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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Estee
Sharon
S
Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, WA 98504-5204, USA. EsteeSL@dshs.wa.gov
Wickizer
Thomas
T
He
Lijian
L
Shah
Melissa Ford
MF
Mancuso
David
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006742:Hospital Bed Capacity; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration*; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D014481:United States; D014861:Washington; D055815:Young Adult