UCLA

The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance abuse treatment systems. One major service gap in the continuum of care for substance use disorders associated with readmissions is not transitioning patients to rehabilitation after a detox service. This study examined the problem of detox readmissions from an interorganizational network perspective. There were four aims: 1) determine the extent to which detox patients transfer to rehabilitation within 14 days of discharge from a detox service, 2) map the linkages between treatment programs, 3) test the impact of detox programs' network ties on their patients' odds of readmission to a detox service within one year, and 4) evaluate the utility of patient transfer rates as a county-level performance measure for detox. Data are from the California Outcomes Measurement System. I used admission and discharge data for all patients treated in 2008-2009 in 32 counties to map linkages between treatment programs and measure structural features of detox programs' local networks using social network analysis. I used multi-level analysis to predict the odds of patient readmissions to detox. Contextual predictors included out-degree (number of out-going ties to other programs) and efficiency (proportion of direct ties within a network that are "non-redundant"). The total number of patients in the dataset was 150,955, including 25,423 detox patients. Approximately 28% of detox patients transferred to some form of rehabilitation care after detox. Transitioning from detox to rehabilitation within 14 days of discharge was associated with lower odds of readmissions (for residential detox: OR .48, 95% CI .40, .57; for narcotic treatment detox: OR .25, 95% CI .19, .32). Network efficiency was associated with lower odds of readmission (for residential detox: OR .25, 95% CI .08, .83; for narcotic treatment detox: OR .34, 95% CI .14, .82). Detox programs with greater efficiency are able to access diverse referral resources. The findings from this study support the use of detox-to-treatment transfer rates as a performance measure for treatment systems.