Association for Public Policy Analysis & Management

Background: Persons appearing in trauma centers have a higher prevalence of unhealthy alcohol use than the general population. Screening and brief intervention (SBI) is designed to moderate drinking levels and avoid costly future readmissions, but few studies have examined the impact of SBI on hospital readmissions and health care costs in a trauma population. This study estimates the effect of the American College of Surgeons Committee on Trauma SBI mandate announced in 2007 on the probability of readmission and cost per readmission in Arizona trauma centers

Methods: The timing of the American College of Surgeons Committee on Trauma SBI mandate created a natural experiment in Arizona.  We use comparative interrupted time-series to exploit this natural experiment, comparing individuals with and without an alcohol diagnosis before and after the mandate was implemented. Study data are census of inpatient hospital admissions from six trauma centers in the Arizona State Inpatient Database from 2007-2010.

Results: The mandate resulted in a 2.2 percentage point reduction (44%) in the probability of readmission. Total health care and readmission costs were not affected by the mandate.

Conclusion: The estimates are consistent with a differential effect of SBI: SBI reduces readmissions among those who present with a less serious alcohol-related problem. Persons with more serious alcohol problems are less likely to respond to SBI. These higher-risk individuals likely have a higher cost, which may explain the lack of change in readmission costs.  Our study is a macro-level intent-to-treat analysis of SBI’s impact that corroborates the potential of SBI implied by efficacy studies in trauma centers and other settings. This study provides a framework for future research involving more states and health systems and evaluating other SBI policies.