Skilled Nursing Facility Care and Outcomes After Hospitalizations Involving Opioid Use Disorder

项目总结 阿片类药物使用障碍(OUD)在老年人(≥65岁)和年轻人中呈上升趋势 参加了联邦医疗保险的人。与阿片类药物相关的住院和急诊科就诊增加 在这一人群中也有报道。OUD患者的急诊后综合护理(PAC) 应解决OUD治疗和其他医疗问题的护理需求。作为现有的预防措施 并主要针对社区居民治疗PWOUD，对于PWOUD何时以及如何治疗仍有许多未知之处 与急诊后护理和长期护理的机构设置互动，如熟练护理设施(SNF)。 关于OUD是否代表着进入更高质量的SNF的障碍，也存在知识差距， 进入SNF的PWOUD患者的结果，以及在这些环境中提供OUD治疗的能力。 然而，作为机构急性后护理机构的主导环境的SNF正在收到更多的转诊 普瓦德。这项研究的长期目标是最终与SNF合作，以提高意愿和 在急性后和长期护理环境中为PWOUD提供药物治疗的能力。这个 这项申请的目标，也是迈向这一长期目标的第一步，是检查入院的SNF的质量 PWOUD，与OUD相关的住院后的生存和医疗保健轨迹，并引出提供者的观点 关于改善小岛屿发展中国家获得Moud机会的战略。双管齐下的研究原理是解决知识 在SNF的使用和PWOUD的结果方面存在差距，并鼓励更好地将成瘾治疗与 老年学和急性后护理服务。我们将分析2015-2019年100%费用的住院索赔- 与其他数据(例如，登记、疗养院)链接或组合的服务性联邦医疗保险受益人 比较，最小数据集，D部分，OmNicare PAC药房数据和SNF电子病历)。我们的 具体目标是：1)评估联邦医疗保险受益人接受急性后护理的情况，包括 他们输入的SNF的属性、医疗保健使用和生存轨迹，以及OUD提供者的可用性 在SNF所在的社区进行治疗。2)确定并描述以下方面的障碍和促进者 养老院中PWOUD的安置，以及通过引诱提供OUD治疗的最佳做法 养老院工作人员的意见。在目标2中，我们将对护理人员进行半结构化电话采访 家庭管理员、入学协调员和直接护理人员，以获取有关 影响急性SNF使用和PWOUD预后的机制。采访还将提供 初步数据，以告知设计和潜在的可行性的干预措施，以改善OUD治疗在SNF。 这两个目标还将研究SNF的使用和结果在患有OUD的年轻人和老年人之间是否存在差异。 发展这一证据将加强设计和定制有效干预措施的努力，以治疗OUD和 在老龄化人口和不同护理环境中促进复苏。

PROJECT SUMMARY Opioid use disorder (OUD) is increasing in older adults (≥65 years) and among younger people with disabilities who are enrolled in Medicare. Increased opioid-related hospitalizations and emergency department visits have also been reported in this population. Comprehensive post-acute care (PAC) for people with OUD (PWOUD) should address the care needs for both OUD treatment and other medical issues. As existing initiatives to prevent and treat OUD primarily target community-based residents, much is still unknown about when and how PWOUD interact with institutional settings for post-acute and long-term care such as skilled nursing facilities (SNFs). There are also knowledge gaps about whether OUD represents a barrier to admission to higher quality SNFs, the outcomes of PWOUD who enter SNFs, and about the capacity to deliver OUD treatment in these settings. Yet, SNFs which are a dominant setting for institutional post-acute care SNFs are receiving more referrals for PWOUD. The long-term goal of this research is eventual partnership with SNFs to improve the willingness and capacity to provide medications for OUD (MOUD) for PWOUD in post-acute and long-term care settings. The objective of this application, the first step toward this long-term goal, is to examine the quality of SNFs that admit PWOUD, survival and health care trajectories after OUD-related hospitalization, and elicit provider perspectives on strategies to improve access to MOUD in SNFs. The two-pronged study rationale is to address knowledge gaps on SNF use and outcomes for PWOUD, and encourage better integration of addiction treatment with gerontologic and post-acute care services. We will analyze 2015-2019 inpatient hospital claims for 100% fee- for-service Medicare beneficiaries linked to or combined with other data (e.g., enrollment, Nursing Home Compare, Minimum Data Set, Part D, Omnicare PAC pharmacy data and SNF electronic medical records). Our Specific Aims are to: 1) Assess receipt of post-acute care by Medicare beneficiaries with OUD, including the attributes of SNFs they enter, health care use and survival trajectories, and availability of providers for OUD treatment in neighborhoods where SNFs are located. 2) Identify and describe barriers and facilitators for the placement of PWOUD in nursing homes, and best practices for providing access to OUD treatment by eliciting the views of nursing home personnel. In Aim 2, we will conduct semi-structured telephone interviews with nursing home administrators, admissions coordinators, and direct care staff to obtain rich contextual information about the mechanisms that shape post-acute SNF use and outcomes for PWOUD. The interviews will also provide preliminary data to inform the design and potential feasibility of interventions to improve OUD treatment in SNFs. Both aims will also examine whether SNF use and outcomes differ between younger and older adults with OUD. Developing this evidence will enhance efforts to design and tailor effective interventions to treat OUD and promote recovery in an aging population and across diverse care settings.