A Comprehensive Peer Mentor-based Disease Management Program for Medically Complex Substance Users

• Adherence to first medical appointment [ Time Frame: 60 days ] [ Designated as safety issue: No ]
• Rate of readmission and emergency department visits [ Time Frame: 3 years ] [ Designated as safety issue: No ]
• Length of stay in a recovery program [ Time Frame: 1 year ] [ Designated as safety issue: No ]
• Number of days without substance use [ Time Frame: 3 years ] [ Designated as safety issue: No ]
• Acquisition of medical insurance [ Time Frame: 1 year ] [ Designated as safety issue: No ]
• acquisition of long-term housing [ Time Frame: 3 years ] [ Designated as safety issue: No ]
• Acquisition of financial support [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Substance-using adults are admitted to hospital for medical complication from their drug and alcohol use at very high rates; yet, their care is often defined by low rates of referral to addiction treatment programs and recidivism. In 1997, we instituted an integrated medical-substance use treatment program at Johns Hopkins, the First Step Day Hospital, designed for intensive post-acute care of previously hospitalized substance using adults. We have shown that patients with dual diagnoses admitted to First Step more often complete their course of medical care and stay in recovery longer than patients not admitted to First Step.(1;2) On discharge from First Step, patients are medically stable and drug-free. Their substance abuse care is transferred to an out-patient substance abuse treatment facility and their medical care is transferred to their primary care provider. Unfortunately, many patients are lost to follow-up during this transition. We believe that a peer mentor-based disease management program (PM) can provide continuity of care that begins in First Step and continues after discharge thereby increasing the proportion of patients who remain in treatment for their addiction and medical conditions. Peer mentors are persons from the target community who have been in recovery for 5 or more years. In cooperation with patients and providers, peer mentors improve the integration of care, quality of care, and access to healthcare services. This pilot study will test the effectiveness of a peer mentor-based disease management program. The specific aims are to compare the impact of the PM intervention verses enhanced usual care on outcomes in three domains (1) medical/psychiatric health status, (2) addiction recovery, and (3) social resource acquisition. If successful, this study will provide evidence supporting a larger randomized controlled trial of the impact of field workers on post-acute care among patients with dual diagnoses.

Inclusion Criteria:

• All patients admitted to an intensive day hospital focused on medically complex substanse users are eligible for enrolment

Exclusion Criteria:

• Inability to provide informed consent