Hospital Prescribing of Opioids to Medicare Beneficiaries.
Hospital Prescribing of Opioids to Medicare Beneficiaries.
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DOI：
10.1001/jamainternmed.2016.2737
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发表时间：
2016-07-01
影响因子：
39
通讯作者：
Karaca-Mandic P
中科院分区：
文献类型：
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作者：
Jena AB;Goldman D;Karaca-Mandic P
在某些临床环境中，在急性住院期间和住院后不久使用阿片类药物是必要的。然而，鉴于阿片类药物可能导致短期不良事件和长期生理耐受性，重要的是要了解出院时阿片类药物处方的频率、医院变化以及与阿片类药物处方相关的患者和医院因素，这在美国目前尚不清楚。估计在住院前60天没有阿片类药物处方索赔的医疗保险受益人出院时阿片类药物处方的频率;记录处方的医院差异;并分析与处方相关的患者和医院因素，包括医院对疼痛相关的医疗保健提供者和系统（HCAHPS）措施的医院消费者评估的平均表现。分析2011年住院的20%随机样本医疗保险受益人的药房索赔，在住院前60天内没有阿片类药物处方索赔。我们的主要结局是出院后7天内新的阿片类药物索赔。我们估计了与新阿片类药物使用相关的患者因素的多变量线性概率模型，并描述了新阿片类药物使用调整率的医院变化。在多变量线性回归分析中，我们还分析了与医院水平的平均调整后新阿片类药物使用相关的医院因素，包括2011年HCAHPS调查中报告住院期间疼痛始终得到良好控制的每家医院患者的百分比。在623957例住院治疗中，92882例（14.9%）与新的阿片类药物索赔相关。在出院后7天内与阿片类药物相关的住院治疗中，77092例患者中有32731例（42.5%）在出院后90天后与阿片类药物相关。在2512家医院中，住院7天内新阿片类药物使用的平均调整率为15.1%（四分位数范围，12.3%-17.4%;十分位数范围，10.5%-20.0%）。医院调整后的新阿片类药物使用率与报告其疼痛始终得到良好管理的住院患者百分比呈中度正相关（HCAHPS测量中从第25百分位数增加到第75百分位数与新阿片类药物使用的绝对增加0.89个百分点或相对增加6.0%相关; P < .001）。住院后使用新的阿片类药物在医疗保险受益人中很常见，各医院之间存在很大差异，很大一部分患者在住院后90天使用处方阿片类药物。在短期和长期阿片类药物使用中观察到的医院差异在多大程度上反映了出院时不适当处方的差异尚不清楚。
Use of opioids during and shortly after an acute hospitalization is warranted in some clinical settings. However, given the potential of opioids for short-term adverse events and long-term physiologic tolerance, it is important to understand the frequency of opioid prescribing at hospital discharge, hospital variation, and patient and hospital factors associated with opioid prescribing, which is currently unknown in the United States. To estimate the frequency of opioid prescribing at hospital discharge among Medicare beneficiaries without an opioid prescription claim 60 days prior to hospitalization; to document hospital variation in prescribing; and to analyze patient and hospital factors associated with prescribing, including hospital average performance on pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures. Analysis of pharmacy claims of a 20% random sample of Medicare beneficiaries hospitalized in 2011 without an opioid prescription claim in the 60 days before hospitalization. Our main outcome was a new opioid claim within 7 days of hospital discharge. We estimated a multivariable linear probability model of patient factors associated with new opioid use and described hospital variation in adjusted rates of new opioid use. In multivariable linear regression analysis, we also analyzed hospital factors associated with average adjusted new opioid use at the hospital level, including the percentage of each hospital’s patients who reported that their pain during hospitalization was always well controlled in the 2011 HCAHPS surveys. Among 623 957 hospitalizations, 92 882 (14.9%) were associated with a new opioid claim. Among those hospitalizations with an associated opioid claim within 7 days of hospital discharge, 32 731 (42.5%) of 77 092 were associated with an opioid claim after 90 days postdischarge. Across 2512 hospitals, the average adjusted rate of new opioid use within 7 days of hospitalization was 15.1% (interquartile range, 12.3%–17.4%; interdecile range, 10.5%–20.0%). A hospital’s adjusted rate of new opioid use was modestly positively associated with the percentage of its inpatients reporting that their pain was always well managed (increase from 25th to the 75th percentile in the HCAHPS measure was associated with an absolute increase in new opioid use of 0.89 percentage points or a relative increase of 6.0%; P < .001). New opioid use after hospitalization is common among Medicare beneficiaries, with substantial variation across hospitals and a large proportion of patients using a prescription opioid 90 days after hospitalization. The degree to which observed hospital variation in short- and longer-term opioid use reflects variation in inappropriate prescribing at hospital discharge is unknown.