Weighting Longitudinal Data to Access Opioid Analgesia Tapering Outcomes among Patients with Co-occurring Chronic Pain and Substance Use Disorder

加权纵向数据以了解同时发生慢性疼痛和药物滥用障碍的患者阿片类镇痛逐渐减少的结果

• 批准号: 10590322
• 负责人: Fares Qeadan
• 金额: $ 209.35万
• 依托单位: LOYOLA UNIVERSITY CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590322
• 关键词: Acupuncture Therapy; Address; Affect; American Hospital Association; Censuses; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Clinics and Hospitals; Color; Complementary Medicine; Data; Databases; Diagnosis; Dimensions; Dose; Electronic Health Record; Ethnic Origin; Goals; Guidelines; Health; Health care facility; Health system; Healthcare Systems; Hospitalization; Hospitals; Inpatients; Intervention; Knowledge; Medicine; Names; Opioid; Opioid Analgesics; Outcome; Overdose; Pain; Pain management; Paint; Patients; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Physical therapy; Population; Population-Based Registry; Procedures; Provider; Race; Research; Resources; Retrospective cohort; Risk; Sample Size; Sampling; Scheme; Severities; Substance Use Disorder; Suicide; Time; Weight; base; chiropracty; chronic pain; chronic pain management; chronic pain patient; demographics; design; experience; falls; high risk; improved; interdisciplinary approach; interest; multidisciplinary; non-opioid analgesic; opioid tapering; opioid use; opioid use disorder; overdose death; overdose risk; patient population; patient subsets; prescription opioid; public health emergency; response; sex; social; trend

Project Summary/Abstract In 2016, the Centers for Disease Control (CDC) released guidelines recommending non-pharmacologic treatment for chronic pain over use of opioid analgesia in response to rising overdose deaths and based on studies showing nonopioid and multidisciplinary approaches to pain contribute to functional and pain severity improvements. CDC guidelines also recommended opioid tapering for chronic pain patients with substance use disorder (SUD) and transition to medications for opioid use disorder (MOUD) for patients with co-occurring opioid use disorder (OUD). While opioid tapering has been widely implemented, few studies assess transitions to MOUD or multidisciplinary medicine use specifically among patients with chronic pain and co-occurring SUD. A primary reason for this limited knowledge is the population with chronic pain and co-occurring SUD is often relatively small in any given healthcare facility or system, and outcomes of interest may occur in low total numbers. Thus, a large database is required to conduct multifactorial research on outcomes associated with different approaches to opioid tapering, especially when evaluating whether trends hold among smaller demographic groups. To address this critical gap, our goal is to create weights for the Cerner Real-World© database, which includes electronic health records (EHR) data from over 100 million unique U.S. patients at 600 participating hospitals and clinics. Our hypothesis is that weighting the database will significantly enhance its representativeness in order to longitudinally assess the relationship between opioid tapering, multidisciplinary medicine, MOUD, and outcomes for chronic pain patients with co-occurring SUD. Our aims are to use American Hospital Association and U.S. Census data to create weights, stratified by hospital characteristics and adjusted by demographic variables, for analyzing the Cerner database (Aim 1); validate the weighting scheme in Aim 1 by comparing weighted estimates from the Cerner database to estimates from a well-established population (the Nationwide Inpatient Sample) for chronic pain, SUD, and overdose diagnoses and relevant multidisciplinary pain interventions for the years 2000-2025 (Aim 2); among patients with chronic pain and co-occurring OUD, examine how tapering opioid analgesics and transitioning to MOUD affects risk for overdose, suicide, and other hospitalizations, and assess how sex and race/ethnicity operate as effect modifiers in these relationships (Aim 3); and among patients with chronic pain and co-occurring SUD, examine how tapering opioid analgesics while using multidisciplinary pain treatment affects risk for overdose, suicide, and other hospitalizations, and assess how sex and race/ethnicity operate as effect modifiers in these relationships (Aim 4). This project will create a national database with validated weighting that will enable rigorous examination of opioid tapering approaches among patients with chronic pain and co-occurring SUD, which will subsequently improve knowledge of how multidisciplinary pain treatment and MOUD affect risks, while considering tapering-related inequities among demographic subpopulations.

项目概要/摘要 2016 年，美国疾病控制中心 (CDC) 发布指南，推荐非药物治疗 因服用阿片类药物镇痛而导致慢性疼痛的治疗，以应对药物过量死亡人数上升的情况，并基于 研究表明非阿片类药物和多学科治疗疼痛方法有助于改善功能和疼痛严重程度 改进。疾病预防控制中心指南还建议使用药物的慢性疼痛患者逐渐减少阿片类药物的用量 对于同时发生阿片类药物的患者，阿片类药物使用障碍 (SUD) 和过渡到阿片类药物使用障碍 (MOUD) 药物治疗 使用障碍（OUD）。尽管阿片类药物逐渐减少已被广泛实施，但很少有研究评估向阿片类药物的过渡 MOUD 或多学科医学特别适用于患有慢性疼痛和并发 SUD 的患者。一个 造成这种认识有限的主要原因是患有慢性疼痛且同时发生 SUD 的人群通常 在任何给定的医疗机构或系统中都相对较小，并且感兴趣的结果可能会以较低的总数发生 数字。因此，需要一个大型数据库来对与相关结果进行多因素研究 阿片类药物逐渐减少的不同方法，特别是在评估小规模药物的趋势是否持续时 人口群体。为了解决这一关键差距，我们的目标是为 Cerner Real-World© 创建权重 数据库，其中包括来自 600 多名美国患者的电子健康记录 (EHR) 数据 参与的医院和诊所。我们的假设是，对数据库进行加权将显着提高其 代表性，以便纵向评估阿片类药物逐渐减少、多学科之间的关系 慢性疼痛患者并发 SUD 的药物、MOUD 和结果。我们的目标是利用美国 医院协会和美国人口普查数据创建权重，按医院特征分层并调整 通过人口统计变量，分析 Cerner 数据库（目标 1）；验证目标 1 中的加权方案 通过将 Cerner 数据库的加权估计值与成熟总体的估计值（ 全国住院患者样本）用于慢性疼痛、SUD 和过量诊断以及相关的多学科疼痛 2000-2025 年的干预措施（目标 2）；在患有慢性疼痛和同时发生 OUD 的患者中，检查 逐渐减少阿片类镇痛药并过渡到 MOUD 如何影响用药过量、自杀和其他风险 住院治疗，并评估性别和种族/民族如何作为这些关系中的影响调节剂（目标 3）；在患有慢性疼痛和同时发生 SUD 的患者中，检查如何在减少阿片类镇痛药用量的同时 使用多学科疼痛治疗会影响用药过量、自杀和其他住院治疗的风险，并评估 性别和种族/族裔如何在这些关系中发挥影响调节作用（目标 4）。该项目将创建一个 具有经过验证权重的国家数据库，可以严格检查阿片类药物逐渐减少的方法 在患有慢性疼痛和同时发生 SUD 的患者中，这将随后提高人们对如何 多学科疼痛治疗和 MOUD 会影响风险，同时考虑到逐渐减少相关的不平等 人口亚群。