Project Engage

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Project Engage

• Basha Silverman,
• Director of Prevention and Advocacy,
• Brandywine Counseling and Community Services
• Terry Horton, MD, FACP
• Chief, Division of Addiction Medicine
• Department of Medicine
• April 3, 2012

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Patient Centered Medical Home
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Substance Use and the Medically Homeless

• Participation assumes compliance
• Substance Use is often the Root Cause Health
  Issue
• If dont address, will remain Medically Homeless
  with significant health issues

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Delawares Epidemiology

• Estimated 2009 population of 885,000
• 9 of adults alcohol/drug abusing or dependent
• 65,000 in need of alcohol/drug treatment
• 8,216 admissions to publicly-funded SA treatment
  services statewide 2006

Tx gap
2004-2005 NSDUH data Wright et al.
2007 Delaware Department of Health and Social
Services, Division of Substance Abuse and
Mental Health, 2007
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Hospitals Inpatient Services Aggregate the
Highly Disordered

• High rates of alcohol and substance dependency
• Significant medical comorbidities
• Expensive revolving door
• higher use of ER (2.3x), inpatient care (6.7x)
• Increased AMA, readmissions

Saitz, 2007 Bertholet, 2010 Stein, 1993
Hwang, 2003 Jankowski, 1977 Chan, 2004
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An Emerging Imperative
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Project Engage

• Targeting hospitalized substance users
• Bedside Peer-to-peer intervention using
  Motivational Interviewing
• Addictions Community Social Worker
• Assistance with barriers to transition to care
• Help with integration into the hospital milieu

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Project Engage

• Initial Pilot at Wilmington Hospital 2008
• Roll out to Christiana Hospital Dec. 2012
• 2 additional Patient Engagement Specialists
• Social Worker
• Rigorous Program Evaluation (May,2012)
• Partnership with U. Pennsylvania, TRI, and State
  Medicaid Office
• Demographics, Engagement parameter and health
  economics

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Gender
667 Patients seen 9/1/08 -3/30/12
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Race
667 Patients seen 9/1/08 -3/30/12
Project Engage - Gender
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Age
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Drug of Choice
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Patient Experience
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Health Insurance
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Outcomes

• Data Review
• N 423 (9/1/08 - 12/10/10)
• 41 successfully admitted into 33 drug/alcohol
  treatment programs
• Overall 667 seen- (9/1/08 -3/30/12)
• Overall 36 successfully engaged into care/drug
  treatment

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DPCI/Aetna Data
Modified from Wright, Delaware Physicians Care
Inc, 2010
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DPCI/Aetna Data
Modified from Wright, Delaware Physicians Care
Inc, 2010
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Cost Savings From A Few Can Support Many
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Next Steps

• Rigorous Program Evaluation to begin May 1 in
  partnership with Treatment Research Institute,
  University of Pennsylvania and Christiana Care
  Center for Outcomes Research and Office of
  Medicaid
• Sustainability is the key
• State-wide roll out?

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For Consideration

• There is value in identifying and engaging
  disenfranchised populations
• Need to find doors for their inclusion into the
  medical home
• Rigorous program evaluation likely to reveal
  potential for significant savings

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Project Engage

• Basha Silverman,
• Director of Prevention and Advocacy,
• Brandywine Counseling and Community Services
• bsilverman_at_brandywinecounseling.org
• Terry Horton, MD, FACP
• Chief, Division of Addiction Medicine
• Department of Medicine
• thorton_at_christianacare.org