BackgroundPrior single‐hospital studies have documented barriers to acceptance that hospitalized patients with opioid use disorder (OUD) face when referred to skilled nursing facilities (SNFs).ObjectiveTo examine the impact of OUD on the number of SNF referrals and the proportion of referrals accepted.Design, Settings, and ParticipantsA retrospective cohort study of hospitalizations with SNF referrals in 2019 at two academic hospitals in Baltimore, MD.ExposureOUD status was determined by receipt of medications for OUD during admission, upon discharge, or the presence of a diagnosis code for OUD.Key ResultsThe cohort included 6043 hospitalizations (5440 hospitalizations of patients without OUD and 603 hospitalizations of patients with OUD). Hospitalizations of patients with OUD had more SNF referrals sent (8.9 vs. 5.6, p < .001), had a lower proportion of SNF referrals accepted (31.3% vs. 46.9%, p < .001), and were less likely to be discharged to an SNF (65.6% vs. 70.3%, p = .003). The effect of OUD status on the number of SNF referrals and the proportion of referrals accepted remained significant in multivariable analyses. Our subanalysis showed that reduced acceptances were driven by the hospitalizations of patients discharged without medications for OUD and those receiving methadone. Hospitalizations of patients discharged on buprenorphine were accepted at the same rates as hospitalizations of patients without OUD.ConclusionsThis multicenter retrospective cohort study found that hospitalizations of patients with OUD had more SNF referrals sent and fewer referrals accepted. Further work is needed to address the limited discharge options for patients with OUD.

中文翻译：

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阿片类药物使用障碍与熟练护理机构接受程度之间的关联：一项多中心回顾性队列研究

背景先前的单家医院研究记录了患有阿片类药物使用障碍（OUD）的住院患者在转诊至熟练护理机构（SNF）时面临的接受障碍。目的探讨 OUD 对 SNF 转诊数量和接受转诊比例的影响。设计、设置和参与者对 2019 年在马里兰州巴尔的摩的两家学术医院进行的 SNF 转诊住院回顾性队列研究。暴露 OUD 状态是通过入院期间、出院时收到 OUD 药物或是否存在 OUD 诊断代码来确定的主要结果 该队列包括 6043 例住院患者（5440 例住院的无 OUD 患者和 603 例住院的 OUD 患者）。OUD 住院患者收到更多 SNF 转诊（8.9 比 5.6，p< .001)，接受 SNF 推荐的比例较低（31.3% 对比 46.9%，p< .001），并且不太可能被出院至 SNF（65.6% vs. 70.3%，p=.003）。在多变量分析中，OUD 状态对 SNF 转诊数量和接受转诊比例的影响仍然显着。我们的子分析显示，接受率下降是由于未接受 OUD 药物治疗而出院的患者和接受美沙酮治疗的患者住院所致。使用丁丙诺啡出院的患者的住院接受率与未使用 OUD 的患者的住院率相同。结论这项多中心回顾性队列研究发现，使用 OUD 住院的患者发送的 SNF 转诊较多，接受的转诊较少。需要进一步开展工作来解决 OUD 患者出院选择有限的问题。