Developing a Real-Time Trajectory Tool to Identify Potentially Unsafe Concurrent Opioid and Benzodiazepine Use among Older Adults

开发实时轨迹工具来识别老年人同时使用阿片类药物和苯二氮卓类药物的潜在不安全情况

• 批准号: 9923531
• 负责人: Wei-Hsuan Lo-Ciganic
• 金额: $ 19.39万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9923531
• 关键词: Adult; Anxiety; Arizona; Benzodiazepines; Caring; Cessation of life; Characteristics; Clinical; Computer software; Data; Development; Dose; Elderly; Florida; Fracture; Future; Guidelines; Health; Healthcare; Healthcare Systems; High Prevalence; Impaired cognition; Information Systems; Infrastructure; Intervention; Intuition; Letters; Literature; Measures; Medicaid; Medicare; Medicare claim; Medicare/Medicaid; Mental Health; Mental disorders; Modeling; Opioid; Outcome; Overdose; Pain; Patients; Pattern; Pharmaceutical Preparations; Policies; Predictive Value; Prescription opioid overdose; Prevalence; Probability; Research; Risk; Risk Estimate; Risk Factors; Sampling; Sleeplessness; Structure; Subgroup; Substance Use Disorder; Time; United States Centers for Medicare and Medicaid Services; Update; Validation; Work; adverse outcome; aged; base; chronic pain patient; chronic painful condition; clinical care; clinical decision-making; clinical practice; comorbidity; dashboard; effective intervention; experience; falls; high risk; improved; ineffective therapies; innovation; operation; opioid mortality; opioid use; overdose risk; patient subsets; prescription opioid; prevent; programs; prospective; structured data; tool; young adult

Project Summary/Abstract Prescription opioid overdose deaths have increased markedly in the past two decades, with a third of these fatalities involving concurrent benzodiazepine (BZD) use. Despite clinical guidelines and FDA black-box warnings cautioning against concurrent opioid (OPI) and BZD use (hereafter OPI-BZD use), the number of patients using OPI-BZD increased by 41% between 2002 and 2014. OPI-BZD use increases the risk of overdose and other adverse outcomes (e.g., falls, fractures, cognitive dysfunction), especially among older adults. The dose and duration of OPI-BZD use varies by patient characteristics and comorbid conditions. However, little is known about the thresholds of duration and dose or patterns of OPI-BZD use profiles most associated with the risk of overdose and other adverse outcomes among older adults. Prior studies have defined OPI-BZD use with arbitrary thresholds (e.g., ≥1 day overlapped supply) and focused only on duration or dose alone rather than combinations of duration and dose of concurrent use. Applying arbitrary and broad thresholds without evidence and validation to all patients imposes challenges in tailoring clinical care, and leads to ineffective therapies and interventions involving OPI-BZD use. Alternatively, advanced group-based trajectory models (GBTMs) can be used to better characterize OPI-BZD use in clinical practice. GBTMs have the ability to account for dynamic medication use, identify subgroups with similar changes over time, and simultaneously examine dose and duration thresholds or other patterns most relevant to outcomes in order to better aid clinical decision-making. The proposed study aims at developing an innovative, real-time “Predicting Risky Opioid-Benzodiazepine Trajectory e-Care Tool (PROTeCT)” for efficiently identifying and predicting subgroups of older adults (aged ≥50 years) with distinct and potentially unsafe patterns of OPI-BZD use. Because both Medicare and Medicaid enrollees are experiencing an increased number of chronic pain conditions, mental health/substance use disorders, and prescription OPI use, Medicare and Medicaid are ideal settings for developing the PROTeCT tool. Using national Medicare claims and Arizona (AZ) and Florida (FL) Medicaid data from 2013-2016, Aim 1 focuses on identifying distinct trajectories of OPI-BZD use. We will also identify predictors associated with specific trajectories or patterns. In Aim 2, we will identify the distinct trajectories or patterns of OPI-BZD use that are the most closely associated with two separate outcomes (i.e., overdoses; falls and fractures). Finally, we propose to develop a beta-version of a real-time PROTeCT platform capable of prospectively and iteratively predicting patients with unsafe patterns of OPI-BZD use by prospectively analyzing more recent data from the 2017-2019 Medicaid in AZ and FL. The infrastructure of our findings and tool may be generalizable to Medicare, Medicaid programs in other states or other healthcare data systems with similar data structures.

项目概要/摘要 过去二十年里，处方阿片类药物过量死亡人数显着增加，其中三分之一 尽管有临床指南和 FDA 黑匣子，但仍存在因同时使用苯二氮卓类药物 (BZD) 导致的死亡。 警告不要同时使用阿片类药物 (OPI) 和 BZD（以下简称 OPI-BZD 使用）， 2002 年至 2014 年间，使用 OPI-BZD 的患者增加了 41%。 OPI-BZD 的使用增加了以下风险： 药物过量和其他不良后果（例如跌倒、骨折、认知功能障碍），尤其是老年人 成年人。 OPI-BZD 的使用剂量和持续时间因患者特征和合并症而异。 对于最相关的 OPI-BZD 使用概况的持续时间和剂量阈值或模式知之甚少 先前的研究已经定义了 OPI-BZD 与老年人服用过量和其他不良后果的风险。 使用任意阈值（例如，≥1天重叠供应）并且仅关注持续时间或剂量 而不是同时使用持续时间和剂量的组合。 如果没有对所有患者进行证据和验证，就会给调整临床护理带来挑战，并导致 涉及 OPI-BZD 使用的无效治疗和干预措施或者先进的基于群体的轨迹。 模型（GBTMs）可用于更好地表征OPI-BZD在临床实践中的使用情况。 考虑动态药物使用，确定随时间变化相似的亚组，同时 检查剂量和持续时间阈值或与结果最相关的其他模式，以便更好地帮助临床 决策。 拟议的研究旨在开发一种创新的实时“预测风险阿片类药物-苯二氮卓类药物” 轨迹电子护理工具（PROTeCT）”，用于有效识别和预测老年人亚组（老年人） ≥50 岁），具有独特且潜在不安全的 OPI-BZD 使用模式，因为医疗保险和医疗补助。 参与者患有慢性疼痛、心理健康/药物滥用的数量不断增加 疾病和处方 OPI 使用、医疗保险和医疗补助是制定 PROTeCT 的理想环境 使用 2013-2016 年国家医疗保险索赔以及亚利桑那州 (AZ) 和佛罗里达州 (FL) 医疗补助数据，目标 1 重点是确定 OPI-BZD 使用的不同轨迹，我们还将确定与相关的预测因素。 在目标 2 中，我们将确定 OPI-BZD 使用的独特轨迹或模式。 与两种不同的结果（即用药过量、跌倒和骨折）最密切相关。 我们建议开发一个实时 PROTeCT 平台的测试版，能够前瞻性地、迭代地 通过前瞻性分析来自 OPI-BZD 的最新数据来预测 OPI-BZD 使用不安全模式的患者 2017-2019 年亚利桑那州和佛罗里达州的医疗补助 我们的研究结果和工具的基础设施可以推广到 其他州的医疗保险、医疗补助计划或具有类似数据结构的其他医疗数据系统。