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Table 3 Multivariate results: adjusted association of 90-day readmission and state policiesa

From: State variation in opioid treatment policies and opioid-related hospital readmissions

Variable

90-Day Readmission

OR

95% CI

Key Independent Variables

 Naloxone standing orders

1.14***

1.07–1.20

 Good Samaritan laws

1.07

0.97–1.19

 Methadone coverage by Medicaid, by payer (reference: without methadone coverage)b

  Medicaid

1.23

0.97–1.56

  Medicare

1.40**

1.15–1.72

  Private insurance

1.87***

1.44–2.41

  Uninsured

1.57*

1.06–2.33

  Other insurance/missing

0.99

0.56–1.72

 MAT coverage generosity by Medicaid, by payer (reference: less generous coverage)c

  Medicaid

1.28**

1.11–1.48

  Medicare

0.80**

0.70–0.91

  Private insurance

0.74***

0.63–0.85

  Uninsured

1.20

0.95–1.51

  Other insurance/missing

1.14

0.86–1.50

Covariates

Patient Sociodemographic Characteristics

 Age

0.99***

0.99–0.99

 Female

0.86***

0.83–0.90

 Race/ethnicity (reference: White)

  Black

0.97

0.91–1.03

  Hispanic

1.05

0.98–1.11

  Other

0.97

0.89–1.05

  Missing

0.78*

0.63–0.97

 Median community-level income (reference: Quartile 4, highest)

  Quartile 1 (lowest)

0.87***

0.82–0.92

  Quartile 2

0.84***

0.79–0.89

  Quartile 3

0.87***

0.82–0.92

  Missing

0.95

0.86–1.05

 Patient location: rural (reference: urban)

0.84***

0.78–0.92

Patient Clinical Factors

 Opioid-related diagnosis: principal (reference: secondary diagnosis only)

1.88***

1.79–1.98

 Any opioid abuse or dependence

0.83***

0.76–0.90

 Continuous opioid abuse or dependence

1.16***

1.10–1.21

 Mental health co-occurring diagnosis

1.09**

1.03–1.15

 Alcohol abuse co-occurring diagnosis

1.01

0.96–1.06

 Number of co-occurring physical conditionsd

1.29**

1.08–1.53

Initial Hospital Stay Characteristics

 Hospital stay began in emergency department

1.16***

1.11–1.22

 Length of index stay

0.98***

0.98–0.99

 Receipt of rehabilitation during index stay

1.96***

1.84–2.09

Hospital Characteristics

 Percentage of annual opioid-related discharges in index year

1.02***

1.02–1.03

 Alcohol/ SUD detoxification unit (reference: no unit)

  Yes

1.27***

1.20–1.34

  Not reported

0.90

0.33–2.43

 Psychiatric acute care unit (reference: no unit)

  Yes

1.01

0.96–1.06

  Not reported

1.23

0.45–3.33

State Factors

 Medicaid coverage of all four ASAM recommended services

0.74***

0.66–0.82

 Newly certified provider capacity for buprenorphine/naloxone per 100,000 state population during year of index stay

1.00*

1.00–1.00

 Number of opioid treatment programs per 100,000 state population during year of index stay

0.35***

0.28–0.44

 SUD treatment capacity per 100,000 state population during year of index stay

1.04***

1.03–1.04

 Opioid overdose death rate during year of index stay

1.02*

1.01–1.04

  1. ASAM American Society of Addiction Medicine, CI confidence interval, MAT medication-assisted treatment, OR odds ratio, SUD substance use disorder
  2. *p < 0.05; **p < 0.01; ***p < 0.001
  3. aThe model also controlled for co-occurring physical conditions and year of discharge, which are not listed in the table
  4. bOdds ratios were calculated by using an interaction term for Medicaid methadone coverage and each of the payer groups
  5. cThis is a composite variable of preauthorization requirements for buprenorphine/naloxone, preauthorization for naltrexone, dosing limits for buprenorphine/naltrexone, and substance use disorder counseling requirements. Odds ratios were calculated by using an interaction term for Medicaid MAT generosity and each of the payer groups
  6. dCo-occurring conditions were formulated from 25 Elixhauser comorbidities (excluding mental health substance abuse variables, which are reported as separate variables)