Opioid use in post-acute hip fracture care: prescribing patterns, effectiveness, and safety

阿片类药物在急性髋部骨折后护理中的使用：处方模式、有效性和安全性

• 批准号: 9980239
• 负责人: Francesca Beaudoin
• 金额: $ 20.27万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980239
• 关键词: Acetaminophen; Activities of Daily Living; Acute; Address; Admission activity; Adult; Age; Alzheimer' s disease related dementia; Analgesics; Benefits and Risks; Body Weight decreased; Caring; Certification; Characteristics; Clinical; Clinical Trials; Clinical assessments; Cognitive; Cohort Studies; Communities; Data; Data Linkages; Data Set; Databases; Delirium; Drug usage; Effectiveness; Elderly; Fracture; Future; Goals; Health; Health care facility; Hip Fractures; Hip region structure; Home environment; Hospitalization; Individual; Inpatients; Investigation; Knowledge; Letters; Link; Long-Term Care; Measures; Medicare; Medicare Part A; Medicare claim; Medication Management; Methods; Morbidity - disease rate; National Institute on Aging; Non-Steroidal Anti-Inflammatory Agents; Nursing Homes; Observational Study; Occupational Therapy; Opioid; Outcome; Pain; Pain management; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacy facility; Physical Function; Physical therapy; Population; Public Health; Publishing; Records; Regimen; Rehabilitation therapy; Reporting; Research; Risk; Safety; Sampling; Skilled Nursing Facilities; Standardization; Surveys; Time; Work; acute care; adverse event risk; adverse outcome; base; beneficiary; cohort; comparative; comparative effectiveness; cost; data resource; evidence base; evidence based guidelines; experimental study; falls; functional decline; functional status; high risk; hospital readmission; improved; large datasets; medication administration; mortality; multiple chronic conditions; non-opioid analgesic; novel; older patient; opioid epidemic; opioid use; opioid user; safety outcomes; study population

Project Summary Pain management in older adults is more important during the post-acute care period than at any other time after hip fracture hospitalization. Pain control can positively impact function and help avert adverse outcomes like delirium, especially among persons with Alzheimer’s disease and related dementias (ADRD). Annually, over 300,000 older U.S. adults are discharged to receive rehabilitation in post-acute skilled nursing facilities (SNFs) after hip fracture, making SNFs a critical place to study analgesic prescribing practices and their impact following fracture. Pain is often inadequately treated following hip fracture, and there are no evidence-based guidelines to guide post-hospitalization pain management. Large clinical trials have not been conducted in post-acute SNFs and until now, observational studies using drug claims data were impossible because drug dispensing data is not captured by Medicare Part D claims for SNF residents. To effectively and safely treat pain in older adults with hip fracture, we must understand the drivers and downstream effects of prescribing different analgesic regimens. This proposal has two specific aims: (1) To describe the individual- (e.g., ADRD) and facility-level (e.g., staffing) predictors of using different analgesic drug regimens, including those containing opioids, in post-acute SNF care after hip fracture; and (2) To evaluate the comparative effectiveness (i.e., pain, functioning) and safety (i.e., rehospitalization) of different analgesic regimens. The rigorous cohort study we propose will combine novel linked administrative and clinical datasets to identify the medication dispensing data that are “missing” from Medicare Part D for >60% of all U.S. SNFs, including over-the-counter and pro re nata (PRN) use. The study population will comprise community-dwelling older adults who were hospitalized for hip fracture between 2013 and 2016, and then admitted to a nursing home for a SNF stay. Subjects will be followed for outcomes after SNF admission, comparing those who were initiated on different analgesic medication regimens in post-acute care. Data for this study will come from (1) a large long-term care pharmacy, which captures drug use during periods of SNF care where claims data from Part D are unavailable; (2) the Minimum Data Set version 3.0, a comprehensive database of standardized clinical assessment data; (3) the Certification and Survey Providence Enhanced Reporting database containing comprehensive facility- level information collected on facilities; (4) Medicare Part A inpatient claims data; (5) Medicare Part D drug claims; and (6) medication administration record data for 125 SNFs. Propensity score approaches and other causal inference methods will be employed. Knowledge gained from this study could provide the first empirical guidance for the management of post-hip fracture pain in older adults, which could ultimately result in improved treatment decisions and subsequent patient health outcomes, thereby addressing Strategic Goal C of the National Institute on Aging. Additionally, the unique database established in this project could be used to conduct many important future medication-related studies to improve health of older adults in post-acute care.

