Social Ecological Contexts of Opioid Overdose and Hospital Readmission in the Postpartum Period

阿片类药物过量和产后再入院的社会生态背景

• 批准号: 10203833
• 负责人: Jessica Frankeberger
• 金额: $ 4.44万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10203833
• 关键词: Address; Admission activity; Adverse event; Area; Attention; Birth; Censuses; Characteristics; Child Rearing; Childbirth; Clinical; Clinical Distribution; Code; Communities; Complement; Complex; Cost Control; Data; Data Sources; Development; Environment; Face; Fellowship; Goals; HIV; Harm Reduction; Health; Health Care Costs; Health Services; Health Services Research; Hepatitis C virus; High Risk Woman; Hospitalization; Hospitals; Income; Individual; Information Distribution; Inpatients; Intervention; Journals; Knowledge; Location; Mental Health; Mental Health Services; Mentors; Mentorship; Neonatal Abstinence Syndrome; Opioid; Outcome; Overdose; Pennsylvania; Pharmacotherapy; Population; Population Density; Postpartum Period; Postpartum Women; Poverty; Predisposition; Pregnancy; Pregnant Women; Prevention; Provider; Public Health Schools; Reading; Reproductive Health; Research; Research Personnel; Research Training; Resources; Risk; Role; Social Conditions; Social Work; Spatial Distribution; Special Supplemental Nutrition Program for Women, Infants, and Children; Statistical Methods; Structure; Subgroup; Time; Training; United States; Universities; Woman; Women' s Health; adverse outcome; base; behavioral health; community intervention; comorbidity; contextual factors; density; design; epidemiologic data; experience; fetal opioid exposure; health inequalities; high risk; hospital readmission; multilevel analysis; opioid epidemic; opioid overdose; opioid use; opioid use disorder; overdose risk; polysubstance use; postpartum outcome; prescription opioid; prevent; public health priorities; racial and ethnic; readmission risk; skills; social; social health determinants; substance use; symposium; treatment program; treatment services

PROJECT SUMMARY/ABSTRACT The goal of this F31 fellowship is to prepare me to become an independent researcher who can effectively contribute to addressing the individual and social ecological contexts that place women at risk for opioid use and overdose in the postpartum period. In the United States, opioid use disorder (OUD) during pregnancy has quadrupled since 1999, with overdose becoming a leading cause of non-pregnancy related death among pregnant and postpartum women. While identifying and treating OUD during pregnancy is a public health priority, limited attention has been given to the overdose and hospital readmission risks among postpartum women (defined here as being within the first year after childbirth) with OUD. Epidemiological data suggest women are at highest risk of overdose 7-12 months post-delivery with rates 25% higher than at pre-conception. Less understood are the co-morbid health issues, systemic social conditions, and limited health and social services women with OUD continue to face in their communities after childbirth. Under the guidance of my mentorship team and enhanced by the training from this fellowship, I will utilize inpatient hospital data from the Pennsylvania Health Care Cost Containment Council (PHC4) to assess hospital readmissions among women with OUD within one year of childbirth. Data will be merged with community-level data sources, such as the U.S. Census and SAMSHA’s Behavioral Health Treatment Services Locator, to determine how community context impacts postpartum opioid outcomes. The Specific Aims of this study are to: 1) Identify subgroups of women with OUD at delivery at increased risk of overall and opioid-specific hospitalizations postpartum; 2) Examine the association between community-level factors and individual class memberships, as well as their independent effects on postpartum opioid-related hospitalizations; and 3) Examine the spatial distribution of hospital births and postpartum opioid-related readmissions among women with OUD, and identify the community factors associated with ZIP code-level counts of deliveries and readmissions. To accomplish the proposed research, I will implement a comprehensive training and mentorship plan that will build on my prior substance use knowledge, research experience, and doctoral training. Specifically, my Training Goals will focus on expanding my knowledge and/or skills in: 1) reproductive health and opioid use among pregnant and postpartum women; 2) social and ecological determinants of substance use; 3) latent class analyses; 4) multilevel analyses; and 5) spatial analyses. These goals will be accomplished through a range of coursework, seminars, clinical observations, conferences, journal readings, and tailored mentoring from a committed team of interdisciplinary researchers. Complemented by support from a dedicated research and training environment at the University of Pittsburgh Graduate School of Public Health, this fellowship will accelerate my trajectory in becoming an independent researcher focused on reducing inequities associated with maternal substance use.

项目概要/摘要 F31 奖学金的目标是让我做好准备成为一名独立研究员，能够有效地 有助于解决使妇女面临阿片类药物使用风险的个人和社会生态环境 以及产后服用过量。在美国，怀孕期间阿片类药物使用障碍（OUD）已 自 1999 年以来增加了四倍，服药过量成为非妊娠相关死亡的主要原因 孕妇和产后妇女。虽然怀孕期间识别和治疗 OUD 是一项公共卫生事业 优先考虑的是产后用药过量和再入院风险 患有 OUD 的女性（此处定义为产后第一年内）。流行病学数据表明 女性在产后 7-12 个月内服用药物过量的风险最高，比率比怀孕前高 25%。 不太了解的是共病健康问题、系统性社会条件以及有限的健康和社会条件 患有 OUD 的妇女在分娩后继续在其社区中面临服务。在我的指导下 导师团队并通过该奖学金的培训得到加强，我将利用来自医院的住院数据 宾夕法尼亚州医疗保健成本控制委员会 (PHC4) 将评估女性再入院情况 分娩后一年内使用 OUD。数据将与社区级数据源合并，例如 美国人口普查和 SAMSHA 的行为健康治疗服务定位器，以确定社区如何 背景影响产后阿片类药物的结果。本研究的具体目标是： 1) 确定亚组 分娩时患有 OUD 的女性产后整体住院和阿片类药物特定住院的风险增加； 2） 检查社区层面的因素和个体阶级成员资格之间的关联，以及它们的影响 对产后阿片类药物相关住院的独立影响； 3）检查空间分布 OUD 妇女的医院分娩和产后阿片类药物相关的再入院，并确定 与邮政编码级别的递送和重新入院计数相关的社区因素。为了实现 拟议的研究，我将实施一项全面的培训和指导计划，该计划将建立在我之前的基础上 物质使用知识、研究经验和博士培训。具体来说，我的培训目标将 专注于扩展我在以下方面的知识和/或技能：1）怀孕和怀孕期间的生殖健康和阿片类药物的使用 产后妇女； 2) 物质使用的社会和生态决定因素； 3）潜在类别分析； 4） 多层次分析； 5）空间分析。这些目标将通过一系列课程来实现， 研讨会、临床观察、会议、期刊阅读以及来自忠诚团队的定制指导 的跨学科研究人员。辅以专门的研究和培训环境的支持 在匹兹堡大学公共卫生研究生院，这项奖学金将加速我的发展轨迹 成为一名独立研究人员，致力于减少与孕产妇物质使用相关的不平等。