scholarly journals Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natalie A. Blackburn ◽  
Elizabeth Joniak-Grant ◽  
Maryalice Nocera ◽  
Samantha Wooten Dorris ◽  
Nabarun Dasgupta ◽  
...  
Keyword(s):  
North Carolina ◽  
Clinical Care ◽  
Healthcare Systems ◽  
Opioid Overdose ◽  
Policy Compliance ◽  
Hospital System ◽  
State Laws ◽  
Hospital Administrators ◽  
Opioid Prescribing ◽  
Compliance With The Law

Abstract Background Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and prescribers used to implement the 2017 North Carolina Strengthen Opioid Prevention (STOP) Act opioid prescribing limits, which limited initial prescriptions to a five (for acute) or seven (for post-surgical) days’ supply. Methods We interviewed 14 hospital administrators and 38 prescribers with degrees in medicine, nursing, pharmacy, business administration and public health working across North Carolina. Interview guides, informed by the Consolidated Framework for Implementation Research, explored barriers and facilitators to implementation. Interview topics included communication, resources, and hospital system support. Interviews were recorded and transcribed, then analyzed using flexible coding, integrating inductive and deductive coding, to inform analytic code development and identify themes. Results We identified three main themes around implementation of STOP act mandated prescribing limits: organizational communication, prescriber education, and changes in the electronic medical record (EMR) systems. Administrators reflected on implementation in the context of raising awareness and providing reminders to facilitate changes in prescriber behavior, operationalized through email and in-person communications as well as dedicated resources to EMR changes. Prescribers noted administrative communications about prescribing limits often focused on legality, suggesting a directive of the organization’s policy rather than a passive reminder. Prescribers expressed a desire for more spaces to have their questions answered and resources for patient communications. While hospital administrators viewed compliance with the law as a priority, prescribers reflected on concerns for adequately managing their patients’ pain and limited time for clinical care. Conclusions Hospital administrators and prescribers approached implementation of the STOP act prescribing limits with different mindsets. While administrators were focused on policy compliance, prescribers were focused on their patients’ needs. Strategies to implement the mandate then had to balance patient needs with policy compliance. As states continue to legislate to prevent opioid overdose deaths, understanding how laws are implemented by healthcare systems and prescribers will improve their effectiveness through tailoring and maximizing available resources.

scholarly journals Quantifying prescribed high dose opioids in the community and risk of overdose

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joe Schofield ◽  
Deborah Steven ◽  
Rebecca Foster ◽  
Catriona Matheson ◽  
Alexander Baldacchino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Service Improvement ◽  
High Dose ◽  
Opioid Overdose ◽  
Opioid Prescribing ◽  
Patient Level ◽  
Strong Opioid ◽  
High Doses ◽  
Strong Opioids ◽  
Very High

Abstract Background Opioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. This study described and quantified the prescribing of strong opioids, comorbidities and other overdose risk factors among those prescribed strong opioids, and factors associated with high/very high opioid dosage in a regional health authority in Scotland as part of a wider service improvement exercise. Methods Participating practices ran searches to identify patients prescribed strong opioids and their characteristics, polypharmacy, and other overdose risk factors. Data were anonymised before being analysed at practice and patient-level. Morphine Equivalent Doses were calculated for patients based on drug/dose information and classed as Low/Medium/High/Very High. Descriptive statistics were generated on the strong opioid patient population and overdose risk factors. The relationship between the prescribing of strong opioids and practice/patient-level factors was investigated using linear and logistic regression models. Results Eighty-five percent (46/54) of GP practices participated. 12.4% (42,382/341,240) of individuals in participating practices were prescribed opioids and, of these, one third (14,079/42,382) were prescribed strong opioids. The most common comorbidities and overdose risk factors among strong opioid recipients were pain (67.2%), cardiovascular disease (43.2%), and mental health problems (39.3%). There was a positive significant relationship between level of social deprivation among practice caseload and level of strong opioid prescribing (p < 0.001). People prescribed strong opioids tended to be older (mean 59.7 years) and female (8638, 61.4%) and, among a subset of patients, age, gender and opioid drug class were significantly associated with prescribing of High/Very High doses. Conclusions Our findings have identified a large population at potential risk of prescription opioid overdose. There is a need to explore pragmatic models of tailored interventions which may reduce the risk of overdose within this group and clinical practice may need to be tightened to minimise overdose risk for individuals prescribed high dose opioids.

