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：
10609800
负责人：
Patience Moyo Dow
金额：
$ 23.74万
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 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10609800
关键词：
Acute Address Administrator Admission activity Adult Area Caring Certification Chronic Communities Complex Computerized Medical Record Continuity of Patient Care Data Data Set Diagnosis Disabled Persons Discrimination Effectiveness Elderly Emergency department visit Enrollment Face Facility Accesses Fee-for-Service Plans Goals Health Health care facility Healthcare High Prevalence Home Home Care Services Hospitalization Hospitals Human Resources Improve Access Individual Infection Inpatients Institution Intervention Interview Knowledge Laws Link Location Long-Term Care Medical Medicare Neighborhoods Nurse Administrator Nursing Homes Opioid Outcome Pain Patients Persons 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 United States Centers for Medicare and Medicaid Services acute care addiction age group aged aging population beneficiary care systems design effective intervention evidence base flexibility improved medication for opioid use disorder mortality multiple chronic conditions opioid policy opioid treatment program opioid use disorder participant interview 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.

项目摘要阿片类药物使用障碍（OUD）在老年人（≥65岁）和年轻人中有所增加加入Medicare的人。阿片类药物相关的住院和急诊就诊的增加该人群也有报道。 OUD患者（Pwoud）的全面急性后护理（PAC）应满足OUD治疗和其他医疗问题的护理需求。作为防止的现有倡议并治疗基于社区的Oud主要居民，关于何时以及如何以及如何居住与机构环境互动，以进行急性后和长期护理，例如熟练的护士设施（SNF）。关于OUD是否代表了接受更高质量SNF的障碍的知识差距，进入SNF的Pwoud的结果以及在这些情况下提供Oud治疗的能力。但是，是机构急性后护理的主要环境的SNF正在接受更多的推荐 pwoud。这项研究的长期目标是与SNF的活动合作伙伴关系，以提高意愿和在急性后和长期护理环境中为Pwoud提供OUD（MOUD）药物的能力。这该应用的目的是朝着这个长期目标迈出的第一步，是检查承认的SNF的质量与奥德相关的住院后的Pwoud，生存和医疗保健轨迹，并引起了提供者的观点关于改善SNF中MOUD访问权限的策略。两管齐的研究基本原理是解决知识 SNF使用和pwoud结果的差距，并鼓励将成瘾治疗更好地整合到老年和急性护理服务。我们将分析2015 - 2019年住院医院索赔100％费用 - 与其他数据相关或合并的服务供应医疗保险受益人（例如，入学人数，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）。我们的具体目的是：1）评估Medicare受益人与Oud的急性后护理的接收，包括他们输入的SNF的属性，医疗保健使用和生存轨迹以及OUD提供商的可用性在SNF所在的社区中的治疗。 2）确定并描述障碍和促进者 Pwoud将Pwoud放置在护士房屋中，以及通过引发提供OUD治疗的最佳实践护士家庭人员的观点。在AIM 2中，我们将对护士进行半结构化电话采访家庭管理员，招生协调员和直接护理人员，以获取有关的丰富上下文信息塑造急性SNF使用后使用和结果的机制。访谈也将提供初步数据，以告知干预措施的设计和潜在可行性，以改善SNF中的OUD治疗。这两个目标还将检查SNF使用和OUD的年轻人和老年人之间的使用和结果是否不同。制定这些证据将加强设计和量身定制有效干预措施的努力，以治疗Oud和促进人口老龄化和潜水员护理环境中的康复。