Hospital Addiction Medicine Consultation Service Orders and Outcomes by Patient Race and Ethnicity in an Urban, Safety-Net Hospital.

BACKGROUND: Hospital admissions involving substance use disorders are increasing and represent an opportunity to engage patients in substance use treatment. Addiction medicine consultation services improve access to medications for opioid use disorder (MOUD) and patient outcomes. However, as hospitals continue to adopt addiction medicine consultation services it is important to identify where disparities may emerge in the process of care. OBJECTIVE: To describe addiction medicine consultation service use by race and ethnicity as well as substance to identify opportunities to reduce substance use treatment disparities. DESIGN: Retrospective cohort study using 2016-2021 Electronic Health Record data from a large Midwest safety-net hospital. PARTICIPANTS: Hospitalized adults aged 18 or older, with one or more substance use disorders. MAIN MEASURES: Consultation orders placed, patient seen by consult provider, and receipt of MOUD by self-reported race. KEY RESULTS: Between 2016 and 2021, we identified 16,895 hospitalized patients with a substance use disorder. Consultation orders were placed for 6344 patients and 2789 were seen by the consult provider. Black patients were less likely (aOR = 0.58; 95% CI: 0.53-0.63) to have an addiction medicine consultation order placed and, among patients with a consultation order, were less likely (aOR = 0.74; 95% CI: 0.65-0.85) to be seen by the consult provider than White patients. Overall, Black patients with OUD were also less likely to receive MOUD in the hospital (aOR = 0.63; 95% CI: 0.50-0.79) compared to White patients. However, there were no differences in MOUD receipt among Black and White patients seen by the consult provider. CONCLUSIONS: Using Electronic Health Record data, we identified racial and ethnic disparities at multiple points in the inpatient addiction medicine consultation process. Addressing these disparities may support more equitable access to MOUD and other substance use treatment in the hospital setting.

An Atypical Case of Extrapulmonary Sarcoidosis.

Sarcoidosis is an idiopathic, inflammatory condition that affects nearly all organs in the body. Lungs are the most frequent and among the earliest sites for detecting it. The most common extrapulmonary manifestations involve the ophthalmic, cardiac, nervous, reticuloendothelial, cutaneous, hepatosplenic, and renal systems. These extrapulmonary manifestations of sarcoid may be misdiagnosed in the absence of the classical pulmonary features, given the high overlap of features with other chronic immunologic diseases. The diagnostic workup to differentiate sarcoid from other similar conditions is extensive, amongst which histology remains a gold standard tool for the diagnosis. Our patient presented with a chronic history of multiple vague complaints including nausea, vomiting, progressive malaise, vision changes, and weight loss. After extensive workup, a diagnosis of sarcoidosis along with multiple rare extrapulmonary involvements was made. The authors highlight essential implications including primary practice goals to avoid misdiagnosis or missed sarcoid diagnoses thus helping improve clinical outcomes in similar populations.

Super fragmented: a nationally representative cross-sectional study exploring the fragmentation of inpatient care among super-utilizers.

BACKGROUND: Super-utilizers with 4 or more admissions per year frequently receive low-quality care and disproportionately contribute to healthcare costs. Inpatient care fragmentation (admission to multiple different hospitals) in this population has not been well described. OBJECTIVE: To determine the prevalence of super-utilizers who receive fragmented care across different hospitals and to describe associated risks, costs, and health outcomes. RESEARCH DESIGN: We analyzed inpatient data from the Health Care Utilization Project's State Inpatient and Emergency Department database from 6 states from 2013. After identifying hospital super-utilizers, we stratified by the number of different hospitals visited in a 1-year period. We determined how patient demographics, costs, and outcomes varied by degree of fragmentation. We then examined how fragmentation would influence a hospital's ability to identify super-utilizers. SUBJECTS: Adult patients with 4 or more inpatient stays in 1 year. MEASURES: Patient demographics, cost, 1-year hospital reported mortality, and probability that a single hospital could correctly identify a patient as a super-utilizer. RESULTS: Of the 167,515 hospital super-utilizers, 97,404 (58.1%) visited more than 1 hospital in a 1-year period. Fragmentation was more likely among younger, non-white, low-income, under-insured patients, in population-dense areas. Patients with fragmentation were more likely to be admitted for chronic disease management, psychiatric illness, and substance abuse. Inpatient fragmentation was associated with higher yearly costs and lower likelihood of being identified as a super-utilizer. CONCLUSIONS: Inpatient care fragmentation is common among super-utilizers, disproportionately affects vulnerable populations. It is associated with high yearly costs and a decreased probability of correctly identifying super-utilizers.