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Two new studies on the #OpioidCrisis. During residency, we treated countless patients w/ opioid use disorder in the hospital w/ infections like endocarditis. They spent weeks hospitalized, discharge options would be limited, many would discharge themselves #MedTwitter
2/ In @PLOSMedicine, we found this was happening nationally - patients w/ OUD & serious infections stayed in the hospital for many days longer than counterparts w/o OUD - with significant financial implications https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003247
3/ Many possible reasons for this including reluctance to send patients w/ OUD to home w/ IVs and excellent recent research by @simkimmel et al showing discrimination by post-acute care facilities https://twitter.com/simkimmel/status/1283771136539611137?s=20
4/ Plus nearly 20% of discharges were patient-directed discharges (or "against medical advice" as it's commonly known but hopefully we'll phase it out of our med lingo). Previous research (+ clinical experience) shows these are associated w/ readmissions, complications, death.
5/ The huge rise in patient-directed discharges was confirmed in our CID @IDSAInfo study led by @simkimmel on people w/ IV drug use & endocarditis. 12% in 2010, 21% in 2015 @AlexanderWalley @LarochelleMarc @UnhealthyAlcDrg @The_BMC @BrighamDGIM https://academic.oup.com/cid/cid/advance-article-abstract/doi/10.1093/cid/ciaa1126/5881411#.Xy11MUU7wic.twitter
6/ Keeping patients hospitalized for weeks, esp during #COVID19, is nonsensical if it's only b/c we lack discharge options due to discrimination, homelessness, etc. Also need to tackle underlying issues for patient-directed discharges e.g. SUD treatment/addiction consults, stigma
7/ Big thanks to amazing mentor @ShaniHerzig whose @Health_Affairs study w/ @mvronan inspired this as well as co-authors @daniellefineMD Lily Li @simkimmel Long Ngo @ChristinPrice Joji Suzuki @BIDMC_GenMedRes @The_BMC @BostonChiefs @BrighamDGIM @SocietyHospMed @SocietyGIM
