New PHC4 Report Shows Substance Use Present in One of every 25 Maternal Hospital Stays
December 11, 2018
The Pennsylvania Health Care Cost Containment Council (PHC4) today released a research brief detailing trends related to the opioid crisis in Pennsylvania. The report found that one in 25 pregnancy-related hospitalizations documented maternal substance use, up from 1 in 69 in 2000–2001. Of those patients with substance use disorder, 49 percent involved opioids.
The brief also found:
- One in 51 pregnancy-related hospitalizations documented maternal opioid use, up from 1 in 329 in 2000–2001
- Compared to maternity patients without opioid use, those with opioid use:
- Were also more likely to have co-occurring conditions (e.g., tobacco or other substance use, mental health disorders, Hepatitis C, false or pre-term labor, and slowed growth of baby during pregnancy)
- Were more likely to delivery early—i.e., in 2016–17, 48 percent delivered at or before 38 weeks (compared with only 33 percent those without opioid use)
- Were more likely to be readmitted—i.e., in 2016, 11.7 percent experienced readmissions (compared with only 4.6 percent of those without opioid use)
It also found that Medicaid was the primary anticipated payer in nearly 82 percent of maternity patients with opioid use (vs. 39 percent of those without). Conversely, commercial insurers were the primary anticipated payer for approximately 56 percent of maternity patients without (vs. 14 percent with) opioid use.
The brief found that maternity patients with opioid use was higher in areas with:
- High poverty—i.e., 26.5 per 1,000 maternity hospital stays, vs. 14.4 per 1,000 in low-poverty areas
- Low levels of education (where less than 10 percent of residents have a bachelor’s degree)—i.e., 26.4 per 1,000 maternal hospital stays. In areas where 40 percent+ residents have a bachelor’s degree, the rate falls to 9.7 per 1,000 stays
Rate of maternal opioid incidence varied by county and ranged from 75.8 per 1,000 (Elk County) to 2.8 per 1,000 (Union County).
Maternal and neonatal exposure to opioids and other substances is a growing public health concern. As part of its work in this area, HAP conducted a study earlier this year, in conjunction with the Pennsylvania Department of Human Services, assessing how hospital labor and delivery units and neonatal intensive care units identify maternal opioid abuse.
In addition, Pennsylvania’s hospitals are taking the lead on key programs such as warm hand-off protocols, prescription guidelines, and drug takeback boxes. Additionally, hospitals are working to develop research-based best practices for medication-assisted treatment, advocating for additional funding for inpatient and outpatient behavioral health treatment, and providing patients with pain management alternatives.
Yesterday, Governor Tom Wolf kicked off “Stop Overdoses in PA: Get Help Now Week,” a statewide initiative to distribute naloxone and get help for residents suffering from opioid-use disorder. The Governor and cabinet officials are hosting a week of events, including announcing an updated emergency department opioid prescribing guideline at Penn Medicine today. They will end the week with a pharmacy drug take-back event on Friday, December 15.
For more information about this report or the Pennsylvania hospital community’s efforts to address the opioid crisis, please contact Michael J. Consuelos, MD, HAP’s senior vice president, clinical integration; Jennifer Jordan, HAP’s vice president, regulatory advocacy; or Sari Siegel, PhD, HAP’s vice president, health care research.