Prescribing of opioids at hospital discharge and associated adverse patient outcomes

项目总结/摘要 美国的阿片类药物成瘾危机越来越多地影响老年人。阿片类药物住院率 从1993年到2012年，老年医疗保险受益人的过量服用增加了五倍。处方率高 考虑到与处方有关的不良后果， 阿片类药物的使用--包括福尔斯、骨折和全因死亡--在老年人中更为常见。 新阿片类药物处方的一个重要，常见和未经研究的情况是在出院时， 医疗住院（例如，非手术病症如肺炎、心力衰竭、败血症、谵妄等）。 因医疗状况住院的老年患者发生不良结局的风险升高， 阿片类药物的使用不仅是由于临床脆弱性，而且是由于护理中的零散过渡，这可能使 门诊提供者难以监测阿片类药物的副作用。然而，几乎没有数据表明， 因医疗条件住院的患者在出院时被处方阿片类药物， 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。 也不知道个别医生和医院如何导致不适当的处方阿片类药物 在一般医疗条件下住院的患者中使用，以及医生和医院一级 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，部分原因是现有的指导方针未得到充分利用， 处方出现。医院处方文化的差异也可能导致处方的变化 阿片类药物的使用 拟议的赠款将提供国家估计的阿片类药物处方率以下一般 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条件 事件最常见;量化与阿片类药物相关的患者、医生和医院风险因素 处方;并使用新的准实验方法来确定供应商的影响（医生和医生） 医院）阿片类药物处方模式对阿片类药物相关不良事件和长期阿片类药物使用。 这项拟议中的研究将是第一次全面研究一次住院如何能够 加速阿片类药物相关的不良后果和长期阿片类药物依赖。这项研究的发现将有助于 政策制定者和临床医生定义过渡到长期阿片类药物使用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，并将有助于告知有针对性的阿片类药物政策，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设施， 允许最新的数据访问，确保项目的发现与当前的临床相关。 政策和阿片类药物。

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.