Associations of Opioid Prescribing with Long-term Functional Outcomes and Mortality Rates in Older Nursing Home Residents

阿片类药物处方与老年疗养院居民的长期功能结果和死亡率之间的关系

• 批准号: 10480904
• 负责人: Taeho Gregory Rhee
• 金额: $ 16.4万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-05 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10480904
• 关键词: Address; Age; Beds; Benzodiazepines; Certification; Cessation of life; Characteristics; Clinical; Clinical assessments; Cognitive; Cross-Sectional Studies; Data; Data Analyses; Data Set; Dementia; Discipline of Nursing; Dose; Elderly; Engineering; Ensure; Future; Gender; Guidelines; Health; Health Personnel; Health Services Research; Hospitals; Impaired cognition; Impairment; Incidence; Knowledge; Link; Literature; Long-Term Effects; Medicaid; Medicare; Medicare claim; Medicine; Methods; Mission; Modeling; Morphine; Nursing Homes; Opioid; Outcome; Outpatients; Pain; Personal Satisfaction; Pharmacoepidemiology; Physicians; Population Heterogeneity; Prevalence; Provider; Public Health; Publishing; Quality of Care; Recommendation; Reporting; Research; Risk; Risk Estimate; Safety; Sampling; Surveys; Survival Analysis; System; Time; United States; United States Centers for Medicare and Medicaid Services; United States National Academy of Sciences; Visit; Woman; base; chronic pain; cognitive performance; ethnic minority; fall risk; feasibility testing; frailty; functional outcomes; high risk population; improved; indexing; milligram; mortality; opioid epidemic; opioid overdose; opioid use; opioid use disorder; opioid user; patient population; prescription opioid; racial and ethnic; response; tool

Project Abstract Prescription opioid use is increasingly common in older adults in nursing home (NH) settings. A nationally representative cross-sectional study of all long-stay (i.e., ≥90 days) older NH residents published in 2018 found that one in three (32.4%) were prescribed an opioid medication for any duration, and one in seven (15.5%) were prescribed opioids for long-term use (i.e., ≥90 days). Relationships between opioid prescribing and long- term cognitive and physical functional outcomes, as well as between opioid prescribing and mortality rates, among older NH residents—perhaps the most vulnerable, highest-risk group of opioid users—are largely unexplored. The proposed nationwide study explicitly addresses these knowledge gaps through investigating opioid prescribing by duration of action (i.e., long-acting versus short-acting opioids) and their associations with long-term functional outcomes and mortality rates among older NH residents. Using the Centers for Medicare and Medicaid Services’ 2018-2019 Medicare claims (e.g., Part A, B, and D) data linked to 1) Minimum Data Set (MDS) 3.0, a federally required clinical assessment of all residents residing in Medicare- or Medicaid-certified NHs quarterly, 2) publicly available NH-level data (e.g., Certification and Survey Provider Enhanced Reporting (CASPER) and Nursing Home Compare), and 3) National Death Index (NDI) data, this proposed study features the following specific aims: 1) to examine incidence and prevalence rates of opioid use by duration of action in older NH residents; 2) to identify resident- and facility-level factors associated with opioid prescribing in NH settings; and 3) to investigate differential risks of short-acting versus long-acting opioids associated with long-term (a) changes in functional outcomes (e.g., cognitive impairment, frailty, and pain) and (b) opioid-related and all-cause mortality rates in older NH residents. To ensure a rigorous study, we will conduct sensitivity analyses by long-term use (e.g., ≥90 days), maximum daily dose (e.g., ≥90 morphine milligram equivalents), and concomitant use of opioid potentiators (e.g., benzodiazepines and gabapentinoids), using longitudinal data analyses (i.e., linear mixed modeling and survival analysis). Our study will also employ propensity-score matching and instrumental variable methods to adjust for potential observed and unobserved confounders. To date, there are two federal guidelines on opioid prescribing, but they largely overlooked older adults living in NHs. In 2019, the National Academies of Science, Engineering, and Medicine (NASEM) convened an expert panel group that framed opioid prescribing guidelines. One recommendation was to conduct research investigating the long-term health outcomes in both patient and population levels. The proposed study is timely and directly addresses this recommendation. Findings from the proposed study will further guide safer opioid use in older adults living in NH settings.

