Associations of Opioid Prescribing with Long-term Functional Outcomes and Mortality Rates in Older Nursing Home Residents

阿片类药物处方与老年疗养院居民的长期功能结果和死亡率之间的关系

• 批准号: 10273544
• 负责人: Taeho Gregory Rhee
• 金额: $ 13.1万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10273544
• 关键词: Address; Age; Beds; Benzodiazepines; Certification; Cessation of life; Characteristics; Clinical; Clinical assessments; Cognitive; Cross-Sectional Studies; Data; Data Analyses; Data Set; Dementia; Discipline of Nursing; Dose; Elderly; Engineering; Ensure; Future; Gender; Guidelines; Health; Health Personnel; Health Services Research; Hospitals; Impaired cognition; Impairment; Incidence; Knowledge; Link; Literature; Long-Term Effects; Medicaid; Medicare; Medicare claim; Medicine; Methods; Mission; Modeling; Morphine; Nursing Homes; Opioid; Outcome; Outpatients; Pain; Personal Satisfaction; Pharmacoepidemiology; Physicians; Population Heterogeneity; Prevalence; Provider; Public Health; Publishing; Quality of Care; Recommendation; Reporting; Research; Risk; Risk Estimate; Safety; Sampling; Surveys; Survival Analysis; System; Time; United States; United States Centers for Medicare and Medicaid Services; United States National Academy of Sciences; Visit; Woman; base; chronic pain; cognitive performance; ethnic minority population; fall risk; feasibility testing; frailty; functional outcomes; high risk population; improved; indexing; milligram; mortality; opioid epidemic; opioid overdose; opioid use; opioid use disorder; opioid user; patient population; prescription opioid; racial and ethnic; response; tool

Project Abstract Prescription opioid use is increasingly common in older adults in nursing home (NH) settings. A nationally representative cross-sectional study of all long-stay (i.e., ≥90 days) older NH residents published in 2018 found that one in three (32.4%) were prescribed an opioid medication for any duration, and one in seven (15.5%) were prescribed opioids for long-term use (i.e., ≥90 days). Relationships between opioid prescribing and long- term cognitive and physical functional outcomes, as well as between opioid prescribing and mortality rates, among older NH residents—perhaps the most vulnerable, highest-risk group of opioid users—are largely unexplored. The proposed nationwide study explicitly addresses these knowledge gaps through investigating opioid prescribing by duration of action (i.e., long-acting versus short-acting opioids) and their associations with long-term functional outcomes and mortality rates among older NH residents. Using the Centers for Medicare and Medicaid Services’ 2018-2019 Medicare claims (e.g., Part A, B, and D) data linked to 1) Minimum Data Set (MDS) 3.0, a federally required clinical assessment of all residents residing in Medicare- or Medicaid-certified NHs quarterly, 2) publicly available NH-level data (e.g., Certification and Survey Provider Enhanced Reporting (CASPER) and Nursing Home Compare), and 3) National Death Index (NDI) data, this proposed study features the following specific aims: 1) to examine incidence and prevalence rates of opioid use by duration of action in older NH residents; 2) to identify resident- and facility-level factors associated with opioid prescribing in NH settings; and 3) to investigate differential risks of short-acting versus long-acting opioids associated with long-term (a) changes in functional outcomes (e.g., cognitive impairment, frailty, and pain) and (b) opioid-related and all-cause mortality rates in older NH residents. To ensure a rigorous study, we will conduct sensitivity analyses by long-term use (e.g., ≥90 days), maximum daily dose (e.g., ≥90 morphine milligram equivalents), and concomitant use of opioid potentiators (e.g., benzodiazepines and gabapentinoids), using longitudinal data analyses (i.e., linear mixed modeling and survival analysis). Our study will also employ propensity-score matching and instrumental variable methods to adjust for potential observed and unobserved confounders. To date, there are two federal guidelines on opioid prescribing, but they largely overlooked older adults living in NHs. In 2019, the National Academies of Science, Engineering, and Medicine (NASEM) convened an expert panel group that framed opioid prescribing guidelines. One recommendation was to conduct research investigating the long-term health outcomes in both patient and population levels. The proposed study is timely and directly addresses this recommendation. Findings from the proposed study will further guide safer opioid use in older adults living in NH settings.

项目摘要 在疗养院(NH)的老年人中，处方阿片类药物的使用越来越普遍。一个全国性的 2018年发表的对所有长期居住(即≥90天)的NH老年居民的代表性横断面研究发现 每三个人中就有一个(32.4%)开过任何时间的阿片类药物，七分之一(15.5%) 是长期使用的处方阿片类药物(即≥90天)。阿片类药物处方与长期用药的关系 术语认知和身体功能结果，以及阿片类药物处方和死亡率之间的关系， 在NH老年居民中-可能是最脆弱、最高风险的阿片类药物使用者群体-主要是 未被开发的。拟议的全国性研究通过调查明确地解决了这些知识差距 按作用持续时间开出的阿片类药物(即长效与短效阿片类药物)及其与 老年NH居民的长期功能结局和死亡率。 使用联邦医疗保险和医疗补助服务中心2018-2019年的联邦医疗保险索赔(例如，A、B和D部分) 数据链接到1)最小数据集(MDS)3.0，这是联邦要求对所有居民进行的临床评估 在Medicare或Medicaid认证的NHS季度中，2)公开可用的NH级别数据(例如，认证和 调查提供商增强型报告(Casper)和疗养院比较)，以及3)国家死亡指数 (NDI)数据，这项拟议的研究具有以下具体目的：1)检查发病率和流行率 老年NH居民的阿片类药物使用率(按行动持续时间分列)；2)确定居民和设施层面的因素 与NH环境中的阿片类药物处方相关；以及3)调查短效与非阿片类药物的不同风险 与长期相关的长效阿片类药物(A)功能结果的改变(例如，认知障碍， (B)NH老年居民中与阿片类药物相关的死亡率和全因死亡率。为了确保严格的 研究中，我们将根据长期使用(例如≥90天)、每日最大剂量(例如≥90)进行敏感性分析 吗啡毫克当量)，以及同时使用阿片类增效剂(例如，苯二氮卓类药物和 使用纵向数据分析(即线性混合建模和生存分析)。我们的研究 还将使用倾向-分数匹配和工具变量方法来调整潜在的观察 和不为人知的混血儿。 到目前为止，有两个关于阿片类药物处方的联邦指南，但它们在很大程度上忽视了老年人 住在英国国家医疗服务体系。2019年，美国国家科学、工程和医学研究院(NASEM)召开了一次 制定阿片类药物处方指南的专家组。其中一项建议是进行研究 从患者和人群两个层面调查长期健康结果。建议的研究恰逢其时。 并直接满足这一建议。拟议研究的结果将进一步指导更安全的阿片类药物 用于生活在NH环境中的老年人。