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.

项目摘要 疼痛管理在老年人更重要的是在急性期后护理期间比在任何其他时间 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 如谵妄，特别是在阿尔茨海默病和相关痴呆症（ADRD）患者中。每年， 超过30万名美国老年人出院后在急性病后专业护理机构接受康复治疗 （SNF）髋部骨折后，使SNF的一个关键的地方，研究镇痛处方的做法和他们的影响 骨折后。髋部骨折后的疼痛往往得不到充分的治疗， 指导住院后疼痛管理的指南。大型临床试验尚未进行， 到目前为止，使用药物声明数据的观察性研究是不可能的，因为药物 SNF居民的Medicare Part D索赔中不包含配药数据。有效安全地治疗 对于髋部骨折老年人的疼痛，我们必须了解处方的驱动因素和下游影响， 不同的镇痛方案该建议有两个具体目标：（1）描述个人-（例如，ADRD） 和设施级（例如，人员配置）使用不同镇痛药物方案的预测因素，包括 阿片类药物，在髋部骨折后的急性SNF护理中;和（2）评价比较有效性（即，疼痛， 功能）和安全性（即，再次住院）不同的镇痛方案。严格的队列研究， 建议将联合收割机结合新的管理和临床数据集，以确定药物分配 对于超过60%的美国SNF，Medicare Part D中“缺失”的数据，包括非处方药和专业处方药。 nata（PRN）使用。研究人群将包括因下列原因住院的社区居住老年人： 2013年至2016年期间髋部骨折，然后入住养老院进行SNF住院。受试者将 随访SNF入院后的结局，比较开始使用不同镇痛药的患者 急性期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 药房，记录在SNF护理期间的药物使用情况，其中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型报告数据库包含全面的设施- 收集的设施级别信息;（4）Medicare Part A住院患者索赔数据;（5）Medicare Part D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经验 指导老年人髋部骨折后疼痛的管理，这可能最终导致改善 治疗决策和随后的患者健康结果，从而解决战略目标C的 国家老龄化研究所。此外，本项目建立的独特数据库可用于 进行许多重要的未来药物相关的研究，以改善老年人在急性后护理的健康。

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