title: Early data from Project Engage: a program to identify and transition medically hospitalized patients into addictions treatment.
abstract: BACKGROUND
  Patients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients.
  
  
  METHODS
  Program-level data on treatment entry after discharge were examined retrospectively. Insurance claims data for two small cohorts who entered treatment after discharge (2009, n = 18, and 2010, n = 25) were reviewed over a six-month period in 2009 (three months pre- and post-Project Engage), or over a 12-month period in 2010 (six months pre- and post-Project Engage). These data provided descriptive information on health-care utilization and costs. (Data on those who participated in Project Engage but did not enter treatment were unavailable).
  
  
  RESULTS
  Between September 1, 2008, and December 30, 2010, 415 patients participated in Project Engage, and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009, and November 30, 2009 (n = 18), insurance claims demonstrated a 33% ($35,938) decrease in inpatient medical admissions, a 38% ($4,248) decrease in emergency department visits, a 42% ($1,579) increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% ($847) increase in outpatient BH/SA admissions, for an overall decrease of $37,760. For a small cohort who participated between June 1, 2010, and November 30, 2010 (n = 25), claims demonstrated a 58% ($68,422) decrease in inpatient medical admissions; a 13% ($3,308) decrease in emergency department visits; a 32% ($18,119) decrease in BH/SA inpatient admissions, and a 32% ($963) increase in outpatient BH/SA admissions, for an overall decrease of $88,886.
  
  
  CONCLUSIONS
  These findings demonstrate that a large percentage of patients entered SUD treatment after participating in Project Engage, a novel intervention with facilitated referral to treatment. Although the findings are limited by the retrospective nature of the data and the small sample sizes, they do suggest a potentially cost-effective addition to existing hospital services if replicated in prospective studies with larger samples and controls.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Pecoraro
authors.forename: Terry
authors.initials: T
authors.lastname: Horton
authors.forename: Edward
authors.initials: E
authors.lastname: Ewen
authors.forename: Julie
authors.initials: J
authors.lastname: Becher
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Wright
authors.forename: Basha
authors.initials: B
authors.lastname: Silverman
authors.forename: Patty
authors.initials: P
authors.lastname: McGraw
authors.forename: George E
authors.initials: GE
authors.lastname: Woody
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000534:rehabilitation*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation; D014481:United States