journals, and NCBI Journals.

For instance, the Journal of the American Geriatric Society Morabet et al. (2018) focused on the preventability of readmission because of drug-related behaviors. It is evident that during the last several decades, there have been movements to decrease the rate of readmissions after discharge especially within a 30-day time frame HCFO Staff (2015). The study identified nineteen complete studies that focused on how opioid drug use has affected hospital readmissions. Some admissions are not necessary, and therefore solutions to combat the high rate of casual effect will decrease the return visits to the hospital (Lagoe, Nanno, & Luziani, 2012). The use of quantitative measurements is useful in identifying definite barriers to successful discharge and what treatments were overlooked that impacted the cost of ongoing interventions.

Framework

The framework utilized is System approach and Evidence-Based Management. As an administrator, we must find the baseline of what the problem is and a goal to acquire a change in healthcare provision. The evidence base framework focuses on six areas of gaining insight into what and who are being affected in the healthcare setting and financial losses or gains. The system framework will bring different disciplines together in developing plans to ensure patients are discharged with proper resources and treatment to decrease readmission and overdose deaths from opiate abuse.

Research Question

H1-Readmission rates are based on current overdoses from opiate and drug use. H0- Readmission rates are Not based on current overdoses from opiate and drug use. H1- Gender, age and economic disparities with drug overdoses affect readmission H0- Gender, age and economic inequalities with drug overdoses do Not affect re-entry. H1-Shorter length of stay versus more extended periods of rest of patients with overdoses on opiates/drugs has a significant impact on readmission and cost. H0: Shorter length of stay versus more extended periods of rest of patients with overdoses on opiates/drugs does Not have a significant impact on readmission and cost H1- Hospital cost has increased with early readmission (30 days) for opiate/drug use patients. H0: Hospital cost has not increased with early readmission (30 days) for opiate/drug use patients.

Nature of study

The quality of this study is to determine how to decrease the level of readmits that is costing the hospital money and lives due to continued misuse of opiate medication and drugs. The gap is that the rate of readmits is not slowed enough to determine if the right intervention was given for the level of care given. Historically, healthcare providers have provided treatment of substance use disorders; previous research such as Burrows (2016) and Lagoe, Nanno & Luziani (2012) developed that positive outcomes of the patients, as well as reduced healthcare costs, are associated with primary care visits.

Limits, Challenges, and Barriers

The study has several limitations. The potential barriers would be not to have a large enough sample to assess data. According to Morabet et al. (2018), it is difficult to verify the accuracy of diagnoses coded in cases where the retrospective database review is used. Lack of enough data to assess makes it challenging to estimate what proportion of patients with opioid abuse and dependence were captured by the diagnosis codes used (Puls, Guerrero & Andrew, 2014). The barrier will be in determining that the overdoses are direct to the hospital level of care given before the readmit and /or death. The third challenge will be the cost of treating the same symptom and potentially not being paid by the patient or insurance companies.

References

Boston University Medical Center. (2015, April 13). Emergency departments may help address opioid overdose, education. Retrieved from Science Daily:
- https://www.sciencedaily.com/releases/2015/04/150413184235.htm

Burrows, M. (2016, June 11). How long do you stay in the hospital after an overdose? Retrieved from Quora:
- https://www.quora.com/How-long-do-you-stay-in-the-hospital-after-an-overdose

Enos, G. E. (2019, January 7). Report Quantifies Staggering Impact of Overdoses on Hospital Care. Retrieved from Behavioral Healthcare:
- https://www.behavioral.net/article/prescription-drug-abuse/report-quantifies-staggering-impact-overdose-hospital-care

Gesensway, D. (2016, July). A pragmatic approach to treating opioid use disorders in the hospital. Retrieved from Today's Hospitalist:
- https://www.todayshospitalist.com/pragmatic-approach-treating-opioid-use-disorders hospital/?utm_source=post_1513&utm_medium=toppost

HCFO Staff. (2015, May). Readmission Challenges: How Cleveland Hospitals Vary. Retrieved from Health Care Financing & Organization:
- http://www.hcfo.org/publications/readmission-challenges-how-cleveland-hospitals-vary.html

Lagoe, R. J., Nanno, D. S., & Luziani, M. E. (2012, November 2). Quantitative tools for addressing hospital readmissions. Retrieved from NCBI:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517364/

Lester, P. (2018, April 11). Evidence-based Opiods Treatment and Prevention. Retrieved from Social Innovation Research Center:
- http://socialinnovationcenter.org/wp-content/uploads/2018/04/SAMHSA-Opioids.pdf

Morabet, N. B., Uitvlugt, E. B., Van-Den Bemt, B. J., Van-Den Bemt, P. P., Janssen, M. J., & Karapinar0Carkit, F. P. (2018). Prevalence and Preventability of Drug-Related HospitalReadmissions: A Systematic Review. Journal The American Geriatrics Society, 1-7.

Peters, L. (2018, January 29). ER visits for opioid overdose gone down statewide; area still seeing the large number. Retrieved from News leader:
- https://www.newsleader.com/story/news/local/2018/01/29/er-visits-opioid-overdose-gone-down-statewide-area-still-seeing-large-number/1065507001/

Phillips, J. K., Ford, M. A., Bonnie, R. J., & National Academies of Sciences, Engineering, and Medicine. (2017). Trends in Opioid Use, Harms, and Treatment. In Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press (US).

Puls, S. E., Guerrero, K. S., & Andrew, D. A. (2014, February 7). Facilitating the safe patient transition of care: A systematic qualitative review. Retrieved from Journal of Nursing Education and Practice:
- http://www.sciedu.ca/journal/index.php/jnep/article/viewFile/4177/2688

Toussaint, J. (2015, August 21). A new framework for health care management. Retrieved from health affairs:
- https://www.healthaffairs.org/do/10.1377/hblog20150821.050034/full/

Vivolo-Kantor, A. M., Seth, P. P., Gladden, M. R., Mattson, C. L., Baldwin, G. T., Kite-Powell, A. M., & Coletta, M. A. (2018, March 9). Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses — United States, July 2016–September 2017. Retrieved from Center of Disease Control and Prevention:
- https://www.cdc.gov/mmwr/volumes/67/wr/mm6709e1.htm

Weiss, A. J., Elixhauser, A. P., Barrett, M. M., Steiner, C. M., Bailey, M. K., & O'Malley, L. (2016, December). Opioid-Related Inpatient Stays, and Emergency Department Visits by State, 2009-2014. Retrieved from H-CUP:
- https://www.hcup-us.ahrq.gov/reports/statbriefs/sb219-Opioid-Hospital-Stays-ED-Visits-by-State.jsp