Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN.
Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN.
Ann Emerg Med. 2020 May;75(5):568-575. doi: 10.1016/j.annemergmed.2019.12.005. Epub 2020 Jan 23.
We describe the prevalence, trends, and factors associated with repeated emergency department (ED) encounters for opioid usage across multiple, independent hospital systems.
A statewide regional health information exchange system provided ED encounters from 4 Indiana hospital systems for 2012 to 2017. In accordance with a series of International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 diagnosis codes for opioid abuse, adverse effects of opioids, opioid dependence and unspecified use, and opioid poisoning, we identified patients with an ED encounter associated with opioid usage (9,295 individuals; 12,642 encounters). Multivariate logistic regression models then described the patient, encounter, prescription history, and community characteristics associated with the odds of a patient's incurring a subsequent opioid-related ED encounter.
The prevalence of repeated nonfirst opioid-related ED encounters increased from 9.0% of all opioid encounters in 2012 to 34.3% in 2017. The number of previous opioid-related ED encounters, unique institutions at which the individual had had encounters, the encounter's being heroin-related, the individual's having a benzodiazepine prescription filled within 30 days before the encounter, and being either Medicaid insured or uninsured compared with private insurance were associated with significantly greater odds of having a subsequent encounter.
The ED is increasingly a site utilized as the setting for repeated opioid-related care. Characteristics of the individual, encounter, and community associated with repeated opioid-related encounters may inform real-time risk-prediction tools in the ED setting. Additionally, the number of institutions to which the individual has presented may suggest the utility of health information exchange data and usage in the ED setting.
我们描述了在多个独立的医院系统中，反复出现因阿片类药物使用而到急诊部（ED）就诊的流行率、趋势和相关因素。
一个全州范围的区域健康信息交换系统提供了 2012 年至 2017 年来自印第安纳州 4 个医院系统的 ED 就诊记录。根据一系列国际疾病分类，第九版（ICD-9）和 ICD-10 阿片类药物滥用、阿片类药物不良反应、阿片类药物依赖和未特指使用以及阿片类药物中毒的诊断代码，我们确定了与阿片类药物使用相关的 ED 就诊患者（9295 人；12642 次就诊）。多变量逻辑回归模型随后描述了与患者发生后续阿片类药物相关 ED 就诊的可能性相关的患者、就诊、处方史和社区特征。
反复出现非首次阿片类药物相关 ED 就诊的比例从 2012 年所有阿片类药物就诊的 9.0%增加到 2017 年的 34.3%。先前的阿片类药物相关 ED 就诊次数、个人就诊过的独特机构数量、就诊与海洛因有关、个人在就诊前 30 天内有苯二氮䓬类药物处方、与私人保险相比，医疗补助保险或无保险与发生后续就诊的可能性显著增加相关。
ED 越来越多地成为重复阿片类药物相关治疗的场所。与重复阿片类药物相关就诊相关的个体、就诊和社区特征可能为 ED 环境中的实时风险预测工具提供信息。此外，个人就诊的机构数量可能表明健康信息交换数据和在 ED 环境中的使用的效用。
