Applying Big Data Analytics to Study the Impact of Opioid Prescribing Policy Changes on Prescribing Behavior and Overdose Outcomes

应用大数据分析研究阿片类药物处方政策变化对处方行为和过量结果的影响

• 批准号: 9528759
• 负责人: Ingrid A Binswanger
• 金额: $ 47.5万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9528759
• 关键词: Address; Adverse effects; Affect; Alcohol or Other Drugs use; Analgesics; Behavior; Big Data; Cessation of life; Characteristics; Chronic; Clinical; Colorado; Communities; Complex; Data; Data Analyses; Data Analytics; Databases; Death Rate; Diagnosis; Disease; Dose; Drug abuse; Electronic Health Record; Epidemic; Formularies; Formulation; Future; Goals; Government; Guidelines; Health system; Heroin; Insurance; Lead; Link; Longitudinal cohort study; Managed Care; Measurement; Measures; Medicaid; Medical; Medical Records; Methods; Modeling; Morphine; Opioid; Opioid Rotation; Outcome; Overdose; Patient-Focused Outcomes; Patients; Pharmacy facility; Physicians; Policies; Population; Population Heterogeneity; Provider; Public Health; Records; Research; Research Personnel; Risk; System; Tablets; Toxicology; United States; Vital Statistics; Withdrawal Symptom; addiction; analytical method; behavior change; behavioral outcome; cost; design; experience; health care service utilization; heroin overdose; indexing; innovation; novel; pain symptom; patient population; prevent; programs; response; trend

PROJECT ABSTRACT Overdoses from opioid pain relievers (OPR) have reached epidemic proportions in the United States. In response to this public health crisis, there have been local, state and national efforts to reduce inappropriate opioid prescribing. Recent small reductions in OPR deaths rates suggest that these efforts may have been effective. However, unprecedented recent increases in heroin use, heroin use disorders, and heroin overdoses have also been observed. It has been suggested that efforts to curb inappropriate OPR prescribing are having the unintended consequence of increasing heroin use and its adverse effects. Low cost and wide availability are common reasons provided for the switch from OPR to heroin use. To effectively manage the risk of heroin initiation, health systems, insurance plans, and medical providers need to understand whether, how, and for whom these risks are affected by OPR prescribing practices. As in other states, several Colorado policies have been directed at curbing opioid prescribing. In August of 2014, Colorado Medicaid limited monthly quantities of short-acting opioid tablets to 120. In February 2016, Medicaid limited the average daily covered morphine equivalent dose (MED) to 300 MED. These policies were intended to encourage providers to taper patients from high-dose opioid therapy, thus reducing the risk of OPR overdose. To date, however, the effect of these policies on physician prescribing behavior, OPR overdose, heroin use, and heroin overdose is not known. The overall goal of this project is to conduct a large, longitudinal cohort study to examine the impact of OPR policies and prescribing practices on OPR overdose, heroin use, and heroin overdose from 2012 to 2019. The study will include data on patients from a large managed care organization (Kaiser Permanente Colorado) and Colorado’s Medicaid program. Together these systems cover approximately 2 million people in Colorado, representing 40% of the state’s population. Exposures, outcomes, and covariates will be measured by linking patient-level data from pharmacy records, diagnoses, toxicology findings, health care utilization, and vital records from the National Death Index. Exposures and outcomes will be validated with medical record review. Analyses will be conducted with linear and nonlinear mixed effects regression models, with propensity scores to account for confounding and quantitative bias analyses to assess misclassification bias. The results of these “Big Data” analyses will help guide future OPR prescribing policies at the state and national level.

项目摘要 阿片类止痛药（OPR）的过量剂量在美国达到了流行病。在 对这一公共卫生危机的回应，有地方，州和国家努力减少不适当的努力 Oopioid处方。最近的OPR死亡率率较小，表明这些努力可能是 有效的。但是，海洛因使用，海洛因使用障碍和海洛因过量的近期增长量的前所未有 也观察到。有人建议遏制不适当的OPR规定的努力 海洛因使用增加及其不良影响的意外后果。低成本和广泛的可用性 是从OPR转换为海洛因使用的常见原因。有效管理海洛因的风险 启动，卫生系统，保险计划和医疗提供者需要了解是否，如何以及 这些风险受OPR处方实践影响。 与其他州一样，科罗拉多州的几项政策旨在遏制阿片类药物处方。在八月 2014年，科罗拉多州医疗补助有限的每月短期阿片类药物片至120。2016年2月， Medicaid将平均每日覆盖吗啡当量剂量（MED）限制为300 MED。这些政策是 旨在鼓励提供者从高剂量阿片类药物治疗的锥形患者中，从而降低了OPR的风险 过量。但是，迄今为止，这些政策对物理处方行为的影响，OPR过量， 海洛因使用，海洛因过量是不知道的。 该项目的总体目标是进行大型的纵向队列研究以检查OPR的影响 从2012年到2019年，关于OPR过量，海洛因使用和海洛因过量的政策和开处方实践。 研究将包括来自大型托管护理组织（Kaiser Permanente Colorado）和 科罗拉多州的医疗补助计划。这些系统共同覆盖了科罗拉多州约200万人 代表该州40％的人口。将通过链接来衡量暴露，结果和协变量 药房记录，诊断，毒理学发现，医疗保健利用和重要的患者级数据 国家死亡指数的记录。暴露和结果将通过病历审查来验证。 分析将使用线性和非线性混合效应回归模型进行，并具有承诺得分 考虑混淆和定量偏见分析以评估错误分类偏见。这些结果 “大数据”分析将有助于指导州和国家一级的未来OPR规定政策。