Indiana University School of Medicine-Terre Haute, 1433 N 6 ½ St, Terre Haute, IN 47802. Email:
Am J Manag Care. 2022 Jul 1;28(7):e248-e254. doi: 10.37765/ajmc.2022.89183.
To examine the relationship between care experiences and inpatient opioid receipt during and after delivery for women hospitalized for vaginal delivery (VD).
We used a pooled cross-sectional design with inverse probability weighting to examine the association between inpatient opioid receipt and care experiences of women hospitalized for VD at a single health care system in a Midwestern state. We used 4 Hospital Consumer Assessment of Healthcare Providers and Systems scores (2 pain care items and 2 global items) as measures of care experiences of women hospitalized for VD.
We used 4 inverse probability-weighted logit regressions to estimate the relationship between inpatient opioid receipt and each patient care experience measure. In supplementary analyses, we used the same inverse probability-weighted methods to estimate the relationship between receipt of opioids and patient care experience measures in 3 patient subgroups based on mean patient-reported pain score during hospitalization (no pain, mild pain, moderate pain).
We found no relationship between inpatient opioid receipt and inpatient pain care experiences. As an exception, we found that women hospitalized for VD were 5 (95% CI, 2-8) percentage points more likely to rate the hospital as 10 ("the best hospital possible") during hospitalizations in which an opioid was received. We also found higher overall ratings of the hospital among hospitalized women who reported mild pain if they received an opioid (marginal effects = 0.05; 95% CI, 2-8 percentage points).
Receipt of opioids may not be a significant determinant of the pain-specific patient care experiences of women hospitalized for VD.
考察在单家中西部地区医疗机构接受阴道分娩（VD）住院治疗的女性在分娩期间和分娩后与护理体验相关的阿片类药物使用情况。
我们使用了一种汇总的横截面设计，并采用逆概率加权法，以检验在该医疗系统接受 VD 住院治疗的女性的阿片类药物使用情况与护理体验之间的关联。我们使用了 4 项医院医疗保健提供者和系统评估（2 项疼痛护理项目和 2 项整体项目）来衡量接受 VD 住院治疗的女性的护理体验。
我们使用了 4 项逆概率加权逻辑回归来估计阿片类药物使用与每个患者护理体验测量值之间的关系。在补充分析中，我们使用了相同的逆概率加权方法，根据住院期间患者报告的疼痛评分的平均值（无疼痛、轻度疼痛、中度疼痛），基于 3 个患者亚组，估计了接受阿片类药物与患者护理体验测量值之间的关系。
我们发现阿片类药物的使用与住院期间的疼痛护理体验之间没有关系。但有一个例外，我们发现接受阿片类药物治疗的 VD 住院女性在住院期间对医院的评价更有可能为 10 分（“尽可能好的医院”），比不接受阿片类药物的女性高 5 个百分点（95%置信区间，2-8 个百分点）。我们还发现，在报告轻度疼痛的住院女性中，如果使用了阿片类药物，对医院的总体评价更高（边缘效应=0.05；95%置信区间，2-8 个百分点）。
阿片类药物的使用可能不是接受 VD 住院治疗的女性疼痛特异性护理体验的重要决定因素。
