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

项目摘要/摘要 2016年，疾病控制中心(CDC)发布了建议非药理学的指南 治疗慢性疼痛过度使用阿片类止痛药应对过量死亡的增加和基于 研究表明，非阿片类药物和多学科方法治疗疼痛有助于改善功能和疼痛严重程度 改进。CDC指南还建议使用阿片类药物的慢性疼痛患者逐步减少使用阿片类药物 阿片类药物共现患者的精神障碍(SUD)和阿片类药物使用障碍(Moud) 使用无序(OUD)。虽然阿片类药物的缩减已被广泛实施，但很少有研究评估向 Moud或多学科药物专门用于慢性疼痛和伴发的SUD患者。一个 这些知识有限的主要原因是患有慢性疼痛的人群，并经常同时发生SUD 在任何给定的医疗机构或系统中相对较小，并且感兴趣的结果可能以较低的总数出现 数字。因此，需要一个大型数据库来对与以下方面有关的结果进行多因素研究 阿片类药物缩减的不同方法，特别是在评估较小规模的人群中是否存在趋势时 人口统计群体。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600,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000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著增强其 代表性以纵向评估阿片类药物逐渐减少之间的关系，多学科 慢性疼痛合并SUD患者的药物、Moud和结果。我们的目标是用美国人 医院协会和美国人口普查数据创建权重，按医院特征分层并进行调整 按人口统计变量，用于分析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公认的人口估计值( 全国住院患者样本)，用于慢性疼痛、SUD、过量诊断和相关的多学科疼痛 2000-2025年干预措施(目标2)；在慢性疼痛和伴发疼痛的患者中，检查 逐渐减少阿片类止痛药和过渡到Moud如何影响过量服药、自杀和其他风险 住院，并评估性别和种族/民族在这些关系中如何作为效果修饰物(目的 3)；在慢性疼痛和伴发SUD的患者中，检查逐渐减少阿片类止痛剂在 使用多学科疼痛治疗会影响服药过量、自杀和其他住院的风险，并评估 性别和种族/族裔如何在这些关系中起到效果修饰物的作用(目标4)。该项目将创建一个 具有经过验证的权重的国家数据库，将能够对阿片类药物缩减方法进行严格检查 在慢性疼痛和伴发SUD的患者中，这将随后提高对如何 多学科疼痛治疗和Moud影响风险，同时考虑与缩减相关的不平等 人口亚群。

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.