From: State variation in opioid treatment policies and opioid-related hospital readmissions
Characteristic | Naloxone Standing Orders | Good Samaritan Laws | Methadone Coverage by Medicaid | MAT Coverage Generosity by Medicaida | ||||
---|---|---|---|---|---|---|---|---|
Yes | No | Yes | No | Yes | No | More Generous | Less Generous | |
Number of stays | 145,262 | 238,072 | 307,369 | 75,965 | 353,335 | 29,999 | 237,221 | 146,113 |
Patient Sociodemographic Characteristics | ||||||||
 Age (mean) | 47.7** | 46.3 | 47.0** | 46.0 | 46.9** | 45.8 | 45.0** | 49.7 |
 Female (%) | 48.1** | 49.4 | 47.7** | 53.7 | 48.2** | 57.4 | 46.5** | 52.8 |
 Race/ethnicity (%) | ||||||||
  White | 68.6 ** | 70.1 | 68.6** | 73.2 | 68.2** | 85.5 | 67.9** | 72.2 |
  Black | 12.4** | 14.2 | 12.8** | 16.5 | 14.2** | 5.9 | 15.3** | 10.7 |
  Hispanic | 13.0** | 9.3 | 12.7** | 2.7 | 11.4 ** | 2.4 | 10.0** | 12.0 |
  Other | 5.5** | 4.1 | 5.3** | 1.9 | 4.9** | 0.6 | 5.3** | 3.5 |
  Missing | 0.5** | 2.3 | 0.6** | 5.7 | 1.3** | 5.5 | 1.6 | 1.6 |
 Expected primary payer (%) | ||||||||
  Medicare | 31.5** | 30.1 | 30.5** | 31.4 | 30.2** | 36.1 | 27.0** | 36.5 |
  Medicaid | 42.4** | 34.7 | 38.9** | 32.5 | 38.6** | 26.1 | 42.3** | 30.0 |
  Private insurance | 18.0** | 17.5 | 17.7* | 17.4 | 17.5** | 17.5 | 16.6** | 19.3 |
  Uninsured/self-pay | 5.1** | 13.2 | 8.8** | 15.5 | 9.7** | 14.7 | 10.9** | 8.8 |
  Other | 3.0** | 4.4 | 4.1** | 2.8 | 4.0** | 2.0 | 3.1** | 5.1 |
 Median community-level income (%) | ||||||||
  Quartile 1 (lowest) | 31.7** | 34.9 | 32.4** | 38.9 | 34.0** | 29.9 | 35.9** | 30.1 |
  Quartile 2 | 24.6** | 23.8 | 23.9** | 25.0 | 23.7** | 28.8 | 22.6** | 26.5 |
  Quartile 3 | 21.1* | 20.8 | 21.1** | 20.2 | 20.6** | 24.2 | 19.9** | 22.5 |
  Quartile 4 (highest) | 17.6** | 16.4 | 17.5** | 14.3 | 16.9** | 15.7 | 16.5** | 17.4 |
  Missing | 5.0** | 4.1 | 5.2** | 1.6 | 4.7** | 1.4 | 5.1** | 3.4 |
 Patient location (%) | ||||||||
  Urban | 89.7** | 90.7 | 92.4** | 82.0 | 92.0** | 70.9 | 93.1** | 85.8 |
  Rural | 8.9** | 8.2 | 6.2** | 17.7 | 6.7** | 28.9 | 5.9** | 12.6 |
Patient Clinical Factors | ||||||||
 Opioid-related diagnosis (%) | ||||||||
  Principal | 13.3** | 13.8 | 13.7* | 13.4 | 13.3** | 17.0 | 14.4** | 12.2 |
  Secondary only | 86.7** | 86.2 | 86.3* | 86.6 | 86.7** | 83.0 | 85.6** | 87.8 |
 Any opioid abuse or dependence (%) | 83.0 | 82.9 | 83.6** | 80.0 | 83.4** | 77.4 | 85.4** | 78.8 |
 Continuous opioid abuse or dependence (%) | 29.9* | 29.6 | 30.8** | 25.2 | 30.4** | 21.4 | 32.6** | 24.9 |
 Mental health co-occurring diagnosis (%) | 54.1** | 55.7 | 54.2** | 58.9 | 54.6** | 61.3 | 55.7** | 54.2 |
 Alcohol abuse co-occurring diagnosis (%) | 19.5 | 19.5 | 19.7** | 18.6 | 19.9** | 14.5 | 21.3** | 16.5 |
 Number of co-occurring physical conditions (mean)b | 2.1** | 2.0 | 2.0** | 2.1 | 2.0** | 1.9 | 1.8** | 2.3 |
Initial Hospital Stay Characteristics | ||||||||
 Hospital stay began in ED (mean %) | 75.0** | 76.7 | 77.4** | 70.9 | 77.2 ** | 63.5 | 76.4** | 75.5 |
 Length of index stay (mean days) | 5.3** | 5.1 | 5.3** | 4.6 | 5.2** | 4.5 | 5.2** | 5.1 |
 Receipt of rehabilitation during index stay (%) | 16.9** | 16.1 | 16.9** | 14.7 | 16.5 | 16.3 | 21.2** | 8.8 |
Hospital Characteristicsc | ||||||||
 Percentage of annual opioid-related discharges in index year (mean) | 3.9 | 3.9 | 3.9 | 3.9 | 3.9** | 3.2 | 4.7** | 2.5 |
 Alcohol/substance use disorder (SUD) detoxification unit (%) | ||||||||
  No | 56.8** | 59.3 | 57.5** | 61.8 | 58.0** | 62.1 | 53.0** | 67.0 |
  Yes | 26.7 ** | 24.3 | 25.9** | 22.3 | 25.7** | 19.4 | 32.8** | 12.8 |
  Not reported | 16.6 | 16.4 | 16.6** | 15.9 | 16.3** | 18.5 | 14.2** | 20.1 |
 Psychiatric acute care unit (%) | ||||||||
  No | 35.9** | 30.9 | 32.9* | 32.5* | 32.7** | 34.7 | 25.7** | 44.4 |
  Yes | 47.5** | 52.8 | 50.6** | 51.6 | 51.1** | 46.8 | 60.1** | 35.7 |
  Not reported | 16.6* | 16.3 | 16.5** | 15.9 | 16.2** | 18.5 | 14.2** | 19.9 |
State Factors | ||||||||
 Medicaid coverage of ASAM recommended treatment services (mean) | 87.1** | 58.7 | 72.0** | 59.1 | 69.2** | 72.6 | 65.0** | 76.6 |
 Newly certified provider capacity for buprenorphine/naloxone per 100,000 state population during year of index stay (mean) | 86.2** | 76.4 | 79.9** | 80.9 | 78.8** | 96.1 | 95.6** | 55.0 |
 Number of opioid treatment programs per 100,000 state population during year of index stay (mean) | 0.6* | 0.6 | 0.6** | 0.5 | 0.6** | 0.1 | 0.7** | 0.3 |
 SUD treatment capacity per 100,000 state population during year of index stay (mean) | 43.4** | 42.2 | 45.2** | 32.4 | 43.7** | 30.5 | 48.6** | 33.0 |
 Opioid overdose death rate during year of index stay (mean) | 9.1** | 9.3 | 8.7** | 11.4 | 9.1** | 11.0 | 10.7** | 6.9 |