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

项目摘要 阿片类药物使用障碍（OUD）在老年人（≥65岁）和年轻残疾人中增加 参加医疗保险的人阿片类药物相关住院和急诊就诊的增加 在这一人群中也有报道。OUD患者的综合急性期后护理（PAC）（PWOUD） 应满足OUD治疗和其他医疗问题的护理需求。现有的预防措施 治疗OUD主要针对社区居民，但关于PWOUD何时以及如何治疗， 与急性期后和长期护理的机构环境互动，如熟练护理设施（SNF）。 关于OUD是否是进入更高质量SNF的障碍， 进入SNF的PWOUD的结果，以及在这些环境中提供OUD治疗的能力。 然而，SNF是机构急性后护理SNF的主要环境， PWOUD。这项研究的长期目标是最终与SNF合作，以提高他们的意愿， 在急性期后和长期护理环境中为PWOUD提供OUD（MOUD）药物的能力。的 本申请的目的，朝着这个长期目标的第一步，是检查SNF的质量， PWOUD，OUD相关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SNF中MOUD访问的战略。双管齐下的研究基本原理是解决知识 SNF使用和PWOUD结果的差距，并鼓励更好地将成瘾治疗与 老年病和急症后护理服务。我们将分析2015-2019年100%费用的住院医院索赔- 与其他数据链接或组合的服务Medicare受益人（例如，入组，疗养院 比较，最小数据集，D部分，Omnicare PAC药房数据和SNF电子病历）。我们 具体目标是：1）评估OUD的Medicare受益人接受的急性期后护理，包括 他们进入的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)确定并描述实现以下目标的障碍和促进因素： 将PWOUD安置在疗养院，以及通过引发 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式电话访谈 家庭管理员、入院协调员和直接护理人员，以获取有关以下内容的丰富上下文信息： 形成急性后SNF使用和PWOUD结局的机制。采访还将提供 提供初步数据，为改善SNF中OUD治疗的干预措施的设计和潜在可行性提供信息。 这两个目标还将研究SNF的使用和结果是否在OUD的年轻人和老年人之间存在差异。 开发这些证据将加强设计和定制有效干预措施以治疗OUD的努力， 促进老龄化人口和不同护理环境的康复。

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.