State Variation in Chronic Opioid Use in Long-Term Care Nursing Home Residents |
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| Institution: | 1. Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;3. Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, TX, USA;4. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA;5. Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA;1. Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX, USA;2. Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA;3. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA;4. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA;5. Sheltering Arms Institute, 2000 Wilkes Ridge Pl Drive, Richmond, VA, USA;6. Sealy Center on Aging, University of Texas Medical Branch, TX, USA;1. Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA;2. Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA;3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA;4. Harvard T.H. Chan School of Public Health, Department of Health Policy, Boston, MA, USA;5. University of Minnesota School of Public Health, Department of Health Policy and Management, Minneapolis, MN, USA;6. University of California San Francisco, Department of Medicine and Center for Clinical Informatics and Improvement Research, San Francisco, CA, USA;1. Medical Director, Baltimore, MD, USA;2. University of Maryland School of Nursing, Baltimore, MD, USA;3. Hickory Ridge Nursing and Rehab Center, Akron, OH, USA;4. Edgemoor DP SNF, Behavioral Health Services, Health and Human Services Agency, County of San Diego, San Diego, CA, USA;5. Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA;6. PC, Oswego, NY, USA;7. NYU Long Island School of Medicine, NYU Langone–Long Island Geriatrics Fellowship, New York, NY, USA;8. Capital Caring Health, Falls Church, VA, USA;9. Alpine Fireside Health Center, Rockford, IL, USA;10. ProMedical Associates, Inc, Newark, NJ, USA |
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| Abstract: | ObjectivePolicies 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.DesignRetrospective cohort study.Setting and ParticipantsWe 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.MeasurementsChronic 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.ResultsWe 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 ImplicationsVariation 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. |
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| Keywords: | Chronic opioid use state variation nursing home variation nursing homes |
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