Prescribing of opioids at hospital discharge and associated adverse patient outcomes

项目摘要/摘要 美国的阿片成瘾危机对老年人的影响越来越大。阿片类药物住院率 从1993年到2012年，老年联邦医疗保险受益人中的过量用药增加了五倍。高处方率 老年人中阿片类药物的使用尤其令人担忧，因为与处方有关的不良后果 众所周知，阿片类药物的使用--包括跌倒、骨折和所有原因造成的死亡率--在老年人中更高。 新的阿片类药物处方的一个重要的、常见的和未研究的情景是在从 住院治疗(如肺炎、心力衰竭、败血症、精神错乱等非外科疾病)。 因病住院的老年患者发生不良后果的风险增加 阿片类药物的使用不仅是由于临床上的脆弱性，而且是由于护理中零散的过渡，这可能会使 门诊提供者很难监测阿片类药物的副作用。然而，很少有数据显示在多大程度上 因病住院的患者在出院时被开出阿片类药物，医生说 处方最多的条件，以及这些阿片类药物处方对不良患者的影响 结果和长期阿片类药物依赖。 也不清楚个别医生和医院如何促成不适当的处方阿片类药物。 在一般情况下住院的患者以及医生和医院层面使用 与阿片类药物处方相关的因素。医生处方的变化被认为是一个重要的 阿片类药物流行的驱动因素，部分原因是现有准则未得到充分利用，允许不统一 开出药方让人浮现。医院处方文化的差异也可能导致处方的差异 阿片类药物在医院中的使用。 拟议的赠款将提供国家对阿片类药物处方率的估计，具体如下 医疗保险中的医疗住院；确定处方和阿片类药物相关不良反应的情况 事件是最常见的；量化患者、医生和医院与阿片类药物相关的风险因素 开处方；并使用新的准实验方法来确定提供者(医生和医生)的效果 医院)阿片类药物处方模式与阿片类药物相关的不良事件和长期使用阿片类药物。 这项拟议的研究将是第一次全面研究一次住院如何 加速阿片类药物相关的不良后果和长期的阿片类药物依赖。这项研究的发现将有助于 政策制定者和临床医生定义了向长期使用阿片类药物过渡的风险和阿片类药物相关的不良反应 住院后环境中的事件，并将有助于为有针对性的阿片类药物政策提供信息，以帮助老年患者 避免与阿片类药物相关的不良后果和依赖。该项目将建立一个数据基础设施， 允许访问最新的数据，确保项目的发现与当前临床相关 实践和阿片类药物政策。

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.