Table 3.
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.