title: An inpatient treatment and discharge planning protocol for alcohol dependence: efficacy in reducing 30-day readmissions and emergency department visits.
abstract: BACKGROUND
  Alcohol dependence results in multiple hospital readmissions, but no discharge planning protocol has been studied to improve outcomes. The inpatient setting is a frequently missed opportunity to discuss treatment of alcohol dependence and initiate medication-assisted treatment, which is effective yet rarely utilized.
  
  
  OBJECTIVE
  Our aim was to implement and evaluate a discharge planning protocol for patients admitted with alcohol dependence.
  
  
  METHODS
  The study took place at the San Francisco General Hospital (SFGH), a university-affiliated, large urban county hospital.
  
  
  METHODS
  Learner participants included Internal Medicine residents at the University of California, San Francisco (UCSF) who staff the teaching service at SFGH. Patient participants included inpatients with alcohol dependence admitted to the Internal Medicine teaching service.
  
  
  METHODS
  We developed and implemented a discharge planning protocol for patients admitted with alcohol dependence that included eligibility assessment and initiation of medication-assisted treatment.
  
  
  RESULTS
  Rates of medication-assisted treatment increased from 0% to 64% (p value < 0.001). All-cause 30-day readmission rates to SFGH decreased from 23.4% to 8.2% (p value = 0.042). All-cause emergency department visits to SFGH within 30 days of discharge decreased from 18.8% to 6.1% (p value = 0.056).
  
  
  CONCLUSIONS
  Through implementation of a discharge planning protocol by Internal Medicine residents for patients admitted with alcohol dependence, there was a statistically significant increase in medication-assisted treatment and a statistically significant decrease in both 30-day readmission rates and emergency department visits.
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA, jennie.wei@ihs.gov.
authors.forename: Jennie
authors.initials: J
authors.lastname: Wei
authors.forename: Triveni
authors.initials: T
authors.lastname: Defries
authors.forename: Mia
authors.initials: M
authors.lastname: Lozada
authors.forename: Natalie
authors.initials: N
authors.lastname: Young
authors.forename: William
authors.initials: W
authors.lastname: Huen
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Tulsky
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000628:therapy*; D002985:Clinical Protocols / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards / Q000639:trends*; D010359:Patient Readmission / Q000592:standards / Q000639:trends*; D016320:Substance Abuse Treatment Centers / Q000379:methods / Q000592:standards / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome
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