scholarly journals Gastrointestinal endoscopy during the coronavirus pandemic in the New York area: results from a multi-institutional survey

2020 ◽  
Vol 08 (12) ◽  
pp. E1865-E1871
Author(s):  
Srihari Mahadev ◽  
Olga C. Aroniadis ◽  
Luis H. Barraza ◽  
Emil Agarunov ◽  
Michael S. Smith ◽  
...  
Keyword(s):  
New York ◽  
Clinical Care ◽  
Patient Characteristics ◽  
Feeding Tube ◽  
Tube Placement ◽  
Peak Time ◽  
City Region ◽  
Peak Period ◽  
Hospital System ◽  
The Impact

Abstract Background and study aims The coronavirus disease 2019 (COVID-19), and measures taken to mitigate its impact, have profoundly affected the clinical care of gastroenterology patients and the work of endoscopy units. We aimed to describe the clinical care delivered by gastroenterologists and the type of procedures performed during the early to peak period of the pandemic. Methods Endoscopy leaders in the New York region were invited to participate in an electronic survey describing operations and clinical service. Surveys were distributed on April 7, 2020 and responses were collected over the following week. A follow-up survey was distributed on April 20, 2020. Participants were asked to report procedure volumes and patient characteristics, as well protocols for staffing and testing for COVID-19. Results Eleven large academic endoscopy units in the New York City region responded to the survey, representing every major hospital system. COVID patients occupied an average of 54.5 % (18 – 84 %) of hospital beds at the time of survey completion, with 14.5 % (2 %-23 %) of COVID patients requiring intensive care. Endoscopy procedure volume and the number of physicians performing procedures declined by 90 % (66 %-98 %) and 84.5 % (50 %-97 %) respectively following introduction of restricted practice. During this period the most common procedures were EGDs (7.9/unit/week; 88 % for bleeding; the remainder for foreign body and feeding tube placement); ERCPs (5/unit/week; for cholangitis in 67 % and obstructive jaundice in 20 %); Colonoscopies (4/unit/week for bleeding in 77 % or colitis in 23 %) and least common were EUS (3/unit/week for tumor biopsies). Of the sites, 44 % performed pre-procedure COVID testing and the proportion of COVID-positive patients undergoing procedures was 4.6 % in the first 2 weeks and up to 19.6 % in the subsequent 2 weeks. The majority of COVID-positive patients undergoing procedures underwent EGD (30.6 % COVID +) and ERCP (10.2 % COVID +). Conclusions COVID-19 has profoundly impacted the operation of endoscopy units in the New York region. Our data show the impact of a restricted emergency practice on endoscopy volumes and the proportion of expected COVID positive cases during the peak time of the pandemic.

A Mixed-Methods Comparison of a National and State Opioid Overdose Surveillance Definition

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 31S-39S
Author(s):  
Danielle M. Brathwaite ◽  
Catherine S. Wolff ◽  
Amy I. Ising ◽  
Scott K. Proescholdbell ◽  
Anna E. Waller
Keyword(s):  
North Carolina ◽  
False Positive ◽  
False Positive Rate ◽  
International Classification Of Diseases ◽  
Opioid Overdose ◽  
The North ◽  
Classification Of Diseases ◽  
Positive Rate ◽  
Icd 10 ◽  
Ed Visits

Objectives We assessed the differences between the first version of the Centers for Disease Control and Prevention (CDC) opioid surveillance definition for suspected nonfatal opioid overdoses (hereinafter, CDC definition) and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance definition to determine whether the North Carolina definition should include additional International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and/or chief complaint keywords. Methods Two independent reviewers retrospectively reviewed data on North Carolina emergency department (ED) visits generated by components of the CDC definition not included in the NC DETECT definition from January 1 through July 31, 2018. Clinical reviewers identified false positives as any ED visit in which available evidence supported an alternative explanation for patient presentation deemed more likely than an opioid overdose. After individual assessment, reviewers reconciled disagreements. Results We identified 2296 ED visits under the CDC definition that were not identified under the NC DETECT definition during the study period. False-positive rates ranged from 2.6% to 41.4% for codes and keywords uniquely identifying ≥10 ED visits. Based on uniquely identifying ≥10 ED visits and a false-positive rate ≤10.0%, 4 of 16 ICD-10-CM codes evaluated were identified for NC DETECT definition inclusion. Only 2 of 25 keywords evaluated, “OD” and “overdose,” met inclusion criteria to be considered a meaningful addition to the NC DETECT definition. Practice Implications Quantitative and qualitative trends in coding and keyword use identified in this analysis may prove helpful for future evaluations of surveillance definitions.

