Applying Big Data Analytics to Study the Impact of Opioid Prescribing Policy Changes on Prescribing Behavior and Overdose Outcomes

项目摘要 阿片类止痛药(OPR)过量在美国已经达到流行的程度。在……里面 为了应对这场公共卫生危机，地方、州和国家都做出了努力，减少不适当的 阿片类药物处方。最近门诊死亡率的小幅下降表明，这些努力可能已经 有效。然而，最近海洛因使用、海洛因使用障碍和海洛因过量的空前增加 也观察到了。有人建议，遏制不适当的OPR处方的努力正在取得进展 增加海洛因使用的意想不到的后果及其不利影响。成本低，供货广泛 是毒品和犯罪问题办公室改用海洛因的常见原因。有效管理海洛因的风险 启蒙计划、健康系统、保险计划和医疗提供者需要了解是否、如何以及 这些风险受OPR处方做法的影响。 与其他州一样，科罗拉多州的几项政策旨在遏制阿片类药物的处方。年8月 2014年，科罗拉多州医疗补助将每月短效阿片类药物的数量限制在120片。2016年2月， 医疗补助计划将平均每日覆盖的吗啡当量剂量(MED)限制在300MED。这些政策是 旨在鼓励提供者逐步减少患者接受大剂量阿片类药物治疗，从而降低OPR的风险 服药过量。然而，到目前为止，这些政策对医生处方行为、OPR过量、 海洛因使用，而海洛因过量则不得而知。 这个项目的总体目标是进行一项大型的纵向队列研究，以检查OPR的影响 2012-2019年OPR过量、海洛因使用和海洛因过量的政策和处方实践。这个 这项研究将包括一家大型管理型医疗组织(Kaiser Permanente Colorado)和 科罗拉多州的医疗补助计划。这些系统总共覆盖了科罗拉多州约200万人， 占全州人口的40%。风险暴露、结果和协变量将通过链接来衡量 来自药房记录、诊断、毒理学发现、医疗保健利用和生命周期的患者级别数据 国家死亡指数的记录。暴露和结果将通过医疗记录审查进行验证。 分析将使用线性和非线性混合效应回归模型，并带有倾向分数 对混杂的和定量的偏差分析进行说明，以评估错误分类偏差。这些研究的结果 “大数据”分析将有助于指导未来OPR在州和国家层面制定政策。

PROJECT ABSTRACT Overdoses from opioid pain relievers (OPR) have reached epidemic proportions in the United States. In response to this public health crisis, there have been local, state and national efforts to reduce inappropriate opioid prescribing. Recent small reductions in OPR deaths rates suggest that these efforts may have been effective. However, unprecedented recent increases in heroin use, heroin use disorders, and heroin overdoses have also been observed. It has been suggested that efforts to curb inappropriate OPR prescribing are having the unintended consequence of increasing heroin use and its adverse effects. Low cost and wide availability are common reasons provided for the switch from OPR to heroin use. To effectively manage the risk of heroin initiation, health systems, insurance plans, and medical providers need to understand whether, how, and for whom these risks are affected by OPR prescribing practices. As in other states, several Colorado policies have been directed at curbing opioid prescribing. In August of 2014, Colorado Medicaid limited monthly quantities of short-acting opioid tablets to 120. In February 2016, Medicaid limited the average daily covered morphine equivalent dose (MED) to 300 MED. These policies were intended to encourage providers to taper patients from high-dose opioid therapy, thus reducing the risk of OPR overdose. To date, however, the effect of these policies on physician prescribing behavior, OPR overdose, heroin use, and heroin overdose is not known. The overall goal of this project is to conduct a large, longitudinal cohort study to examine the impact of OPR policies and prescribing practices on OPR overdose, heroin use, and heroin overdose from 2012 to 2019. The study will include data on patients from a large managed care organization (Kaiser Permanente Colorado) and Colorado’s Medicaid program. Together these systems cover approximately 2 million people in Colorado, representing 40% of the state’s population. Exposures, outcomes, and covariates will be measured by linking patient-level data from pharmacy records, diagnoses, toxicology findings, health care utilization, and vital records from the National Death Index. Exposures and outcomes will be validated with medical record review. Analyses will be conducted with linear and nonlinear mixed effects regression models, with propensity scores to account for confounding and quantitative bias analyses to assess misclassification bias. The results of these “Big Data” analyses will help guide future OPR prescribing policies at the state and national level.