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How Mass General Cut Readmission Risk for Substance Use Disorders by 25%

In This Article

  • A 2012 Mass General community survey identified substance use as the most important issue faced in communities served by the hospital
  • The Substance Use Disorders (SUDs) Initiative was formed in response to this result
  • The SUDs Initiative provides comprehensive continuity of care for substance use patients across settings

Massachusetts General Hospital has been actively engaged in creating a comprehensive plan to help patients confront substance use disorders (SUDs) since a 2012 community survey. That survey, conducted in the communities served by the hospital, found that 60-75% of patients identified substance use as the most important issue faced by their community.

In response, the hospital formed the Substance Use Disorders Initiative, a hospital-wide program designed to transform care and improve accessibility of care for patients facing this illness. The initiative is a collaborative effort between the following:

The SUDs Initiative's three-step plan was profiled in a post on the Advisory Board's Care Transformation Center Blog.

A Three-step Plan: SUDs Initiative Provides Care Across Settings

1. Inpatient Care: The Addiction Consult Team

The multidisciplinary Addiction Consult Team works with patients during inpatient stays to assess and address their SUD-specific treatment needs. The team is made up of nurse practitioners, psychiatrists, social workers, internists and peer recovery coaches with specialized SUDs training and experience. This group evaluates patients and makes treatment recommendations for tailored care plans. It is estimated that the work of this team lowers the chances of readmission by 25%.

2. Connections to Ongoing Care: The Bridge Clinic

The Bridge Clinic offers low-barrier transitional care. The goal of the clinic is harm reduction and helping patients maintain medical wellness. It provides a variety of services, including addiction pharmacotherapy, peer support and brief psychotherapy, and helps connect patients to long-term care. The clinic's model appears to be working—only 10% of these patients are readmitted to the hospital within 30 days.

3. Long-term Care: Community Health Centers

Mass General's community health centers provide patients with direct access to SUD treatment in the context of a primary care setting. A key component of this care is the peer recovery coaches, who provide not only motivational support, but also assist patients in overcoming treatment barriers.

estimated reduction in readmission for substance use issues as a result of the work of the Addiction Consult Team

of Bridge Clinic patients readmitted to the hospital within 30 days

Learn more about the Substance Use Disorders Initiative

Learn more about the Center for Addiction Medicine

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