scholarly journals Linking Emergency Medical Services and Emergency Department Data to Improve Overdose Surveillance in North Carolina

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 54S-61S
Author(s):  
Jonathan Fix ◽  
Amy I. Ising ◽  
Scott K. Proescholdbell ◽  
Dennis M. Falls ◽  
Catherine S. Wolff ◽  
...  
Keyword(s):  
Emergency Department ◽  
North Carolina ◽  
Emergency Medical Services ◽  
Data Linkage ◽  
Medical Services ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Emergency Medical ◽  
Diagnosis Codes ◽  
Linkage Methods

Introduction Linking emergency medical services (EMS) data to emergency department (ED) data enables assessing the continuum of care and evaluating patient outcomes. We developed novel methods to enhance linkage performance and analysis of EMS and ED data for opioid overdose surveillance in North Carolina. Methods We identified data on all EMS encounters in North Carolina during January 1–November 30, 2017, with documented naloxone administration and transportation to the ED. We linked these data with ED visit data in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. We manually reviewed a subset of data from 12 counties to create a gold standard that informed developing iterative linkage methods using demographic, time, and destination variables. We calculated the proportion of suspected opioid overdose EMS cases that received International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for opioid overdose in the ED. Results We identified 12 088 EMS encounters of patients treated with naloxone and transported to the ED. The 12-county subset included 1781 linkage-eligible EMS encounters, with historical linkage of 65.4% (1165 of 1781) and 1.6% false linkages. Through iterative linkage methods, performance improved to 91.0% (1620 of 1781) with 0.1% false linkages. Among statewide EMS encounters with naloxone administration, the linkage improved from 47.1% to 91.1%. We found diagnosis codes for opioid overdose in the ED among 27.2% of statewide linked records. Practice Implications Through an iterative linkage approach, EMS–ED data linkage performance improved greatly while reducing the number of false linkages. Improved EMS–ED data linkage quality can enhance surveillance activities, inform emergency response practices, and improve quality of care through evaluating initial patient presentations, field interventions, and ultimate diagnoses.

scholarly journals Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Daniel M. Hartung ◽  
Jonah Geddes ◽  
Sara E. Hallvik ◽  
P. Todd Korthuis ◽  
Luke Middleton ◽  
...  
Keyword(s):  
Performance Improvement ◽  
Emergency Department Visits ◽  
Prescription Opioid ◽  
High Dose ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Improvement Project ◽  
Opioid Prescribing ◽  
Percentage Points ◽  
Prescription Opioid Use

Abstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.

scholarly journals COST-EFFICIENCY ANALYSIS OF A MULTI-PAVILION HOSPITAL IN CLUJ COUNTY

2016 ◽  
Vol 89 (1) ◽  
pp. 110-116
Author(s):  
Mihai Mleșnițe ◽  
Ioan Stelian Bocșan
Keyword(s):  
Internal Medicine ◽  
Retrospective Study ◽  
Cost Efficiency ◽  
Time Frame ◽  
Healthcare Systems ◽  
Efficiency Analysis ◽  
Financial Indicators ◽  
Target Groups ◽  
Hospital Administrators ◽  
Clinical Hospital

