PINC AI™ Data: Urgent Hospital Care for Opioid Use Disorders Varies Heavily by State

Key Takeaways:

• Serious opioid use disorders (OUDs) that require emergency department (ED) care and subsequent inpatient or outpatient care are not evenly distributed across the states.
• Fourteen states and the District of Columbia provided emergency care for a larger percentage of patients with OUD than the national average.
• New Mexico (7.09 percent) and New Jersey (5.54 percent) had the highest proportion of hospital inpatient visits with OUD diagnosis, followed by Washington, Oregon, Massachusetts, Maryland, Connecticut, West Virginia and Arizona.

New data from PINC AI™ Applied Sciences (PAS) shows that the prevalence of opioid use disorder (OUD) is not evenly distributed across states.

Across the country, PINC AI™ data shows about 2.28 percent of ED inpatient admissions had OUD diagnoses. However, in New Mexico, the percentage of inpatients with OUD was nearly triple the national average at 7.09 percent. In New Jersey, the percentage was about two times higher than the national average, while states like Washington, Oregon, Massachusetts and Maryland had percentages nearly double the national average.

Additionally, 14 states and the District of Columbia provided emergency outpatient care for a larger percentage of patients with OUD than the national average of 0.58 percent with New Jersey having the highest proportion of 2.29 percent.

States with higher-than-average OUD encounters are more likely to serve a higher population of patients living in poverty (defined as those living below the poverty line and qualifying for Medicaid, the uninsured and/or homeless) and indigenous people, which have the highest prevalence of OUD-related healthcare needs.

States in bold treated a higher percentage of OUDs than the national average. Note: There was insufficient data to determine the prevalence of OUDs in Idaho, Maine, New Hampshire, Rhode Island, Utah and Vermont.

Behind the Numbers: A Nation in Crisis

OUD is a complex illness characterized by chronic, compulsive pattern of opioid drug use even when the person wants to stop, or when using the drugs creates physical impairment and/or distress.

Though opioids can be prescribed by a doctor to treat pain, misuse of opioids (including morphine, codeine, oxycodone, hydrocodone, fentanyl and heroin) may lead to an opioid use disorder. According to the U.S. Centers for Disease Control, more than 932,000 people have died since 1999 from a drug overdose, and nearly 75 percent of drug overdose deaths in 2020 involved an opioid.

The devastating effect of OUD on individuals, families, society and healthcare system led to the declaration of the opioid crisis as a public health emergency by the U.S. Department of Health and Human Services in 2017.

How Leading Health Systems are Innovating for Change

Leading hospitals are taking control of the OUD epidemic situation in various ways.

• Advocating for solutions. Premier and its members are strong advocates for improving regulations and policies to help tackle the opioid epidemic, including legislation to remove limits around care coordination for addiction. For example, the passage of the Overdose Prevention and Patient Safety Act in June 2018 is paving the way to modernize a 40-year-old regulation that has impeded healthcare providers' ability to diagnose, treat and prevent addiction and other opioid-related disorders.
• Using high-quality services and solutions to support better pain management practices. By understanding which products most safely and effectively help patients recover from pain and prevent addiction, hospitals can ensure their patients receive the right care from the onset. Using learnings from its members, Premier developed a Safer Pain Management Toolkit that provides easy-to-access information and an aggregated inventory of products, solutions and resources that support pain management methods to improve patient safety.
• Applying business intelligence to understand how these patients are cared for in the hospital. Hospital data that shows opioid visits, utilization and prescribing practices in various units, and especially the emergency department (ED), can help providers understand where they have opportunities to build new care models for these patients. PAS conducted an analysis looking at these factors in the ED across nearly 750 hospitals to understand national trends, affected populations and national costs of treatment.
• Leveraging technology to monitor and track patients in real time. Technology makes it easier than ever to monitor patients’ statuses across units, even between in-person clinical rounds, to help prevent adverse outcomes. For example, medication surveillance solutions can fire real-time alerts when a patient receives a potentially high-risk drug or a drug that could cause a dangerous interaction. Also useful are clinical decision support tools, which help clinicians select the correct dosage and duration of drugs, and solutions that monitor patients who are prescribed high-dose, extended-release opioids, to help screen for signs of overdose.

There is an urgent need to provide health systems and emergency caregivers with frontline solutions to stem the tide of opioid addiction in our communities. Providers leveraging these best practices are creating focused initiatives to reduce pain management and addiction specifically for the patients who need them.

Methodology

Leveraging the largest hospital discharge database in the U.S., the PINC AI ™ Healthcare Database (PHD), data scientists analyzed all discharges for ED outpatient visits and inpatient admissions occurred during Q1 of 2017 and Q1 of 2022. OUD was defined as having a principal or secondary discharge diagnosis of opioid abuse (ICD-10 diagnosis codes: F11.2 percent), opioid dependence (ICD-10 diagnosis codes: F11.2 percent), or unspecified opioid use (ICD-10 diagnosis codes: F11.9 percent) disorder. Prevalence of OUD was estimated for ED outpatient visits and inpatient admissions separately. Mean total cost of care was also reported for ED outpatient visits and inpatient admissions separately by OUD status. National estimates were created by leveraging prevalence and cost estimates from the PHD analysis and the total number of ED outpatient visits reported from the 2018 National Hospital Ambulatory Medical Care Survey and the total number of inpatient visits from the 2020 American Hospital Association Annual Survey.   

Read the additional blogs in the PINC AI™ opioids data series:

• Check out our first blog in the PINC AI™ opioids data series to see just how much OUD is costing the U.S. healthcare system.
• The third and final blog provides a deep dive into data revealing the health disparities associated with OUD.