Defining Opioid-related Problems Using a Health Care Safety Net Institution's Inpatient Electronic Health Records: Limitations of Diagnosis-based Definitions
Defining Opioid-related Problems Using a Health Care Safety Net Institution's Inpatient Electronic Health Records: Limitations of Diagnosis-based Definitions
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DOI：
10.1097/adm.0000000000001041
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发表时间：
2023-01-01
影响因子：
5.5
通讯作者：
Shlay，Judith C.
中科院分区：
文献类型：
--
作者：
Arifkhanova，Aziza;Prieto，Jose Tomas;Shlay，Judith C.
由于缺乏标准定义和编码实践，测量医疗保健系统中临床相关的阿片类药物相关问题具有挑战性。明确定义的阿片类药物相关健康问题（ORHPs）将改善对临床干预、危机应对和预防活动的流行率估计和评价。我们试图估计阿片类药物使用障碍（OUD），阿片类药物滥用和阿片类药物中毒的患病率在一个大的，安全网，health care institution.MethodsOur研究包括事件记录在电子健康记录（EHRs）在丹佛健康医疗中心住院患者在2017年1月1日至2018年12月31日。多个EHR标记物（即阿片类药物相关诊断代码、临床评估、实验室结果和自由文本文件）用于开发OUD、阿片类药物滥用和阿片类药物中毒的诊断和扩展定义。我们使用这些定义来估计这些conditions.ResultsDuring 2年的研究期间，715独特的患者被确定为仅使用阿片类药物相关的诊断代码，OUD代码占最大的比例（499/715，69.8%）。扩展定义确定了另外973名独特患者（~ 136%增长），其中包括155/973（15.9%）通过临床评估标志物确定，1/973（0.1%）通过实验室测试标记，第817/973号来文（84.0%）结论仅使用诊断代码来估计临床相关ORHP的患病率遗漏了大多数患者ORHPs。使用额外的EHR标记生成更具包容性的估计值。改进的方法来估计医疗保健系统的患者中的ORHP将更充分地估计组织和经济负担，以更有效地分配资源，并确保提供临床服务的能力。
BackgroundMeasuring clinically relevant opioid-related problems in health care systems is challenging due to the lack of standard definitions and coding practices. Well-defined, opioid-related health problems (ORHPs) would improve prevalence estimates and evaluation of clinical interventions, crisis response, and prevention activities. We sought to estimate prevalence of opioid use disorder (OUD), opioid misuse, and opioid poisoning among inpatients at a large, safety net, health care institution.MethodsOur study included events documented in the electronic health records (EHRs) among hospitalized patients at Denver Health Medical Center during January 1, 2017 to December 31, 2018. Multiple EHR markers (ie, opioid-related diagnostic codes, clinical assessment, laboratory results, and free-text documentation) were used to develop diagnosis-based and extended definitions for OUD, opioid misuse, and opioid poisoning. We used these definitions to estimate number of hospitalized patients with these conditions.ResultsDuring a 2-year study period, 715 unique patients were identified solely using opioid-related diagnostic codes; OUD codes accounted for the largest proportion (499/715, 69.8%). Extended definitions identified an additional 973 unique patients (~ 136% increase), which includes 155/973 (15.9%) who were identified by a clinical assessment marker, 1/973 (0.1%) by a laboratory test marker, and 817/973 (84.0%) by a clinical documentation marker.ConclusionsSolely using diagnostic codes to estimate prevalence of clinically relevant ORHPs missed most patients with ORHPs. More inclusive estimates were generated using additional EHR markers. Improved methods to estimate ORHPs among a health care system’s patients would more fully estimate organizational and economic burden to more efficiently allocate resources and ensure capacity to provide clinical services.