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

涉及阿片类药物使用障碍的住院后熟练护理机构的护理和结果

基本信息

批准号：
10371281
负责人：
Patience Moyo Dow
金额：
$ 19.75万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-15 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10371281
关键词：
Acute Address Administrator Admission activity Adult Area Caring Chronic Communities Complex Computerized Medical Record Continuity of Patient Care Data Data Set Diagnosis Disabled Persons Effectiveness Elderly Emergency department visit Enrollment Face Facility Accesses Fee-for-Service Plans Gerontology Goals Health Health care facility Healthcare High Prevalence Home Home Care Services Hospital Nursing Hospitalization Hospitals Human Resources Improve Access Individual Infection Inpatients Intervention Interview Knowledge Laws Link Location Long-Term Care Medical Medicare Neighborhoods Nurse Administrator Nursing Homes Opioid Outcome Pain Participant Patients Persons Pharmaceutical Preparations Pharmacy facility Policies Population Provider Quality of Care Recovery Recovery Support Reporting Research Shapes Skilled Nursing Facilities Statutes and Laws Structure Suboxone Telephone Interviews Testing Treatment outcome United States Centers for Medicare and Medicaid Services acute care addiction age group aged aging population base beneficiary care outcomes care systems design effective intervention evidence base flexibility improved mortality multiple chronic conditions opioid policy opioid treatment program opioid use disorder prevent recruit substance use willingness young adult

项目摘要

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.

项目概要阿片类药物使用障碍 (OUD) 在老年人（≥65 岁）和年轻残疾人中呈上升趋势参加医疗保险的人与阿片类药物相关的住院和急诊就诊人数增加。在该人群中也有针对 OUD (PWOUD) 患者的综合急性后护理 (PAC) 的报告。应满足 OUD 治疗和其他医疗问题的护理需求，作为现有的预防举措。并主要针对社区居民治疗 OUD，但关于 PWOUD 何时以及如何进行仍有很多未知与急症后和长期护理机构环境互动，例如熟练护理设施 (SNF)。关于 OUD 是否构成进入更高质量 SNF 的障碍，也存在知识差距，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，作为机构急性后护理的主要环境的 SNF 正在收到更多的转介 PWOUD。这项研究的长期目标是最终与 SNF 建立伙伴关系，以提高意愿和水平。在急性后和长期护理环境中为 PWOUD 提供 OUD (MOUD) 药物的能力。该应用程序的目标是实现这一长期目标的第一步，是检查承认的 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改善 SNF 中 MOUD 获取的策略该双管齐下的研究理由是解决知识问题。 SNF 使用和 PWOUD 结果方面的差距，并鼓励成瘾治疗与我们将分析 2015 年至 2019 年住院患者医院索赔的 100% 费用。与其他数据相关联或结合的服务医疗保险受益人（例如，登记、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）。具体目标是： 1) 评估 Medicare 受益人使用 OUD 接受急性期后护理的情况，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 SNF 所在社区的治疗 2) 识别并描述治疗的障碍和促进因素。 PWOUD 在疗养院的安置，以及通过诱导获得 OUD 治疗的最佳实践在目标 2 中，我们将与护理人员进行半结构化电话访谈。家庭管理员、招生协调员和直接护理人员获取丰富的背景信息访谈还将提供影响 PWOUD 急性后 SNF 使用和结果的机制。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患有 OUD 的年轻人和老年人之间 SNF 的使用和结果是否存在差异。开发这一证据将加强设计和定制有效干预措施的努力，以治疗 OUD 和促进老龄化人口和不同护理环境中的康复。