ECCO - Evaluation of Outcomes Associated with Community Care Prescribed Opioids

ECCO - 社区护理处方阿片类药物相关结果评估

• 批准号: 10537122
• 负责人: Wei Duan-Porter
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10537122
• 关键词: Acute Pain; Address; Adverse event; Affect; Ambulatory Care; Authorization documentation; Caring; Charge; Client satisfaction; Clinical Services; Collaborations; Communication; Communities; Communities That Care; Community Healthcare; Data; Data Reporting; Dose; Elements; Eligibility Determination; Emergency department visit; Enrollment; Ensure; Evaluation; Feedback; Female; Future; Goals; Health; Healthcare; Hospitalization; Individual; Infrastructure; Insurance Carriers; Intervention; Leadership; Medical Records; Methodology; Methods; Modeling; Morphine; Nature; Observational Study; Opioid; Outcome; Outpatients; Pain; Pain Clinics; Pain intensity; Pain management; Pain quality; Patient Outcomes Assessments; Patient Self-Report; Patients; Pattern; Personal Satisfaction; Pharmacists; Pharmacy facility; Predictive Factor; Prospective cohort; Provider; Publications; Quality of Care; Quality of life; Reporting; Research; Resources; Risk; Rural Community; Safety; Services; Severities; Specialist; Surveys; Translating; Treatment outcome; Variant; Veterans; Woman; Work; acute care; authority; care coordination; care episode; care providers; care systems; chronic pain; chronic pain management; cohort; community clinic; design; follow-up; geographic difference; health care availability; health related quality of life; high risk; improved; improved outcome; innovation; medical specialties; medication safety; milligram; opioid therapy; opioid use; pain outcome; pain reduction; poor health outcome; predictive modeling; prescription opioid; primary care provider; primary outcome; programs; prospective; response; rural residence; satisfaction; sex

Background: Starting in 2013, VA's Opioid Safety Initiative expanded resources for pain management and successfully reduced high-risk opioid prescriptions. MISSION Act expansion of VA Community Care (CC) includes authorization for CC providers to prescribe opioids for outpatient treatment of acute and chronic pain, but charges VA with ensuring that these are safely and appropriately dispensed from VA pharmacies. Veterans who use both VA and non-VA services may be particularly at risk for opioid-related harms, but past work was conducted before MISSION Act implementation and mainly addressed services paid by non-VA insurers. Although the main goal of MISSION Act is to improve Veterans' health care access, it remains unclear how CC expansion has impacted opioid safety and patient-reported outcomes for Veterans. Significance & Impact: Reducing opioid-related harms and improving treatment for chronic pain are high- priority goals for VA HSRD and clinical services. Given increasing numbers of Veterans now using CC, there is an urgent need to better understand Veteran, community, and VA facility factors associated with receipt of CC opioids, and explore potential differences in higher-risk CC prescriptions, compared with VA-prescribed opioids. Moreover, examination of Veteran-centered pain outcomes will address the ORD-wide priority of increasing real- world impact of VA research. Innovation: This study will be the first to evaluate Veteran-centered outcomes associated with CC opioids, including functioning and health-related quality of life. The proposed design also includes multiple elements to rigorously address multilevel confounders, including variation in community opioid prescribing patterns. We use innovative causal estimation methods in our predictive models, in order to understand the relative importance of a variety of factors in contributing to likelihood of receiving CC opioids. Specific Aims: 1) Identify key multilevel predictors of receiving any CC vs. only VA-prescribed opioids for outpatient pain treatment, and evaluate potential differences in higher-risk opioid prescriptions; and 2) for a national prospective cohort of Veterans receiving any CC vs. only VA-prescribed opioids, examine differences in patient-reported outcomes and acute care episodes over 1 year. Methodology: First, we will conduct a retrospective analysis using national VA data from January-December 2021 to determine key Veteran, community, and VA facility factors that predict receiving any CC-prescribed opioids. Then, we will use propensity score adjusted models to examine differences in higher-risk opioids prescriptions between Veterans receiving any CC vs. only VA-prescribed opioids. For Aim 2, we will enroll a prospective national cohort to evaluate outcomes associated with receiving any CC vs. only VA-prescribed opioids. We will use survey data (at baseline and 1-year follow-up) to assess patient-reported outcomes (pain- related functioning, pain severity, quality of life, and satisfaction with pain care) and acute care episodes (hospitalizations and emergency department visits). Implementation & Next Steps: We will disseminate study results to various stakeholders, including Veterans, VA staff, and VA leadership. The exact next steps will depend on the nature of findings and their immediate relevance to different stakeholders. We will work with our operational partners in the VA Program for Pain Management, Opioid Safety and PDMP, Office for Medication Safety, and Office of Community Care to develop the dissemination plan. We will also seek feedback from our Veteran Engagement Panel to inform dissemination efforts. We will communicate findings through presentations and publications, cyber-seminars, and involvement with groups or networks focused on improving CC services and pain treatment for Veterans.

