EpiCenter ? EPIdemiology of opioid prescribing in community health CENTERs

项目总结 震中项目是第一个探索如何通过以下方式在安全网临床人群中开阿片类药物的项目 链接四个强大的数据集。根据我们以前的经验，我们使用电子健康记录(EHR)数据 来自OCHIN(不是首字母缩写)基于实践的研究网络，该网络服务于150多万活跃患者 在18个州的581个社区卫生中心(CHC)。我们探索了EHR中的多级别变量 说明接受长期阿片类药物处方的原因和相关的健康后果。为了做某事 因此，我们将患者记录与社区健康社会决定因素的衡量标准联系起来。为201家人道协调厅诊所服务 在俄勒冈州，我们将电子病历记录与医疗补助管理索赔以及生命统计数据联系起来。这使我们能够 研究慢性阿片类药物治疗与阿片类药物过量和死亡等结局之间的关系。 具体目标是：目标1：描述阿片类药物处方的总体趋势，按强度(吗啡) 等效性)、配方(长效与短效)、使用的长期性(急性与慢性)以及与 在安全网/社区卫生中心使用苯二氮卓类药物，并与全国趋势进行比较。目标2：实现 评估阿片类药物处方(包括强度、配方、慢性化和协同作用)之间的关系。 使用苯二氮卓类药物)和多层次因素，如患者级别的人口统计(种族/民族， 性别、联邦贫困水平百分比等)和诊断，社区层面的健康和临床社会决定因素- 安全网社区卫生保健中心的水平因素(规模、农村、提供者类型)。目标3：检查两者之间的关系 阿片类药物处方(包括强度、配方、慢性化、与苯二氮类药物联合处方)和 安全网/社区卫生中心人群中的相关健康结果(共病、过量用药)。建议的工作使用 提供独特、丰富的数据集(电子病历、社区因素、州生命统计数据和医疗补助报销数据) 为期十年(2009-2018年)的纵向研究项目，以提供对 社区卫生中心有问题的阿片类药物处方。通过关注安全网诊所，我们将更好地 了解这个问题是如何以及为什么会出现在受其影响最大的社区和人群中 了解哪些政策将带来更好的做法和结果。

PROJECT SUMMARY The EPICENTER project is the first to explore how opioids are prescribed in safety net clinic populations by linking four powerful datasets. Building on our prior experience, we use electronic health record (EHR) data from the OCHIN (not an acronym) practice-based research network that serves over 1.5 million active patients in 581 community health centers (CHCs) in 18 states. We explore multilevel variables within the EHR that shed light on the reasons for receiving chronic opioid prescriptions and associated health outcomes. In order to do so, we link patient records to measures of community social determinants of health. For the 201 OCHIN clinics in Oregon we link EHR records to Medicaid administrative claims as well as vital statistics data. This allows us to examine associations between chronic opioid therapy and outcomes such as opioid overdose and death. The specific aims are: Aim 1: To describe trends of opioid prescribing overall, by strength (morphine equivalence), formulation (long vs. short acting), chronicity of use (acute vs. chronic) and co-prescribing with benzodiazepines in safety net/community health centers and compare them with national trends. Aim 2: To assess the relationship between opioid prescribing (including strength, formulation, chronicity, and co- prescribing with benzodiazepines) and multilevel factors such as patient-level demographics (race/ethnicity, sex, % federal poverty level, etc.) and diagnoses, community-level social determinants of health and clinic- level factors (size, rurality, provider type) in safety net CHCs. Aim 3: To examine the relationship between opioid prescribing (including strength, formulation, chronicity, co-prescribing with benzodiazepines) and relevant health outcomes (co-morbidity, overdoses) in a safety net/CHC population. The proposed work uses unique, rich datasets (EHR, community-level factors, state vital statistics and Medicaid claims data) in a longitudinal research project of ten years (2009-2018) in order to provide a multidimensional assessment of problematic opioid prescribing in community health centers. By focusing on safety net clinics, we will better understand how and why this problem arose in the communities and populations it has most affected in order to understand what policies will lead to better practices and outcomes.