Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA 02130, United States.
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, United States.
Pain Med. 2024 Feb 1;25(2):125-130. doi: 10.1093/pm/pnad129.
To evaluate the degree to which differences in incidence of mortality and serious adverse events exist across patient race and ethnicity among Veterans Health Administration (VHA) patients receiving outpatient opioid prescriptions and who have similar predicted risks of adverse outcomes. Patients were assigned scores via the VHA Stratification Tool for Opioid Risk Mitigation (STORM), a model used to predict the risk of experiencing overdose- or suicide-related health care events or death. Individuals with the highest STORM risk scores are targeted for case review.
Retrospective cohort study of high-risk veterans who received an outpatient prescription opioid between 4/2018-3/2019.
All VHA medical centers.
In total, 84 473 patients whose estimated risk scores were between 0.0420 and 0.0609, the risk scores associated with the top 5%-10% of risk in the STORM development sample.
We examined the expected probability of mortality and serious adverse events (SAEs; overdose or suicide-related events) given a patient's risk score and race.
Given a similar risk score, Black patients were less likely than White patients to have a recorded SAE within 6 months of risk score calculation. Black, Hispanic, and Asian patients were less likely than White patients with similar risk scores to die within 6 months of risk score calculation. Some of the mortality differences were driven by age differences in the composition of racial and ethnic groups in our sample.
Our results suggest that relying on the STORM model to identify patients who may benefit from an interdisciplinary case review may identify patients with clinically meaningful differences in outcome risk across race and ethnicity.
评估在接受门诊阿片类药物处方的退伍军人健康管理局 (VHA) 患者中，种族和民族差异对死亡率和严重不良事件发生率的影响，这些患者具有相似的不良结局预测风险。患者通过 VHA 阿片类药物风险缓解分层工具 (STORM) 获得评分，该模型用于预测经历与过量或自杀相关的医疗保健事件或死亡的风险。STORM 风险评分最高的个体是审查病例的目标。
接受门诊处方阿片类药物的高危退伍军人的回顾性队列研究，时间为 2018 年 4 月至 2019 年 3 月。
所有 VHA 医疗中心。
共有 84473 名患者，其估计风险评分在 0.0420 至 0.0609 之间，这些评分与 STORM 开发样本中风险最高的 5%-10%的风险评分相关。
我们研究了患者风险评分和种族对死亡率和严重不良事件 (SAE；与过量或自杀相关的事件) 的预期概率。
在风险评分相似的情况下，黑人患者在计算风险评分后 6 个月内发生 SAE 的可能性低于白人患者。在计算风险评分后 6 个月内，与风险评分相似的黑人和西班牙裔患者死亡的可能性低于白人患者。在我们的样本中，种族和民族群体的构成在年龄上存在差异，这导致了一些死亡率差异。
我们的研究结果表明，依赖 STORM 模型来识别可能从跨学科病例审查中受益的患者，可能会识别出在不同种族和民族之间具有临床意义的结局风险差异的患者。
