Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI, 02912, USA.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
BMC Geriatr. 2024 Oct 30;24(1):897. doi: 10.1186/s12877-024-05486-0.
Although a majority of patients in the U.S. receive post-acute care in skilled nursing facilities (SNFs) following hip fracture, large-sample observational studies of analgesic prescribing and use in SNFs have not been possible due to limitations in available data sources. We conducted a proof-of-concept federated analysis of electronic health records (EHRs) from 11 SNF chains to describe analgesic use during hip fracture post-acute care.
We included residents with a diagnosis of hip fracture between January 1, 2018 and June 30, 2021 who had at least one administration of an analgesic. Use of analgesics was ascertained from EHR medication orders and medication administration records. We quantified the proportion of residents receiving analgesic regimens based on the medications that were administered up to 100 days after hip fracture diagnosis. Plots visualizing trends in analgesic use were stratified by multiple resident characteristics including age and Alzheimer's Disease and Related Dementias (ADRD) diagnosis.
The study included 23,706 residents (mean age 80.5 years, 68.6% female, 87.7% White). Most (~ 60%) residents received opioids + APAP. Monotherapy with APAP or opioids was also common. The most prevalent regimens were oxycodone + APAP (20.1%), hydrocodone + APAP (15.8%), APAP only (15.1%), tramadol + APAP (10.4%), and oxycodone only (4.3%). During the study period, use of APAP-only increased, opioids-only decreased, and opioids + APAP remained stable. Use of APAP-only appeared to be more prevalent among individuals aged > 75 years (versus ≤ 75 years) and those with ADRD (versus without).
We successfully leveraged federated SNF EHR data to describe analgesic use among residents receiving hip fracture post-acute care.
尽管美国大多数髋部骨折患者在康复护理机构（SNF）接受急性后期护理，但由于现有数据源的限制，对 SNF 中阿片类药物处方和使用情况进行大样本观察性研究是不可能的。我们对 11 个 SNF 连锁机构的电子健康记录（EHR）进行了联邦分析，以描述髋部骨折急性后期护理期间的阿片类药物使用情况。
我们纳入了 2018 年 1 月 1 日至 2021 年 6 月 30 日期间患有髋部骨折且至少接受过一次阿片类药物治疗的居民。通过 EHR 药物医嘱和药物管理记录来确定阿片类药物的使用情况。我们根据髋部骨折诊断后 100 天内给予的药物，确定接受阿片类药物治疗方案的居民比例。根据包括年龄和阿尔茨海默病和相关痴呆症（ADRD）诊断在内的多个居民特征对阿片类药物使用趋势进行分层，绘制图表。
该研究纳入了 23706 名居民（平均年龄 80.5 岁，68.6%为女性，87.7%为白人）。大多数（约 60%）居民接受了阿片类药物+对乙酰氨基酚。单独使用对乙酰氨基酚或阿片类药物也很常见。最常见的方案是羟考酮+对乙酰氨基酚（20.1%）、氢可酮+对乙酰氨基酚（15.8%）、对乙酰氨基酚单药（15.1%）、曲马多+对乙酰氨基酚（10.4%）和羟考酮单药（4.3%）。研究期间，仅使用对乙酰氨基酚的比例增加，仅使用阿片类药物的比例减少，而阿片类药物+对乙酰氨基酚的比例保持稳定。在年龄>75 岁（而非≤75 岁）和患有 ADRD（而非没有）的个体中，使用仅对乙酰氨基酚的比例似乎更高。
我们成功地利用联邦 SNF EHR 数据描述了接受髋部骨折急性后期护理的居民的阿片类药物使用情况。