Background and aim: Multi-hospital health systems have become the most popular administrative structure in healthcare, leading to both opportunities and challenges for hospital administrators. In government-funded healthcare systems, there is a balance between costs and the provision of health services.The aim of the present study is to assess the efficiency in terms of costs of a multi-pavilion hospital from Cluj County, Romania.Methods: The institution analyzed in this article is the Adults’ Clinical Hospital in Cluj-Napoca. A descriptive retrospective study collected data from January 2004 to December 2010. A set of indicators were compiled, divided into three main categories: personnel, statistics, and financial.Results: Twenty-one financial indicators were investigated. Heterogeneity between different years was observed for the continuous hospitalization indicator and the wage budget indicator. The highest variability was observed between the budget and expenses indicators, while a smaller variability was observed at the average costs per patient. The costs per patient have increased at all pavilions in the studied time frame, the higher costs being at the Internal Medicine and Surgery pavilions: 10,203 RON in 2010 (1 euro ~ 4.4 RON)Conclusion: The pavilions included in the Adults’ Clinical Hospital Cluj-Napoca have different expenses patterns, as each pavilion is focused on different specialties. Each pavilion serves different target groups, requiring different procedures. This in turn results in different expense patterns across each pavilion.

Characterizing Opioid Overdoses Using Emergency Medical Services Data

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 62S-71S
Author(s):  
Josie J. Sivaraman ◽  
Scott K. Proescholdbell ◽  
David Ezzell ◽  
Meghan E. Shanahan
Keyword(s):  
Machine Learning ◽  
North Carolina ◽  
Emergency Medical Services ◽  
Expert Knowledge ◽  
Case Definition ◽  
Medical Services ◽  
Opioid Overdose ◽  
Machine Learning Classification ◽  
Emergency Medical ◽  
Definition Of

Objectives Tracking nonfatal overdoses in the escalating opioid overdose epidemic is important but challenging. The objective of this study was to create an innovative case definition of opioid overdose in North Carolina emergency medical services (EMS) data, with flexible methodology for application to other states’ data. Methods This study used de-identified North Carolina EMS encounter data from 2010-2015 for patients aged >12 years to develop a case definition of opioid overdose using an expert knowledge, rule-based algorithm reflecting whether key variables identified drug use/poisoning or overdose or whether the patient received naloxone. We text mined EMS narratives and applied a machine-learning classification tree model to the text to predict cases of opioid overdose. We trained models on the basis of whether the chief concern identified opioid overdose. Results Using a random sample from the data, we found the positive predictive value of this case definition to be 90.0%, as compared with 82.7% using a previously published case definition. Using our case definition, the number of unresponsive opioid overdoses increased from 3412 in 2010 to 7194 in 2015. The corresponding monthly rate increased by a factor of 1.7 from January 2010 (3.0 per 1000 encounters; n = 261 encounters) to December 2015 (5.1 per 1000 encounters; n = 622 encounters). Among EMS responses for unresponsive opioid overdose, the prevalence of naloxone use was 83%. Conclusions This study demonstrates the potential for using machine learning in combination with a more traditional substantive knowledge algorithm-based approach to create a case definition for opioid overdose in EMS data.

Opicapone and Levodopa-Carbidopa Intestinal Gel Infusion: The Way Forward Towards Cost Savings for Healthcare Systems?

2020 ◽  
Vol 10 (4) ◽  
pp. 1535-1539
Author(s):  
Valentina Leta ◽  
Daniel J. van Wamelen ◽  
Anna Sauerbier ◽  
Shelley Jones ◽  
Miriam Parry ◽  
...  
Keyword(s):  
United Kingdom ◽  
Side Effects ◽  
Retrospective Analysis ◽  
Dose Reduction ◽  
Clinical Care ◽  
Cost Savings ◽  
Healthcare Systems ◽  
Methyl Transferase ◽  
The United Kingdom ◽  
Daily Dose

Combined catechol-O-methyl-transferase-inhibition and Levodopa-Carbidopa intestinal gel (LCIG) infusion has the potential to reduce LCIG daily dose and the costs of this therapy. In this retrospective analysis, we report on Parkinson’s disease (PD) patients on LCIG with concomitant Opicapone. In 11 patients, the introduction of Opicapone led to LCIG daily dose being reduced by 24.8% (p = 0.05) without any significant worsening of dyskinesia. Three patients withdrew from Opicapone due to side effects or inefficacy. LCIG daily dose reduction could lead to cost savings of £142,820.63/year in the United Kingdom while maintaining clinical care.

Sign in / Sign up

Export Citation Format

Share Document