Maeng Daniel D, Han John J, Fitzpatrick Michael H, Boscarino Joseph A
Department of Epidemiology and Health Services Research.
Department of Pain Medicine.
Subst Abuse Rehabil. 2017 Aug 16;8:57-67. doi: 10.2147/SAR.S135884. eCollection 2017.
To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data.
Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender, plan type, year, and comorbidity via multivariate regression models.
A total of 942 opioid OD patients with an average GHP enrollment period of 41.4 months were identified. ED visit rates rose rapidly starting around 19-24 months prior to the opioid OD date. Acute inpatient admission rates and total medical cost also rose rapidly starting around 12 months prior. After the OD date, the utilization rates and cost declined but tended to remain above those of the pre-OD period.
Opioid OD is preceded by sharp increases in utilization of acute care and cost well before the actual OD. These findings therefore suggest that early signals of OD may be detected from patterns of acute care utilization, particularly the ED visits.
利用健康计划理赔数据描述10年期间阿片类药物过量（OD）前后的医疗保健利用纵向模式及护理成本。
从盖辛格医疗系统的电子健康记录中识别出2005年4月至2015年3月期间经历过阿片类药物OD的患者。在这些患者中，还识别出在2006年1月至2015年12月期间任何时间为盖辛格健康计划（GHP）成员的患者亚组。从相应的GHP理赔数据中，获取他们的全因医疗保健利用情况（住院入院、急诊科就诊和医师门诊就诊）以及总医疗费用（不包括处方药费用）。通过多变量回归模型对阿片类药物OD索引日期前后每个月的人均每月估计值进行计算，并对年龄、性别、计划类型、年份和合并症进行调整。
共识别出942例阿片类药物OD患者，其平均GHP参保期为41.4个月。急诊科就诊率在阿片类药物OD日期前约19 - 24个月开始迅速上升。急性住院入院率和总医疗费用也在约12个月前开始迅速上升。在OD日期之后，利用率和成本下降，但仍倾向于高于OD前时期。
在实际发生阿片类药物OD之前，急性护理的利用率和成本会急剧增加。因此，这些发现表明，OD的早期信号可能可以从急性护理利用模式中检测到，特别是急诊科就诊情况。