项目概要 老年人的疼痛管理在急性后期护理期间比任何其他时间都更为重要 髋部骨折住院后。疼痛控制可以积极影响功能并有助于避免不良后果 例如谵妄，尤其是患有阿尔茨海默病和相关痴呆症 (ADRD) 的人。每年， 超过 300,000 名美国老年人出院，在急性后专业护理机构接受康复治疗 (SNF) 髋部骨折后，使 SNF 成为研究镇痛处方实践及其影响的关键场所 骨折后。髋部骨折后的疼痛往往没有得到充分治疗，并且没有基于证据的证据 指导住院后疼痛管理的指南。尚未进行大型临床试验 急性后 SNF 以及迄今为止，使用药物声称数据进行观察性研究是不可能的，因为药物 SNF 居民的 Medicare D 部分索赔未捕获配药数据。为了有效、安全地治疗 对于患有髋部骨折的老年人的疼痛，我们必须了解处方的驱动因素和下游影响 不同的镇痛方案。该提案有两个具体目标： (1) 描述个体（例如 ADRD） 以及使用不同镇痛药物治疗方案的设施层面（例如人员配置）预测因素，包括那些包含 阿片类药物，用于髋部骨折后急性 SNF 护理； (2) 评估比较效果（即疼痛、 不同镇痛方案的功能）和安全性（即再住院）。我们进行了严格的队列研究 提议将结合新颖的关联管理和临床数据集来识别药物配发 超过 60% 的美国 SNF 的 Medicare D 部分“缺失”数据，包括非处方药和专业药 nata (PRN) 使用。研究人群将包括因住院治疗而住院的社区老年人 2013 年至 2016 年间发生髋部骨折，然后入住疗养院进行 SNF 治疗。科目将是 对 SNF 入院后的结果进行随访，比较那些开始使用不同镇痛剂的患者 急性后护理中的药物治疗方案。本研究的数据将来自（1）大型长期护理中心 药房，记录 SNF 护理期间的药物使用情况，而 D 部分的索赔数据不可用； （2）最小数据集3.0版，标准化临床评估数据的综合数据库； (3) 认证和调查普罗维登斯增强报告数据库包含综合设施- 收集的设施水平信息； (4) Medicare A 部分住院索赔数据； (5) Medicare D 部分药物 索赔； (6) 125个SNF的用药记录数据。倾向评分方法和其他 将采用因果推理方法。从这项研究中获得的知识可以提供第一个实证 老年人髋部骨折后疼痛管理指南，最终可能导致改善 治疗决策和随后的患者健康结果，从而实现战略目标 C 国家老龄化研究所。此外，该项目中建立的独特数据库可用于 开展许多重要的未来药物相关研究，以改善老年人急性期后护理的健康。

项目成果

Comparing Treatment Response Between Older and Younger Patients with Chronic Hepatitis C Virus Infection on Direct-acting Antiviral Agents.

比较老年和年轻慢性丙型肝炎病毒感染患者对直接作用抗病毒药物的治疗反应。

• 发表时间: 2020
• 期刊: Rhode Island medical journal (2013)
• 作者: Francis,AlyssaK;Beaudoin,FrancescaL;Naidjate,SafiyaS;Berard-Collins,Christine;Zullo,AndrewR
• 通讯作者: Zullo,AndrewR