Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, TX, USA.
J Am Med Dir Assoc. 2021 Dec;22(12):2593-2599.e4. doi: 10.1016/j.jamda.2021.04.016. Epub 2021 May 19.
Policies and regulations on opioid use have evolved from being primarily state-to federally based. We examined the trends and variation in chronic opioid use among states and nursing homes.
Retrospective cohort study.
We used the nursing home Minimum Data Set and Medicare claims from 2014 to 2018 and included long-term care nursing home residents from each year who had at least 120 days of consecutive stay.
Chronic opioid use was defined as use for ≥90 days. Three-level hierarchical logistic regression models (resident, nursing home, state) were constructed to estimate intraclass correlation coefficient (ICC) at the state level and at the nursing home level. The ICC shows the proportion of variation in chronic opioid use that is attributable to states or nursing homes. All models were constructed separately for each calendar year and controlled for resident, nursing home, and state characteristics.
We included 3,245,714 nursing home stays from 2014 to 2018, representing 1,502,131 unique residents. The stays ranged from 676,413 in 2014 to 594,874 in 2018, with residents contributing a maximum of 1 stay per year. Chronic opioid use among nursing home residents declined from 14.1% in 2014 to 11.4% in 2018. The variation (ICC) in chronic opioid use among states declined from 2.5% in 2014 to 1.7% in 2018. In contrast, the variation (ICC) among nursing homes increased from 5.6% in 2014 to 6.5% in 2018.
Variation in chronic opioid use declined by one-third at the state level but not at the nursing home level. National guidelines on opioid use and federal policies on opioid use may have contributed to reducing state-level variation in chronic opioid use.
阿片类药物使用的政策和法规已经从主要以州为基础转变为以联邦为基础。我们研究了各州和养老院慢性阿片类药物使用的趋势和变化。
回顾性队列研究。
我们使用了养老院最低数据集和 2014 年至 2018 年的医疗保险索赔，并包括每年至少有 120 天连续入住的长期护理养老院居民。
慢性阿片类药物使用的定义为使用时间≥90 天。构建了三级层次逻辑回归模型（居民、养老院、州），以估计州一级和养老院一级的组内相关系数（ICC）。ICC 显示了慢性阿片类药物使用变化中归因于州或养老院的比例。所有模型均按每年单独构建，并控制了居民、养老院和州的特征。
我们纳入了 2014 年至 2018 年的 3245714 次养老院入住，代表了 1502131 名独特的居民。入住时间从 2014 年的 676413 人到 2018 年的 594874 人不等，居民每年最多可入住一次。养老院居民慢性阿片类药物使用从 2014 年的 14.1%下降到 2018 年的 11.4%。各州慢性阿片类药物使用的变化（ICC）从 2014 年的 2.5%下降到 2018 年的 1.7%。相比之下，养老院之间的变化（ICC）从 2014 年的 5.6%增加到 2018 年的 6.5%。
州一级慢性阿片类药物使用的变化减少了三分之一，但养老院一级没有变化。阿片类药物使用的国家指南和阿片类药物使用的联邦政策可能有助于减少州一级慢性阿片类药物使用的变化。
