2058. Continuity of Care Services and Substance Use Disorder Patients' Engagement in Continuing Care
JA Schaefer, Center for Health Care Evaluation, VA Palo Alto Health Care System, RC Cronkite, Center for Health Care Evaluation, E Ingudomnukul, Center for Health Care Evaluation

Objectives: We know little about the impact of continuity of care (COC) services on patients' engagement in continuing care. Our objective was to identify program factors (COC services provided, treatment experiences) and patient factors (demographics, clinical characteristics, motivation) that predict SUD patients' engagement in continuing care.

Methods: Twenty-eight SUD programs with varying COC practices were recruited. Addiction Severity Index data were obtained on 878 patients at treatment entry. At discharge, counselors provided data on COC services and amount of treatment given to 835 patients and their motivation for continuing care. Five sets of COC services were assessed:  (1) continuity in providers over time, and provider efforts to (2) maintain contact with patients, (3) connect patients to community resources, (4) coordinate their care, and (5) ensure access to care. Standardized summary scores for each COC dimension and an overall COC score were calculated for each patient. The VA OPC File was used to determine engagement (any SUD clinic visits) and total SUD visits at one and 4 months after discharge.

Results: Multiple and logistic regressions showed that patients who received greater overall COC services were more likely to be engaged in continuing care and to have more SUD clinic visits at the 1- and 4-month follow-ups. Of the COC services, greater provider continuity and coordination were associated with more SUD clinic visits at 1- and 4-month follow-ups.   Additional patient factors associated with more engagement included intake ASI employment score, patient motivation and a history of any SUD clinic visits during the year prior to the index treatment. In contrast, having minority status, being treated in an inpatient program, and receiving more intensive treatment were associated with less likelihood of engaging in continuing care and fewer SUD clinic visits at the 1- and 4-month follow-ups.

Conclusions: Both program and patient factors predicted engagement. Patients who received more COC services overall engaged in more continuing care. Provider continuity and coordination are key COC practices that promote engagement.

Impact: It is important to identify specific aspects of provider continuity and coordination that are related to patient engagement in continuing care. Intervention studies are needed to determine the particular COC practices that best facilitate engagement in care.