Characterizing Opioid-related Adverse Events in Older Adults After Hospital Discharge

项目概要/摘要 在美国，每年有超过1200万65岁及以上的成年人住院，的 出院过渡期是护理连续体中特别脆弱的时期。出院后不良 不良事件是常见的，药物是此类不良事件的主要原因， 影响老年人，由于更大程度的合并症和多种药物，以及改变 药物的药代动力学和药效学。特别是阿片类药物， 导致出院后药物不良事件（ADE）的药物类别，并为数百万 老年人每年出院后。然而，出院后阿片类药物相关的具体性质 尚未描述ADE以及此类事件的患者和处方相关预测因素。广大 拟议工作的目标是通过定义发病率、特征和 老年人出院后阿片类药物相关ADE的预测因素。这些知识是至关重要的， 制定成功的、有针对性的干预措施，以减少类阿片使用的不良后果， 在这个非常脆弱的护理窗口期为老年人提供服务。该提案的具体目标是： 1)确定老年患者出院后30天内不良事件的发生率和预测因素， 使用大型国家数据集，在出院后一周内有阿片类药物索赔的成年人。使用索赔数据， 医疗保险（美国65岁以上成年人的最大保险公司），我们将确定发病率和患者-和 出院后服用阿片类药物的老年人中出院后不良事件的处方相关风险因素， 包括死亡、阿片类药物过量、住院、急诊、福尔斯、谵妄、恶心， 便秘 2)定义阿片类药物相关的临床重要的严重程度、功能后果和根本原因， 30岁以下老年人的用药错误（包括可预防/可改善的ADE和潜在ADE） 使用从两个大型医疗保健系统前瞻性收集的临床数据， 马萨诸塞州。将通过病历审查和出院后30天的电话访谈收集数据， 病人出院时服用阿片类药物。详细的临床数据将使我们能够将不良事件分类为 可预防/可改善的，并确定本可预防/改善事件的系统改进。 用于每项目标的数据源将提供补充信息， 对阿片类药物相关的出院后ADE进行“肉眼”和 “微观”层面。更好地了解患者和处方相关因素， 阿片类药物相关出院后ADE的最高风险将为医疗保健系统的改善提供信息， 这些对老年人具有潜在破坏性的事件的发生率和后果。

PROJECT SUMMARY/ABSTRACT For the more than 12 million adults age 65 and older hospitalized each year in the United States (U.S.), the transition out of the hospital is an exceptionally vulnerable time in the care continuum. Post-discharge adverse events are common, and medications are the leading cause of such adverse events, which disproportionately affect older adults owing to greater degrees of comorbidity and polypharmacy, as well as altered pharmacokinetics and pharmacodynamics of drugs. Opioids in particular are consistently among the top medication classes to cause post-discharge adverse drug events (ADEs), and are prescribed to millions of older adults after hospital discharge each year. However, the specific nature of post-discharge opioid-related ADEs and patient- and prescribing-related predictors of such events have not been characterized. The broad goal of the proposed work is to address this knowledge gap by defining the incidence, characteristics, and predictors of post-discharge opioid-related ADEs in older adults. Such knowledge is crucial as a prelude to developing successful, targeted interventions to reduce the adverse consequences of opioid use, particularly for older adults during this highly vulnerable window of care. The Specific Aims of this proposal are: 1) To define the incidence and predictors of adverse events within 30 days of hospital discharge among older adults with an opioid claim in the week after discharge using a large national dataset. Using claims data from Medicare (the largest insurer for U.S. adults age 65+), we will determine the incidence and patient- and prescribing-related risk factors for post-discharge adverse events among older adults discharged on opioids, including death, opioid overdose, hospitalizations, emergency department visits, falls, delirium, nausea, and constipation. 2) To define the severity, functional consequences, and underlying causes of opioid-related clinically important medication errors (including preventable/ameliorable ADEs and potential ADEs) among older adults within 30 days of hospital discharge using prospectively collected clinical data from two large healthcare systems in Massachusetts. Data will be collected through chart review and a 30 day post-discharge telephone interview of patients discharged on opioids. The detailed clinical data will allow us to classify the adverse event as preventable/ameliorable, and identify systems improvements that could have prevented/ameliorated the event. The data sources used for each of these Aims will provide complementary information, allowing for a comprehensive examination of opioid-related post-discharge ADEs at both the “macroscopic” and “microscopic” level. A better understanding of the patient- and prescribing-related factors that place patients at highest risk for opioid-related post-discharge ADEs will inform improvements in healthcare systems to reduce the incidence and consequences of these potentially devastating events for older adults.