EpiCenter ? EPIdemiology of opioid prescribing in community health CENTERs

项目摘要 EPICENTER项目是第一个探索阿片类药物如何在安全网诊所人群中处方的项目， 连接四个强大的数据集。基于我们之前的经验，我们使用电子健康记录（EHR）数据 来自OCHIN（不是首字母缩略词）基于实践的研究网络，为150多万活跃患者提供服务 在18个州的581个社区卫生中心（CHCs）。我们探讨了EHR中的多层次变量， 了解接受慢性阿片类药物处方的原因和相关的健康结果。为做 因此，我们把病人的病历和社区健康的社会决定因素联系起来。201家OCHIN诊所 在俄勒冈州，我们将EHR记录链接到Medicaid行政索赔以及重要统计数据。这让我们 研究慢性阿片类药物治疗与阿片类药物过量和死亡等结果之间的关系。 具体目的是：目的1：按规格（吗啡）描述阿片类药物处方的总体趋势 等效性）、制剂（长效与短效）、长期使用（急性与慢性）以及与 安全网/社区卫生中心的苯二氮卓类药物使用情况，并将其与国家趋势进行比较。目标2： 评估阿片类药物处方（包括强度、配方、慢性和共 开苯二氮卓类处方）和多水平因素如患者水平的人口统计学（种族/民族， 性别、联邦贫困线百分比等）和诊断，社区一级的健康和诊所的社会决定因素- 安全网社区卫生中心的水平因素（规模、农村性、提供者类型）。目标3：研究 阿片类药物处方（包括规格、剂型、慢性、与苯二氮卓类药物联合处方）和 安全网/CHC人群中的相关健康结局（共病、过量）。拟议的工作使用 独特、丰富的数据集（EHR、社区层面因素、州生命统计数据和医疗补助索赔数据）， 十年（2009-2018年）纵向研究项目，以提供多方面的评估， 社区卫生中心的阿片类药物处方问题。通过关注安全网诊所，我们将更好地 了解这一问题如何以及为什么在受其影响最大的社区和人口中出现， 了解哪些政策将带来更好的实践和成果。

PROJECT SUMMARY The EPICENTER project is the first to explore how opioids are prescribed in safety net clinic populations by linking four powerful datasets. Building on our prior experience, we use electronic health record (EHR) data from the OCHIN (not an acronym) practice-based research network that serves over 1.5 million active patients in 581 community health centers (CHCs) in 18 states. We explore multilevel variables within the EHR that shed light on the reasons for receiving chronic opioid prescriptions and associated health outcomes. In order to do so, we link patient records to measures of community social determinants of health. For the 201 OCHIN clinics in Oregon we link EHR records to Medicaid administrative claims as well as vital statistics data. This allows us to examine associations between chronic opioid therapy and outcomes such as opioid overdose and death. The specific aims are: Aim 1: To describe trends of opioid prescribing overall, by strength (morphine equivalence), formulation (long vs. short acting), chronicity of use (acute vs. chronic) and co-prescribing with benzodiazepines in safety net/community health centers and compare them with national trends. Aim 2: To assess the relationship between opioid prescribing (including strength, formulation, chronicity, and co- prescribing with benzodiazepines) and multilevel factors such as patient-level demographics (race/ethnicity, sex, % federal poverty level, etc.) and diagnoses, community-level social determinants of health and clinic- level factors (size, rurality, provider type) in safety net CHCs. Aim 3: To examine the relationship between opioid prescribing (including strength, formulation, chronicity, co-prescribing with benzodiazepines) and relevant health outcomes (co-morbidity, overdoses) in a safety net/CHC population. The proposed work uses unique, rich datasets (EHR, community-level factors, state vital statistics and Medicaid claims data) in a longitudinal research project of ten years (2009-2018) in order to provide a multidimensional assessment of problematic opioid prescribing in community health centers. By focusing on safety net clinics, we will better understand how and why this problem arose in the communities and populations it has most affected in order to understand what policies will lead to better practices and outcomes.