背景：从2013年开始，退伍军人事务部的阿片类药物安全倡议扩大了疼痛管理和 成功减少高风险阿片类药物处方。《退伍军人事务部社区关怀扩大使命法案》(CC) 包括授权CC提供者为急慢性疼痛的门诊治疗开阿片类药物， 但指控退伍军人管理局确保这些药物从退伍军人管理局药房安全和适当地分发。退伍军人 同时使用退伍军人管理局和非退伍军人管理局服务的人可能特别容易受到阿片类药物相关的伤害，但过去的工作是 在《任务法》实施之前进行，主要涉及非退伍军人保险公司支付的服务。 尽管使命法案的主要目标是改善退伍军人的医疗保健机会，但尚不清楚CC如何 扩张影响了阿片类药物的安全性和退伍军人患者报告的结果。 意义和影响：减少阿片类药物相关的伤害和改善慢性疼痛的治疗是很高的 退伍军人事务部HSRD和临床服务的优先目标。考虑到越来越多的退伍军人现在使用CC，有 迫切需要更好地了解与收到CC相关的退伍军人、社区和退伍军人设施因素 阿片类药物，并探索与VA处方阿片类药物相比，高风险CC处方中的潜在差异。 此外，以退伍军人为中心的疼痛结果检查将解决全美范围内增加真实疼痛结果的优先事项。 退伍军人事务部研究的世界影响。 创新：这项研究将第一次评估与CC阿片类药物相关的以退伍军人为中心的结果， 包括功能和与健康相关的生活质量。拟议的设计还包括多个元素，以 严格解决多层面的混杂因素，包括社区阿片类药物处方模式的变化。我们用 在我们的预测模型中创新的因果估计方法，以了解 导致接受CC阿片类药物可能性的各种因素。 具体目标：1)确定接受CC与仅接受VA处方阿片类药物治疗的关键多水平预测因素 门诊疼痛治疗，并评估高风险阿片类药物处方的潜在差异；以及2)对于 接受CC与仅接受VA处方阿片类药物的国家退伍军人预期队列，检查差异 在患者报告的结果和超过1年的急性护理事件中。 方法：首先，我们将使用1-12月的全国VA数据进行回顾分析 2021以确定预测收到CC处方的退伍军人、社区和退伍军人管理局的关键因素 阿片类药物。然后，我们将使用倾向性评分调整模型来检查高风险阿片类药物的差异 接受CC的退伍军人与只接受VA处方的阿片类药物之间的处方。对于目标2，我们将注册一个 对接受CC与仅接受VA处方的结果进行评估的预期国家队列 阿片类药物。我们将使用调查数据(基线和一年随访)来评估患者报告的结果(疼痛- 相关功能、疼痛严重程度、生活质量和对疼痛护理的满意度)和急性护理事件 (住院和急诊科就诊)。 实施和下一步：我们将向包括退伍军人在内的各个利益攸关方传播研究结果， 退伍军人管理局工作人员和退伍军人管理局领导层。下一步的具体措施将取决于调查结果的性质及其直接影响 与不同利益攸关方的相关性。我们将在退伍军人管理局疼痛计划中与我们的运营合作伙伴合作 管理、阿片类药物安全和PDMP、用药安全办公室和社区护理办公室正在发展 传播计划。我们还将寻求我们的资深参与小组的反馈，以提供信息传播 努力。我们将通过演讲和出版物、网络研讨会和参与来交流研究结果。 与专注于改善CC服务和退伍军人疼痛治疗的团体或网络合作。