Presentation (CTI)

OBJECTIVES: Patient-directed discharge (PDD) is associated with adverse health outcomes among individuals with opioid use disorders (OUD). Understanding factors associated with PDD among patients with OUD who visit the emergency department (ED) can inform targeted interventions.
METHODS: We conducted a retrospective chart review of unique patients visiting the ED between April 2020 and December 2024 at a large healthcare system. We collected data on patient’s race, ethnicity, insurance status, sex, housing status, overdose history, and comorbidity index (a score ranging from 0 to 12 representing the total number of comorbid conditions across 12 common disease states). ED visits and inpatient admissions occurring in the past 12 months prior to the index visit were summed to create a composite measure of prior acute-care utilization and scaled per 10 encounters for interpretability. The proportion of visits with PDD was computed. Binary logistic regression was used to identify predictors of PDD.
RESULTS: Of 929 unique patient ED encounters, 159 (17.1%) resulted in PDD. Prior acute-care utilization in the past 12 months was the main predictor of PDD. For every 10 additional acute-care encounters in the prior 12 months, the odds of PDD increase by 10.3%, after adjustment for covariates (OR = 1.103, 95% CI = 1.018 - 1.195, p = 0.017). Comorbidity index was also modestly associated with the outcome (OR=0.87, 95% CI = 0.76 - 0.999, p = 0.048). Other covariates were not statistically significant.
CONCLUSIONS: Recent acute-care utilization was the primary predictor of PDD among individuals with OUD visiting the ED, while comorbidity burden showed a modest borderline association. Findings suggest that cumulative prior interaction with the acute-care system may be more informative for identifying patients at risk of PDD rather than sociodemographic or comorbidity characteristics. Findings highlight an opportunity for targeted utilization-informed interventions for patients with OUD at the ED.