Article

Evaluation of the Washington state screening, brief intervention, and referral to treatment project: cost outcomes for Medicaid patients screened in hospital emergency departments.

Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, WA 98504-5204, USA.
Medical care (Impact Factor: 2.94). 11/2009; 48(1):18-24. DOI: 10.1097/MLR.0b013e3181bd498f
Source: PubMed

ABSTRACT Substance abuse is a major determinant of morbidity, mortality, and health care resource consumption. We evaluated a screening, brief intervention, and referral to treatment (SBIRT) program, implemented in 9 hospital emergency departments (ED) in Washington State.
Working-age, disabled Medicaid patients who were screened and received a brief intervention (BI) from April 12, 2004 through September 30, 2006 were included in the study's intervention group (N = 1557). The comparison group (N = 1557), constructed using (one-to-one) propensity score matching, consisted of Medicaid patients who received care in one of the counties in which an intervention hospital ED was located but who did not receive a BI. We estimated difference-in-difference (DiD) regression models to assess the effects of the SBIRT program for different patient groups.
The SBIRT program was associated with an estimated reduction in Medicaid costs per member per month of $366 (P = 0.05) for all patients, including patients who received a referral for chemical dependency (CD) treatment. For patients who received a BI only and had no CD treatment in the year before or the year after the ED visit, the estimated reduction in Medicaid per member per month costs was $542 (P = 0.06). The SBIRT program was also associated with decreased inpatient utilization (P = 0.04).
SBIRT programs have potential to limit resource consumption among working-age, disabled Medicaid patients. The hospital ED seems especially well suited for SBIRT programs given the large number of injured patients treated in the ED and the fact that many conditions treated are related to substance abuse.

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    • "Over the past 20 years, many research studies have focused on the value of SBIRT as a harm reduction model for at-risk alcohol use with significant impacts on patient safety and health care costs (InSight Project Research Group 2009; Madras et al. 2009; Saitz 2008; Babor et al. 2007; Bien, Miller & Tonigan 1993). SBIRT has been clearly described and is teachable; however, it is not widely implemented (Estee et al. 2009; Bernstein et al. 2007). "
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    • "In a quasiexperimental multi-site study of SBIRT in Emergency Departments, researchers found that brief intervention was effective in reducing alcohol consumption at 3 month follow-up (Academic ED SBIRT Research Collaborative, 2007). In the Emergency Department SBIRT program in Washington State, researchers found that those who received SBIRT services were more likely to access substance abuse treatment (Krupski et al., 2010) and incurred fewer Medicaid costs (Estee et al., 2010) than matched comparison groups. Another study found substantial decreases in drug use and heavy drinking among individuals receiving SBIRT in a public healthcare system where SBIRT was implemented as standard care (InSight Project Research Group, 2009). "
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