Suboxone (Buprenorphine/Naloxone) is associated with Lower Hospital Readmission Rates for Narcotic Dependence Patients at Adcare Hospital Of Worcester based on Real World Evidence Study of Medicare Claims Data

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In Suboxone, Narcotic Dependence

By: Sara Riascos  Apr. 04, 2022

Background:

Narcotic Dependence is frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payers such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Suboxone (Buprenorphine/Naloxone) is a combination of buprenorphine and naloxone, used to treat opioid addiction. Studies have shown that Suboxone (Buprenorphine /Naloxone) is effective in reducing opioid use short term relative to placebo.

Dexur’s analysis of Real-World Evidence based on Medicare Claims data showed that the use of Suboxone (Buprenorphine/Naloxone) within 7 days of hospitalization was associated with lower hospital readmission rates for Narcotic Dependence Patients at Adcare Hospital Of Worcester in Worcester, Massachusetts. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real-World Evidence from Medicare Claims data, for hospitalizations at Adcare Hospital Of Worcester between January 2017 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Narcotic Dependence related codes (Listed in table below)
2. Stratified Selected population into cohorts
   1. Narcotic Dependence patients dispensed Suboxone (Buprenorphine/Naloxone) within 7 Days of Hospitalization using Part D drugs claims database
   2. Narcotic Dependence patients not dispensed with Suboxone (Buprenorphine/Naloxone) within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Suboxone (Buprenorphine/Naloxone) was associated with lower hospital readmission rates for all Primary ICD/DRG Diagnosis Codes examined at Adcare Hospital Of Worcester . For patients whose primary DRG Diagnosis was “Detoxification Services for Substance Abuse Treatment” (HZ2ZZZZ) and when Suboxone (Buprenorphine/Naloxone) was used within 7 days of hospitalization, the readmission rate was 26.64% compared to the cohort where Suboxone (Buprenorphine/Naloxone) was not used, whose readmission rate was 32.21%. The readmission odds ratio for these cohorts was 0.69. The use of Suboxone (Buprenorphine/Naloxone) was associated with a 31% lower readmission rate when used within 7 days of hospitalization. The full list of studied ICD/DRG codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Suboxone (Buprenorphine/Naloxone) at Adcare Hospital Of Worcester is shown below.

Primary ICD/DRG Diagnosis Code	Primary ICD/DRG Diagnosis Code Description	Total Hospitalizations without Suboxone (Buprenorphine/Naloxone)	Readmission Without Suboxone (Buprenorphine/Naloxone)	Readmission Rate without Suboxone (Buprenorphine/Naloxone)	Total Hospitalizations with Suboxone (Buprenorphine/Naloxone)	Readmission with Suboxone (Buprenorphine/Naloxone)	Readmission Rate with Suboxone (Buprenorphine/Naloxone)	Readmission Odds Ratio	Reduction in Readmission with Suboxone (Buprenorphine/Naloxone) (%)	Confidence Interval (-)	Confidence Intervals (+)
HZ2ZZZZ	Detoxification Services for Substance Abuse Treatment	7,610	2451	32.21%	138	34	24.64%	0.69	31%	-8%	-7%
897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Major Complication Or Comorbidity (MCC)

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Narcotic Dependence were not prescribed Suboxone (Buprenorphine/Naloxone) within 7 days of discharge.

ICD/DRG CODE	Hospital	Hospitalizations with Narcotic Dependence	% of Hospitalizations without Suboxone
HZ2ZZZZ	Adcare Hospital Of Worcester	7,644	99.56%
	Christus St Michael Hospital	860	98.60%
	Christus St Michael Hospital	4,453	At Least 99.78%
897	Adcare Hospital Of Worcester	4,117	99.42%
	WVU Medicine Chestnut Ridge Center - Morgantown	158	93.04%
	Berkshire Medical Center	860	98.60%

​Hospitalizations with Narcotic Dependence = Above Listed ICD/DRG Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real-World Evidence of Medicare Claims data, for hospitalizations between January January 2017 to September 2019, the use of Suboxone (Buprenorphine/Naloxone) within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Narcotic Dependence patients at Adcare Hospital Of Worcester . This analysis shows that a significant number of Patients are not dispensed Suboxone (Buprenorphine /Naloxone) after Narcotic Dependence hospitalizations at Adcare Hospital Of Worcester or major US Hospitals.