North Frederick, Tulledge-Scheitel Sidna M, Crane Sarah J
Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
SAGE Open Med. 2017 Mar 29;5:2050312117701024. doi: 10.1177/2050312117701024. eCollection 2017.
Opioids are being prescribed at increasing rates in primary care practices, and among individual providers there is significant variability in opioid prescribing. Primary care practices also vary significantly in complexity of their patients, ranging from healthy patients to those with multiple comorbidities. Our objective was to examine individual primary care providers for an association between their opioid prescribing and the complexity/risk of their panel of patients (a panel of patients is a group of patients whose medical care is the responsibility of a specific healthcare provider or care team).
We retrospectively examined 12 months of opioid prescription data from a primary care practice. We obtained counts of opioids prescribed by providers in the Mayo Clinic, Rochester, Minnesota primary care practice. For patients paneled (assigned) to family medicine and internal medicine, we used the Centers for Medicare and Medicaid Services hierarchical condition category patient risk score as a measure of patient complexity. After adjusting the opioid counts for panel patient count (to get opioid counts per patient), we used linear regression analysis to determine the correlation between the hierarchical condition category risk and the amount of opioid prescribed by individual providers.
Among our combined 103 primary care providers, opioid unit counts prescribed per patient were highly correlated with the providers' hierarchical condition category panel risk score (r = 0.54). After excluding three outliers, r was 0.74. With and without the outliers, the correlation was very significant (p < 0.0001). Subgroup analysis of panels with hierarchical condition category ⩽ 0.45 showed no correlation of opioid prescribing volume with hierarchical condition category (r < 0.02; p = 0.32). Provider panels with hierarchical condition category > 0.45 showed significant correlation with hierarchical condition category (r = 0.26; p = 0.001).
When examining differences in primary care providers' opioid prescribing practices, the Centers for Medicare and Medicaid Services endorsed risk score (the hierarchical condition category score) can help adjust for population differences of a provider's patients.
在基层医疗实践中，阿片类药物的处方开具率不断上升，而且在个体医疗服务提供者之间，阿片类药物的处方开具存在显著差异。基层医疗实践中患者的复杂程度也有很大差异，从健康患者到患有多种合并症的患者都有。我们的目的是研究个体基层医疗服务提供者的阿片类药物处方开具情况与其患者群体的复杂程度/风险之间的关联（患者群体是指由特定医疗服务提供者或护理团队负责医疗护理的一组患者）。
我们回顾性分析了一家基层医疗实践机构12个月的阿片类药物处方数据。我们获取了明尼苏达州罗切斯特市梅奥诊所基层医疗实践机构中医疗服务提供者开具的阿片类药物数量。对于分配到家庭医学和内科的患者群体，我们使用医疗保险和医疗补助服务中心的分层病情分类患者风险评分作为患者复杂程度的衡量指标。在将阿片类药物数量根据患者群体数量进行调整（以获得每位患者的阿片类药物数量）后，我们使用线性回归分析来确定分层病情分类风险与个体医疗服务提供者开具的阿片类药物数量之间的相关性。
在我们总共103名基层医疗服务提供者中，每位患者开具的阿片类药物单位数量与医疗服务提供者的分层病情分类患者群体风险评分高度相关（r = 0.54）。排除三个异常值后，r为0.74。无论有无异常值，相关性都非常显著（p < 0.0001）。对分层病情分类≤0.45的患者群体进行亚组分析显示，阿片类药物处方量与分层病情分类无相关性（r < 0.02；p = 0.32）。分层病情分类>0.45的医疗服务提供者患者群体与分层病情分类显示出显著相关性（r = 0.26；p = 0.001）。
在研究基层医疗服务提供者阿片类药物处方开具实践的差异时，医疗保险和医疗补助服务中心认可的风险评分（分层病情分类评分）有助于调整医疗服务提供者患者群体的差异。
