{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T12:16:54Z","timestamp":1788524214716,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Alcohol withdrawal hospitalizations present unmet opportunities to initiate medications for alcohol use disorder (MAUD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine patient and hospital factors associated with MAUD initiation during hospitalizations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of alcohol withdrawal hospitalizations in a large health system using electronic health record and pharmacy data from 2022 to 2024. The outcome was MAUD initiation defined as inpatient administration of injectable naltrexone or prescriptions for outpatient oral naltrexone, acamprosate, disulfiram, topiramate, or baclofen. We excluded patients who filled MAUD in the prior 90 days. We used a multivariable linear model with socioeconomic, clinical, and hospitalization factors as fixed effects and individual patients and hospital sites as random effects to account for clustering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 5993 alcohol withdrawal hospitalizations across 12 hospitals, 19.8% (range: 5.1%\u2013 43.2%) initiated MAUD. Oral naltrexone was the most common MAUD initiated, while topiramate was the least common (66.9% and 1.2% of MAUD initiated, respectively). Patients less likely to initiate MAUD were age \u2265 65 years (absolute adjusted difference \u22126.89 percentage points [pp] vs. age 18\u201329; 95% confidence interval [CI] \u221212.20, \u22121.58) and those without cirrhosis and liver enzymes &gt;200\u2009U\/L (\u22123.46\u2009pp vs. liver enzymes \u2264 200\u2009U\/L; 95% CI: \u22126.87, \u22120.01). Four hospitals initiated MAUD at significantly lower rates, and two at higher rates including the only hospital with an addiction consult service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MAUD initiation during alcohol withdrawal hospitalizations was low and varied by patient factors and hospital sites. Factors driving this variation can inform interventions to address MAUD underutilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70201","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T21:20:20Z","timestamp":1759958420000},"page":"487-494","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Variation in initiation of medications for alcohol use disorder during alcohol withdrawal hospitalizations in a large health system: A retrospective cohort study"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8798-7968","authenticated-orcid":false,"given":"Eden Y.","family":"Bernstein","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Hospital Medicine University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob A.","family":"Lebin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izzie","family":"Clinton","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Mark","family":"Gritz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Health Care Policy &amp; Research University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6681-220X","authenticated-orcid":false,"given":"Gina R.","family":"Kruse","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Internal Medicine University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Jennifer","family":"Edelman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA"},{"name":"Program in Addiction Medicine Yale School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Alcohol Facts and Statistics | National Institute on Alcohol Abuse and Alcoholism (NIAAA).2025. Accessed April 28 2025.https:\/\/www.niaaa.nih.gov\/publications\/brochures-and-fact-sheets\/alcohol-facts-and-statistics"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7308a1"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","unstructured":"The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder | American Journal of Psychiatry.2018. 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