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

老年人出院后阿片类药物相关不良事件的特征

基本信息

批准号：
10439612
负责人：
Shoshana J Herzig
金额：
$ 34.73万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10439612
关键词：
Characterizing Opioid related Adverse Events

项目摘要

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.

项目摘要/摘要对于每年在美国住院的超过1200万65岁及以上的成年人来说，在护理连续体中，出院过渡是一个特别脆弱的时期。出院后不良反应事件是常见的，药物是这些不良事件的主要原因，不成比例地影响老年人，由于更大程度的合并症和多药，以及改变药物的药代动力学和药效学。尤其是阿片类药物一直位居榜首导致出院后不良药物事件(ADE)的药物类别，并被开给数百万人每年出院后的老年人。然而，出院后阿片类药物的特殊性与之有关 ADS以及与患者和处方相关的此类事件的预测因素尚未确定。《博大》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不良反应的预测因素。这样的知识是至关重要的，因为它是制定成功的、有针对性的干预措施，以减少阿片类药物使用的不良后果，特别是对于老年人来说，在这个高度脆弱的护理窗口。这项建议的具体目标是： 1)确定老年人出院后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，患有阿片类药物的成年人在出院后一周内声称服用阿片类药物。使用以下来源的索赔数据联邦医疗保险(美国65岁以上成年人最大的保险公司)，我们将确定发病率和患者-以及对服用阿片类药物的老年人出院后不良事件的相关危险因素进行处方，包括死亡、阿片类药物过量、住院、急诊科就诊、跌倒、精神错乱、恶心和便秘。 2)确定与阿片类药物相关的临床重要的严重性、功能后果和潜在原因 30岁以下老年人的用药差错(包括可预防/可改善的不良反应和潜在的不良反应) 使用从两个大型医疗系统前瞻性收集的临床数据的出院天数马萨诸塞州。数据将通过图表审查和出院后30天的电话采访收集服用阿片类药物出院的病人。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，并确定本可阻止/改善该事件的系统改进。用于每个目标的数据源将提供补充信息，从而允许对阿片类药物出院后不良反应的宏观和微观两个层面的全面检查 “微观”层面。更好地了解患者和处方相关的因素，使患者处于与阿片类药物相关的出院后ADE的最高风险将促使医疗保健系统的改进，以减少这些对老年人具有潜在破坏性的事件的发生率和后果。

项目成果

期刊论文数量（15）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Risk Factors for Opioid-Related Adverse Drug Events Among Older Adults After Hospitalization for Major Orthopedic Procedures.

老年人因主要骨科手术住院后发生阿片类药物相关不良药物事件的危险因素。

DOI：
10.1097/pts.0000000000001144
发表时间：
2023
期刊：
Journal of patient safety
影响因子：
2.2
作者：
Herzig,ShoshanaJ;Anderson,TimothyS;Urman,RichardD;Jung,Yoojin;Ngo,LongH;McCarthy,EllenP
通讯作者：
McCarthy,EllenP

Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: A nationwide cohort study.