Community-based Care Coordination and Treatment Retention in Opioid Use Disorder: A 5-year Retrospective Cohort Study.

Abstract

Treatment for opioid use disorder (OUD) is constrained by financial and geographic barriers. Community-based approaches may help address these challenges, yet evidence regarding their sustained impact on treatment retention and quality of life (QOL) remains limited. This study evaluated treatment retention and QOL outcomes in a community-based care coordination program for OUD. We conducted a retrospective cohort study of participants enrolled in the Houston Emergency Opioid Engagement System (HEROES), a community-based treatment program in the Texas Medical Center. From January 1, 2020, through December 31, 2024, 1124 participants received individualized treatment plans, including medical visits, counseling, peer support, and group services. The primary outcome was treatment retention at 90 days. As a secondary descriptive measure, mean days retained within a 180-day observation window were compared across service utilization categories using analysis of variance. Additional secondary outcomes included substance use reoccurrence, overdose, and mortality. Participants were 57.7% male with a mean age of 34.9 years (SD, 9.76); 62.8% were uninsured, and 63.6% had a prior overdose. At 90 days, 74.1% of participants remained in treatment. Mean days retained differed significantly across service utilization categories, with greater engagement associated with longer retention. Nearly 71% of participants reported improvements in QOL, with a mean increase of 13.2 points. In this 5-year retrospective cohort study, greater participation in a community-based care coordination program for OUD was associated with improved treatment retention and quality of life. Strategies that increase patient engagement through counseling and peer support may improve outcomes.