Navigation Services to Avoid Rehospitalization (NavSTAR)

In recent years, the problem of rehospitalization has come under intense focus as a major
contributor to preventable morbidity and escalating healthcare costs. Substance use disorders
are strongly associated with poor health outcomes and highly inefficient use of healthcare
services, including repeat hospitalizations. Interventions that increase adherence to
recommendations for outpatient medical care and substance abuse treatment could potentially
help recently-hospitalized individuals with substance use disorders to avoid unnecessary
rehospitalization, associated morbidity, and medical expenses. The current study is a
randomized controlled trial comparing the effectiveness of Navigation Services to Avoid
Rehospitalization (NavSTAR) vs. Treatment-as-Usual (TAU) for hospital patients with
co-occurring medical problems and substance use disorders. Applying Andersen's theoretical
model of health service utilization, NavSTAR will employ the promising strategies of Patient
Navigation and motivational interventions to facilitate engagement in outpatient medical and
substance abuse treatment, thereby lowering the likelihood of rehospitalization. Patient
Navigators embedded within the substance abuse consultation liaison service at a large urban
hospital will deliver patient-centered, proactive navigation and motivational services
initiated during the hospital stay and continued for 3 months post-discharge. Participants
randomized to TAU will receive usual care from the hospital and the substance abuse
consultation liaison service, which includes referral to substance abuse treatment but no
continued contact post-hospital discharge. Participants will be assessed at study entry and
again at 3-, 6-, and 12-months follow-up on various measures of healthcare utilization,
substance use, and functioning. The primary outcome of interest is time-to-rehospitalization
through 12 months. In addition, a range of secondary outcomes spanning the medical and
substance abuse service areas will be assessed. The study will include an economic evaluation
of the cost, incremental cost-effectiveness, and cost-benefits of NavSTAR from the service
provider perspective.

Inclusion Criteria:

1. adult (ages 18 and older) hospital patients;

2. current DSM-5 SUD (not in remission) for alcohol, cocaine, or opioids

3. willing and able to provide informed consent.

Exclusion Criteria:

1. current enrollment in SUD treatment;

2. primary residence outside of Baltimore City;

3. pregnant;

4. terminal medical condition (e.g., planned discharge to hospice);

5. hospitalized for a suicide attempt.