revised outline of your proposed final project to include updated content, appendices, and references. See Attachment for guidance and references.

Implementation of continuity healthcare

Addiction treatment requires organizational interaction through referrals. Referrals are intended to help patients transfer to facilities that can meet their medical needs. Treatment programs exchange patients to provide continuous care (Maarsingh & Henry, 2016). In order to continue with care after detoxification treatment, program physician may transfer a patient to outpatient program for substance-use-disorder treatment. Therefore, patient transfer is part of continuity of service within the drug addiction treatment.

Implementation of continuity care from detox to SUD treatment requires well-managed process of change, the involvement of all stakeholders such as caregiver, patients, administrators, and policy-makers. It also require strong leadership, workforce development, aligned governance, enabling technical systems and use of financial levers (WHO, 2018). Some of the factors to consider in implementing the continuity of care from detoxification to Substance use disorder treatment include: linking patients to facilities which can offer the medical needs, (2) communicating result to patients and families, (3) Following up with patient after hospital discharge, and (4) integrating behavior health into detox therapy through referral protocols.

Quality improvement

The present study show that treatment programs for addicts should be connected to other programs to ensure continuity of care. The connections provide useful resources for patients. This position is based on network theory. This theory argue that strength of relationship is a determiner of quality social capital. The strength of the interaction depends on level of information shared and the kind of people in the network. Multiplex ties are stronger and source of social capital. The multiplex ties between detox centers and Substance use disorder treatment programs are useful because one can draw upon the resources from one treatment for use in another. The coordination between detox and SUD treatment facilities leads to safe and quality treatment. When test are communicated between the various providers and between providers and patients, and there is awareness of the medications the patient is taking, the chance of desired patient outcomes is high.

Cost-effectiveness

Uncoordinated care is expensive for patients and the entire healthcare system. It increased duplicate services, contribute to overuse of intensive procedures, and increase risks of hospital readmissions. On average, patients who receive uncoordinated care are estimated to pay about 70% more for healthcare compared to patient with coordinated care. According to Spear (2016), enhanced care coordinate between detox and SUD treatment reduce 30% of costs. Because of the appreciated impact of coordinated care, the Patient Protection and Affordable Care Act invokes care throughout its provisions to control costs and improve the quality of care. Care coordination is important feature of evolving accountable care organizations, which seeks to integrate effective care coordination with quality measurement and accountability.

SWOT Analysis

Multidisciplinary coordinate of care is crucial, especially for complex situations involving reducing frequent detox readmissions. Continuity of care can help identify resources for patients battling chronic addictions.

Strengths

There are several governmental initiative which promote and provide seamless healthcare. For example, the government funded coordination centers and discharge policies help coordinate care at primary level and between hospital and specialist care.

Weakness

Coordination initiatives between detoxification centers and SUD treatment are fragmented. The reason for fragmentation are: coordination initiatives are mostly organization-centered (some hospital offer care package), or they are single disease-centered. Second, General practitioners in healthcare have incidental integration. There are many challenges which prevent general practitioners from engaging in continuity care. For example, physicians can make decision about when to discharge but they are not involved in assessing preparedness of home after detoxification.

Healthcare system is structured in silos, such health care versus support care. No institution is appointed to oversee coordination of care. There continuity of care between detoxification and substance use disorder is affected by poor use of healthcare informatics, lack of financial resources, outdated healthcare facilities, insufficient management training and poor communication

Opportunities

There are a many business initiatives which offer opportunities to healthcare organizations to give continuity of care and reduce frequent detox readmissions. For example, the collaborations with different healthcare organizations, increased funds for healthcare informatics, and development of healthcare programs.

Threats

Patient freedom of choice of care provider is a threat to care coordination between detox and substance use disorder treatment. These care providers are hired by different hospitals and are independent and do not share common clinical information tools or values. The hierarchical structure affect the flow of information.

Addressing the above threats and weakness

Patients should be involved in their coordination and continuity of care. Patients have obstacles such as financial challenges that keep them from follow up with specialty providers. Primary care providers can assist patients by providing resources to their patients that need help in these areas (Friedman & Howard, 2018). Other strategies to involve patients in continuity of care from detox to substance use treatment include motivational interviewing. This strategy is effective and should be taught to clinicians. Similarly, clinicians can practice sharing personal anecdotes and earning trust from patient to encourage them participate in medical procedures.

Harmful polypharmacy, negative interaction that are caused by medications prescribed by many providers, can be obstacle to care coordination and continuity of care from detox to SUD treatment. Electronic Health Records (EHR) offer solution to gaps in information sharing. The EHR allow sharing patient information between healthcare providers and this improve ease of clinicians providing care to patient and patients can move from one facility to another for continuity of care. Health care facilities such as detoxification centers need to interact with facilities giving substance-use-disorder treatment in order to share patient information. Health care providers needs to communicate to avoid interactions that are challenging to continuity of care.

Conclusion

The present study indicate that frequent detox readmission are caused by lack of care coordination or lack of continuity in healthcare. Patients who access SUD treatment within 2 weeks after detox are less likely to get detoxification readmission. However, continuity of care is a challenge and this is brought by: degree of integration between primary care and specialty; access to resources for patients; and functionality of information technology. These factors should be addressed to achieve infrequent readmission after detox. Relationship building is important to continuity of care between detox and substance use disorder treatment.

References

Acevedo, A., & Ritter, G. A. (2014). A performance measure for continuity of care after. Journal of Substance Abuse Treatment detoxification: Relationship with outcomes, 47, 130-139.

Chaojie, L., Yeqing, W., & Xueyang, C. (2017). Relationship preferences and experience of primary care patients in continuity of care: a case study in Beijing, China. BMC Health Services Research, 17, 1-10. Retrieved from https://doi.org/10.1186/s12913-017-2536-1

Chen, L., & Ayanian, J. (2016). Care continuity and care coordination: what counts? JAMA International Med, 174(5), 749–50.

Friedman, A., & Howard, J. (2018). Facilitators and Barriers to Care Coordination in Patient-centered Medical Homes (PCMHs) from Coordinators’ Perspectives. Journal of the American Board of Family , 29(1), 90–101. doi:10.3122/jabfm.2016.01.150175

Garnick, D. W., & Horgan, C. M. (2014). Criminal justice outcomes after engagement in outpatient substance abuse treatment. Journal of Substance Abuse Treatment, 46(3), 295-305.

Maarsingh, O., & Henry, Y. (2016). Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study. Journal of General Practice, 649(6), e531–9.

SAMHSA. (2017). Detoxification and Substance Abuse Treatment. Center for Substance Abuse Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Spear, S. E. (2016). Reducing Readmissions to Detoxification: An Interorganizational Network Perspective. Drug Alcohol Dependency, 137, 76–82.

Upadhyay, S., & Stephenson, A. L. ( 2019). Readmission Rates and Their Impact on Hospital Financial Performance: A Study of Washington Hospital. Inquiry, 3-9. doi:10.1177/0046958019860386

WHO. (2018). Continuity and coordination of care: a practice brief to support implementation of the WHO Framework. Geneva: World Health Organization.