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. 2020 Nov 11;136(2):228–238. doi: 10.1177/0033354920968805

Table 3.

Association of hospital, community, and state policy factors and 5 of 9 hospital-implemented substance abuse initiatives among a national sample of nonprofit hospitals (N = 446) to explore how nonprofit hospitals are addressing opioid use disorder in their communities, United States, 2015-2018a

Characteristic Hospital-implemented initiative
Substance abuse treatment Primary care Harm reduction Prescriber initiatives Risk education
Hospital characteristics
Hospital belongs to a health care system
 Yes 0.96 (0.57-1.60) 1.03 (0.62-1.72) 1.29 (0.49-3.43) 0.60 (0.26-1.40) 1.67 (1.01-2.75)b
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
Hospital is a teaching hospital
 Yes 1.03 (0.43-2.49) 2.47 (1.00-6.05)b 0.93 (0.17-5.05) 1.50 (0.33-6.81) 0.99 (0.40-2.42)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
No. of beds at hospital
 <50 0.69 (0.30-1.60) 1.35 (0.54-3.38) 1.81 (0.38-8.60) 0.74 (0.14-4.00) 0.77 (0.33-1.76)
 50-199 0.55 (0.26-1.15) 1.70 (0.76-3.79) 0.28 (0.06-1.30) 1.11 (0.25-4.91) 0.75 (0.36-1.57)
 200-399 0.55 (0.26-1.17) 2.22 (1.00-4.93)b 0.35 (0.07-1.67) 1.06 (0.25-4.44) 1.16 (0.56-2.44)
 ≥400 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
County characteristics
Rural location
 Yes 0.81 (0.46-1.44) 0.86 (0.48-1.53) 0.39 (0.12-1.25) 1.01 (0.36-2.79) 1.95 (1.14-3.36)b
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
Percentage <138% federal poverty level 0.96 (0.93-0.99)b 0.98 (0.95-1.01) 0.93 (0.87-1.00) 1.01 (0.95-1.07) 0.96 (0.93-0.99)b
State policiesc
Medicaid expansion
 Yes 1.68 (0.88-3.20) 0.69 (0.37-1.29) 2.13 (0.59-7.70) 2.16 (0.65-7.22) 1.32 (0.74-2.37)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
Targeted risk education
 Yes 1.09 (0.65-1.81) 1.73 (1.05-2.87)b 4.39 (1.26-15.26)b 2.25 (0.82-6.20) 1.14 (0.72-1.82)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
Provider education
 Yes 0.71 (0.41-1.22) 0.43 (0.25-0.76)d 0.28 (0.11-0.73)b 1.44 (0.54-3.84) 0.93 (0.55-1.56)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
MAT funding
 Yes 0.78 (0.41-1.49) 1.55 (0.81-2.98) 0.15 (0.03-0.79)b 0.31 (0.08-1.17) 0.72 (0.40-1.31)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
Naloxone access
 Yes 1.34 (0.71-2.54) 1.41 (0.76-2.59) 8.43 (1.61-44.21)b 1.25 (0.34-4.59) 1.57 (0.88-2.80)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
PDMP reporting
 Yes 1.29 (0.73-2.29) 0.87 (0.49-1.52) 1.95 (0.47-8.16) 3.54 (1.17-10.71)b 1.06 (0.63-1.79)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
Pain management regulations
 Yes 1.21 (0.62-2.38) 0.58 (0.30-1.13) 4.51 (1.22-16.69)b 1.03 (0.31-3.37) 1.02 (0.55-1.90)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
Prescriber guidelines
 Yes 1.51 (0.89-2.57) 2.34 (1.37-3.98)d 1.01 (0.33-3.12) 0.29 (0.11-0.81)d 1.15 (0.71-1.88)
 No 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]

Abbreviations: MAT, medication-assisted treatment; PDMP, prescription drug monitoring program.

aSample was drawn from a 20% random sample of all US nonprofit hospitals (n = 2715) in each state using the American Hospital Association’s 2015 Annual Survey database.24 All values are odds ratio (95% CI). Data on the other 4 hospital initiatives are presented in Table 4.

bSignificant at P < .05 using a 2-tailed Wald χ2 test.

cList of 7 state policies was developed by Wickramatilake and colleagues26; Medicaid expansion was added by the authors.

dSignificant at P < .01 using a 2-tailed Wald χ2 test.