The Litaker Group, LLC, P. O. Box 160505, Austin, TX, 78716, USA.
Sendero Health Plans, 2028 E Ben White Blvd #400, Austin, TX, 78741, USA.
BMC Public Health. 2019 Aug 13;19(1):1091. doi: 10.1186/s12889-019-7394-9.
The United States appears to be in the midst of an opioid epidemic. National data indicate a rise in emergency department visits for opioid-related causes over the past decade. This data, while important in helping to explain the magnitude of the epidemic nationally offers only a glimpse of what can be expected to occur locally. The objective of this secondary data analysis was to describe the impact that opioid abuse, adverse events, poisoning, and dependence have on emergency department utilization for individuals who purchased health insurance under the Affordable Care Act in Central Texas from a community-based health maintenance organization.
Individuals who purchased health insurance from Sendero Health Plans in calendar years 2016, 2017, and 2018 were eligible for participation if they had both an emergency department encounter and an opioid-related ICD-10-CM diagnosis. Eligible individuals were assessed to determine if they were dispensed an opioid agonist or opioid antagonist prescription during the year of their emergency department encounter. Sendero medical claims data for calendar years 2016, 2017, and 2018 were used to calculate both the incidence and ratio of emergency department visits per 100,000-person Sendero member population. Sendero data were compared to available national data estimates.
A total of 55 individuals had an emergency department encounter with a primary or secondary opioid-related diagnosis from January 1, 2016 through December 31, 2018. These 55 individuals had 69 unique emergency department encounters during this time period. The incidence of new claims per 100,000-member Sendero population was 67.1, 64.5, and 62.6 in 2016, 2017, and 2018 respectively. The ratio of unique emergency department encounters per 100,000-member Sendero population was 95.9, 82.6, and 66.5 in 2016, 2017, and 2018 respectively.
Health insurance claims data from a community-based health plan can be used as a source of local information by policy makers and officials as they seek to address the impact of opioid abuse, adverse events, poisoning, and dependence in Central Texas as national data may not represent the local impact of this epidemic.
美国似乎正处于阿片类药物泛滥的中期。国家数据显示，在过去十年中，因阿片类药物相关原因而前往急诊的人数有所增加。这些数据虽然对于帮助解释全国范围内的流行程度很重要，但只能略窥一斑，了解当地可能发生的情况。本二次数据分析的目的是描述阿片类药物滥用、不良事件、中毒和依赖对在得克萨斯州中部的一个社区医疗保健组织购买平价医疗法案保险的个人急诊就诊的影响。
在 2016、2017 和 2018 年日历年度购买 Sendero 健康计划保险的个人，如果在急诊就诊时有阿片类药物相关 ICD-10-CM 诊断，则有资格参加。对符合条件的个人进行评估，以确定他们在急诊就诊当年是否开了阿片类激动剂或阿片类拮抗剂处方。2016、2017 和 2018 年 Sendero 医疗索赔数据用于计算每 10 万 Sendero 会员人群的急诊就诊率和急诊就诊率。将 Sendero 数据与可获得的全国数据估计值进行比较。
2016 年 1 月 1 日至 2018 年 12 月 31 日期间，共有 55 人因主要或次要阿片类药物相关诊断而急诊就诊。在此期间，这 55 人共有 69 次独特的急诊就诊。2016 年、2017 年和 2018 年，每 10 万 Sendero 参保人群的新索赔发生率分别为 67.1、64.5 和 62.6。2016 年、2017 年和 2018 年，每 10 万 Sendero 参保人群独特急诊就诊率分别为 95.9、82.6 和 66.5。
社区医疗保健计划的健康保险索赔数据可作为决策者和官员解决得克萨斯州中部阿片类药物滥用、不良事件、中毒和依赖影响的本地信息来源，因为国家数据可能无法代表该流行病对当地的影响。
