Table 4.

Association of hospital, community, and state policy factors and 4 of 9 hospital-implemented substance abuse initiatives among a national sample of nonprofit hospitals (N = 446) used to explore how nonprofit hospitals are addressing opioid use disorder in their communities, United States, 2015-2018^a

Factor	Hospital-implemented initiative
	Social determinants	Emergency department services	Policy advocacy	Community coalition
Hospital characteristics
Hospital belongs to a health care system
Yes	2.39 (0.82-6.97)	0.69 (0.38-1.27)	1.86 (0.50-6.95)	1.10 (0.66-1.81)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
Hospital is a teaching hospital
Yes	1.80 (0.29-10.97)	0.79 (0.26-2.43)	1.29 (0.26-6.39)	0.75 (0.26-2.18)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
No. of beds at hospital
<50	4.30 (0.60-30.58)	0.58 (0.20-1.68)	0.27 (0.05-1.56)	1.51 (0.60-3.8)
50-199	2.05 (0.33-12.71)	0.73 (0.29-1.85)	0.16 (0.03-0.82)b	1.90 (0.82-4.37)
200-399	4.52 (0.77-26.56)	0.73 (0.28-1.89)	0.63 (0.16-2.43)	1.16 (0.48-2.77)
≥400	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
County characteristics
Rural location
Yes	1.72 (0.56-5.23)	1.32 (0.66-2.66)	1.95 (0.50-7.57)	1.21 (0.70-2.09)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
Percentage <138% federal poverty level
Yes	0.95 (0.90-1.02)	1.00 (0.96-1.04)	0.98 (0.91-1.06)	0.99 (0.96-1.02)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
State policiesc
Medicaid expansion
Yes	4.75 (0.88-25.67)	1.08 (0.48-2.44)	1.40 (0.33-5.92)	0.94 (0.51-1.73)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
Targeted risk education
Yes	0.86 (0.33-2.27)	1.09 (0.58-2.05)	0.58 (0.20-1.75)	1.11 (0.68-1.82)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
Provider education
Yes	0.49 (0.17-1.43)	1.03 (0.52-2.03)	2.53 (0.59-10.78)	1.03 (0.60-1.76)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
MAT funding
Yes	2.87 (0.85-9.75)	1.16 (0.50-2.68)	0.79 (0.21-3.03)	0.75 (0.40-1.42)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
Naloxone access
Yes	1.85 (0.53-6.43)	1.57 (0.69-3.60)	1.41 (0.36-5.48)	1.48 (0.79-2.76)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
PDMP reporting
Yes	0.37 (0.11-1.33)	2.03 (1.00-4.12)	1.01 (0.28-3.59)	1.66 (0.96-2.87)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
Pain management regulations
Yes	1.09 (0.27-4.46)	0.34 (0.15-0.79)b	1.69 (0.40-7.19)	0.62 (0.32-1.18)
No	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
Prescriber guidelines
Yes	2.48 (0.77-7.97)	1.76 (0.90-3.44)	1.42 (0.42-4.79)	0.91 (0.54-1.53)
No	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 5 hospital initiatives are presented in Table 3.

^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.