项目摘要 在全国疗养院 (NH) 中，处方阿片类药物的使用在老年人中越来越普遍。 2018 年发表的针对所有长期居住（即≥90 天）的新罕布什尔州老年居民的代表性横断面研究发现 三分之一 (32.4%) 的人长期服用阿片类药物，七分之一 (15.5%) 长期使用阿片类药物（即≥90天）。阿片类药物处方与长期使用之间的关系。 术语认知和身体功能结果，以及阿片类药物处方和死亡率之间的关系， 在新罕布什尔州老年居民中——也许是阿片类药物使用者中最脆弱、风险最高的群体——主要是 拟议的全国性研究通过调查明确解决了这些知识差距。 按作用持续时间（即长效与短效阿片类药物）开阿片类药物处方及其与 NH 老年居民的长期功能结果和死亡率。 使用 Medicare 和 Medicaid 服务中心的 2018-2019 年 Medicare 索赔（例如 A、B 和 D 部分） 数据链接至 1) 最低数据集 (MDS) 3.0，联邦政府要求对所有居住的居民进行临床评估 每季度获得 Medicare 或 Medicaid 认证的 NH 数据，2) 公开可用的 NH 级别数据（例如，认证和 调查提供者增强报告 (CASPER) 和疗养院比较），以及 3) 全国死亡指数 （NDI）数据，这项拟议的研究具有以下具体目的：1）检查发病率和患病率 NH 老年居民按用药持续时间划分的阿片类药物使用率；2) 确定居民和机构层面的因素； 与 NH 环境中阿片类药物处方相关；3) 研究短效与阿片类药物的不同风险 长效阿片类药物与长期 (a) 功能结果变化（例如认知障碍、 虚弱和疼痛）和 (b) 老年新罕布什尔州居民中与阿片类药物相关的死亡率和全因死亡率。 研究中，我们将按长期使用（如≥90天）、每日最大剂量（如≥90 吗啡毫克当量），以及同时使用阿片类增效剂（例如苯二氮卓类药物和 加巴喷丁类药物），使用纵向数据分析（即线性混合模型和生存分析）。 还将采用倾向得分匹配和工具变量方法来调整潜在的观察到的结果 和未观察到的混杂因素。 迄今为止，有两项关于阿片类药物处方的联邦指南，但它们在很大程度上忽视了老年人 2019 年，美国国家科学、工程和医学院 (NASEM) 召开了一次会议。 制定阿片类药物处方指南的专家小组的一项建议是进行研究。 调查患者和人群的长期健康结果拟议的研究是及时的。 并直接解决这一建议。拟议研究的结果将进一步指导更安全的阿片类药物。 用于居住在 NH 环境中的老年人。

项目成果

Comparison of industry payments to psychiatrists and psychiatric advanced practice clinicians in the USA, 2021: a cross-sectional study.

2021 年美国精神科医生和精神科高级实践临床医生的行业支付比较：一项横断面研究。

• DOI: 10.1136/bmjopen-2023-081252
• 发表时间: 2024
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Havlik,John;Ososanya,Lydia;Lee,MeganS;Wahid,Syed;Heyang,Michael;Sun,QiweiWilton;Ross,JosephS;Rhee,TaehoGreg
• 通讯作者: Rhee,TaehoGreg

Clinical efficacy and safety of Zuranolone (SAGE-217) in individuals with major depressive disorder.

Zuranolone (SAGE-217) 对重度抑郁症患者的临床疗效和安全性。

• DOI: 10.1016/j.jad.2023.08.027
• 发表时间: 2023
• 期刊: Journal of affective disorders
• 影响因子: 6.6
• 作者: Meshkat,Shakila;Teopiz,KaylaM;DiVincenzo,JoshuaD;Bailey,JuliaB;Rosenblat,JoshuaD;Ho,RogerC;Rhee,TaehoGreg;Ceban,Felicia;Kwan,AngelaTH;Cao,Bing;McIntyre,RogerS
• 通讯作者: McIntyre,RogerS

Estimates of Gaps in Supportive Housing Among Racially and Ethnically Diverse Older Adults with Serious Mental Illness in New York City Boroughs: Manhattan, Bronx, and Brooklyn.

纽约市曼哈顿区、布朗克斯区和布鲁克林区患有严重精神疾病的不同种族和民族老年人的支持性住房差距估计。

• DOI: 10.1016/j.jagp.2023.04.006
• 发表时间: 2023
• 期刊: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
• 作者: Fortuna,KarenL;Heller,Rebecca;Crowe-Cumella,Hannah;Bohm,Andrew
• 通讯作者: Bohm,Andrew

Estimates of loneliness among racially and ethnically diverse adults with serious mental illness in New York City boroughs: Manhattan, Bronx, and Brooklyn.

纽约市曼哈顿、布朗克斯和布鲁克林等行政区患有严重精神疾病的不同种族和民族成年人的孤独感估计。

• DOI: 10.1111/jgs.18688
• 发表时间: 2024
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Fortuna,KarenL;Rhee,TaehoGreg;Leininger,LindseyJ;Ferron,Joelle;Elwyn,Glyn;Raue,PatrickJ;Heller,Rebecca;Werlin,Jonathan
• 通讯作者: Werlin,Jonathan