Hemalkumar B Mehta1, Yong-Fang Kuo2, Mukaila A Raji3, Jordan Westra2, Cynthia Boyd4, G Caleb Alexander5, James S Goodwin3. 1. 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. Electronic address: hbmehta@jhu.edu. 2. Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, TX, USA. 3. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA. 4. Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA. 5. 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.
Abstract
OBJECTIVE: 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. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 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. MEASUREMENTS: 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. RESULTS: 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. CONCLUSIONS AND IMPLICATIONS: 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.
OBJECTIVE: 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. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 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. MEASUREMENTS: 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. RESULTS: 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. CONCLUSIONS AND IMPLICATIONS: 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.
Authors: Jacob N Hunnicutt; Stavroula A Chrysanthopoulou; Christine M Ulbricht; Anne L Hume; Jennifer Tjia; Kate L Lapane Journal: J Am Geriatr Soc Date: 2017-09-21 Impact factor: 5.562
Authors: Jacob N Hunnicutt; Jonggyu Baek; Matthew Alcusky; Anne L Hume; Shao-Hsien Liu; Christine M Ulbricht; Jennifer Tjia; Kate L Lapane Journal: Med Care Date: 2018-10 Impact factor: 2.983
Authors: Rishi J Desai; Yinzhu Jin; Patricia D Franklin; Yvonne C Lee; Brian T Bateman; Joyce Lii; Daniel H Solomon; Jeffrey N Katz; Seoyoung C Kim Journal: Arthritis Rheumatol Date: 2019-04-02 Impact factor: 10.995
Authors: Hemalkumar B Mehta; Yong-Fang Kuo; Mukaila Raji; Shuang Li; Jordan Westra; James S Goodwin Journal: J Am Med Dir Assoc Date: 2020-06-27 Impact factor: 4.669
Authors: Gery P Guy; Kun Zhang; Michele K Bohm; Jan Losby; Brian Lewis; Randall Young; Louise B Murphy; Deborah Dowell Journal: MMWR Morb Mortal Wkly Rep Date: 2017-07-07 Impact factor: 17.586