Thomas Mason1, William Whittaker1, Andrew Jones1, Matt Sutton1,2. 1. Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. 2. Melbourne Institute, Applied Economic and Social Research, Melbourne, Australia.
Abstract
AIMS: To estimate how a scheme to pay substance misuse treatment service providers according to treatment outcomes affected hospital admissions. DESIGN: A controlled, quasi-experimental (difference-in-differences) observational study using negative binomial regression. SETTING: Hospitals in all 149 organisational areas in England for the period 2009-2010 to 2015-2016. PARTICIPANTS: 572 545 patients admitted to hospital with a diagnosis indicating drug misuse, defined based on International Classification of Diseases 10th Revision (ICD-10) diagnosis codes (37 964 patients in 8 intervention areas and 534 581 in 141 comparison areas). INTERVENTION AND COMPARATORS: Linkage of provider payments to recovery outcome indicators in 8 intervention organisational areas compared with all 141 comparison organisational areas in England. Outcome indicators included: abstinence from presenting substance, abstinent completion of treatment and non-re-presentation to treatment in the 12 months following completion. MEASUREMENTS: Annual counts of hospital admissions, emergency admissions and admissions including a diagnosis indicating drugs misuse. Covariates included age, sex, ethnic origin and deprivation. FINDINGS: For 37 245 patients in the intervention areas, annual emergency admissions were 1.073 times higher during the operation of the scheme compared with non-intervention areas (95% CI = 1.049; 1.097). There were an estimated additional 3 352 emergency admissions in intervention areas during the scheme. These findings were robust to a range of secondary analyses. CONCLUSION: A programme in England from 2012 to 2014 to pay substance misuse treatment service providers according to treatment outcomes appeared to increase emergency hospital admissions.
AIMS: To estimate how a scheme to pay substance misuse treatment service providers according to treatment outcomes affected hospital admissions. DESIGN: A controlled, quasi-experimental (difference-in-differences) observational study using negative binomial regression. SETTING: Hospitals in all 149 organisational areas in England for the period 2009-2010 to 2015-2016. PARTICIPANTS: 572 545 patients admitted to hospital with a diagnosis indicating drug misuse, defined based on International Classification of Diseases 10th Revision (ICD-10) diagnosis codes (37 964 patients in 8 intervention areas and 534 581 in 141 comparison areas). INTERVENTION AND COMPARATORS: Linkage of provider payments to recovery outcome indicators in 8 intervention organisational areas compared with all 141 comparison organisational areas in England. Outcome indicators included: abstinence from presenting substance, abstinent completion of treatment and non-re-presentation to treatment in the 12 months following completion. MEASUREMENTS: Annual counts of hospital admissions, emergency admissions and admissions including a diagnosis indicating drugs misuse. Covariates included age, sex, ethnic origin and deprivation. FINDINGS: For 37 245 patients in the intervention areas, annual emergency admissions were 1.073 times higher during the operation of the scheme compared with non-intervention areas (95% CI = 1.049; 1.097). There were an estimated additional 3 352 emergency admissions in intervention areas during the scheme. These findings were robust to a range of secondary analyses. CONCLUSION: A programme in England from 2012 to 2014 to pay substance misuse treatment service providers according to treatment outcomes appeared to increase emergency hospital admissions.