Prescribing of opioids at hospital discharge and associated adverse patient outcomes

出院时阿片类药物的处方和相关的不良患者结局

• 批准号: 10225290
• 负责人: Anupam Bapu Jena
• 金额: $ 37.5万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10225290
• 关键词: Prescribing; opioids; hospital; discharge; associated

Project Summary/Abstract The opioid addiction crisis in the US is increasingly affecting older adults. Hospitalization rates for opioid overdoses grew five-fold from 1993 to 2012 among older Medicare beneficiaries. High rates of prescription opioid use among older adults are particularly concerning given that adverse outcomes related to prescription opioid use - including falls, fractures, and all cause-mortality - are known to be greater in older adults. An important, common, and unstudied scenario for new opioid prescription is at the time of discharge from a medical hospitalization (e.g., non-surgical conditions such as pneumonia, heart failure, sepsis, delirium, etc.). Elderly patients who are hospitalized with medical conditions are at elevated risk of adverse outcomes related to opioid use not only due to clinical fragility but also fragmented transitions in care, which may make monitoring of opioids’ side effects by outpatient providers difficult. Yet, little data exist on the extent to which patients hospitalized for medical conditions are prescribed an opioid at time of discharge, the medical conditions for which prescribing is greatest, and the effects of these opioid prescriptions on adverse patient outcomes and long-term opioid dependence. It is also unknown how individual physicians and hospitals contribute to inappropriate prescription opioid use among patients hospitalized with general medical conditions, as well as the physician- and hospital-level factors that correlate with opioid prescribing. Variation in physician prescribing is thought to be an important driver of the opioid epidemic, in part because existing guidelines are underutilized, allowing for non-uniform prescribing to emerge. Differences in hospital prescribing cultures may also drive variation in prescription opioid use across hospitals. The proposed grant will provide national estimates of the rate of opioid prescribing following general medical hospitalizations in Medicare; identify conditions for which prescribing and opioid-related adverse events are most common; quantify patient, physician, and hospital risk-factors that are associated with opioid prescribing; and use novel quasi-experimental methods to determine the effects of provider (both physician hospital) opioid prescribing patterns on opioid-related adverse events and long-term opioid use. The proposed research will be the first to comprehensively study how a single hospitalization can precipitate opioid-related adverse outcomes and long-term opioid dependence. The study’s findings will help policymakers and clinicians define the risks of transition to long-term opioid use and opioid-related adverse events in the post-hospitalization setting and will help inform targeted opioid policy to help elderly patients avoid opioid-related adverse consequences and dependency. The project will build a data infrastructure that allows for up-to-date data access, ensuring that the project’s findings are relevant to the current clinical practice and opioid policy.

项目摘要/摘要 美国的卵毒危机越来越多地影响老年人。卵 从1993年到2012年，过量服用在老年医疗保险受益人中增长了五倍。高处方率 老年人中的opioid使用特别担心广告结果与处方有关 已知阿片类药物的使用 - 包括跌倒，裂缝和所有原因死亡 - 在老年人中更大。 新的阿片类药物处方的重要，常见和未研究的情况是从 医疗住院（例如，非手术状况，例如肺炎，心力衰竭，败血症，ir妄等）。 住院治疗病情的老年患者与不良后果的风险较高 不仅是由于临床脆弱性，而且在护理中的过渡碎片，这可能会使阿片类药物使用 难以监测门诊提供者对阿片类药物的副作用。但是，很少有数据存在于多大程度上 出院时，处方治疗医疗状况的患者是阿片类药物 处方最大的条件，这些阿片类药物处方对广告患者的影响 结果和长期阿片类药物依赖性。 个人医师和医院如何贡献不适当的处方OID是未知的 在患有一般医疗状况的患者以及医院和医院水平的患者中使用 与阿片类药物处方相关的因素。物理处方的变化被认为是重要的 阿片类药物流行的驱动因素，部分原因是现有指南未被充分利用，因此允许不均匀 开处方出现。医院处方文化的差异也可能导致处方差异 跨医院使用的opioid。 拟议的赠款将对一般后的阿片类药物处方率提供全国性的估计 医疗保险的医疗住院；确定处方和阿片类药物不良的条件 事件最常见；量化与卵子相关的患者，身体和医院风险因素 处方；并使用新颖的准实验方法来确定提供者的效果 医院）关于阿片类药物相关的不良事件和长期使用的阿片类药物处方模式。 拟议的研究将是第一个全面研究单个住院的方法 沉淀与阿片类药物相关的不良结果和长期阿片类药物依赖性。该研究的发现将有所帮助 决策者和临床医生定义了过渡到长期使用阿片类药物的风险和与阿片类药物相关的不良 院后环境中的活动，将有助于告知阿片类药物政策，以帮助老年患者 避免阿片类药物相关的不良后果和依赖性。该项目将建立一个数据基础架构 允许最新数据访问，以确保项目的发现与当前的临床相关 实践和阿片类药物政策。