Opioid Policy and Chronic Pain Treatment Access Experiences: A Multi-Stakeholder Qualitative Analysis and Conceptual Model.

Purpose: Patients on long-term opioid therapy (LTOT) for pain have difficulty accessing primary care clinicians who are willing to prescribe opioids or provide multimodal pain treatment. Recent treatment guidelines and statewide policies aimed at reducing inappropriate prescribing may exacerbate these access issues, but further research is needed on this issue. This study aimed to understand barriers to primary care access and multimodal treatment for chronic pain from the perspective of multiple stakeholders.

Impact of Advanced Practice Provider Integration into Multispecialty Group Practices on Outcomes Following Major Surgery.

. While advanced practice providers (APPs) are increasingly integrated into care delivery models, little is known about their impact in surgical settings. Given that many patients undergo surgery in multispecialty group practice settings, we examined the impact of APP integration into such practices on outcomes after major surgery.

Factors influencing treatment of veterans with advanced prostate cancer.

Background: Treatments for metastatic castration-resistant prostate cancer (CRPC) differ in toxicity, administration, and evidence. In this study, clinical and nonclinical factors associated with the first-line treatment for CRPC in a national delivery system were evaluated.

Methods: National electronic laboratory and clinical data from the Veterans Health Administration were used to identify patients with CRPC (ie, rising prostate-specific antigen [PSA] on androgen deprivation) who received abiraterone, enzalutamide, docetaxel, or ketoconazole from 2010 through 2017.

Identifying individuals with opioid use disorder: Validity of International Classification of Diseases diagnostic codes for opioid use, dependence and abuse.

Background: Policy evaluations and health system interventions often utilize International Classification of Diseases (ICD) codes of opioid use, dependence, and abuse to identify individuals with opioid use disorder (OUD) and assess receipt of evidence-based treatments. However, ICD codes may not map directly onto the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) OUD criteria. This study investigates the positive predictive value of ICD codes in identifying patients with OUD.

A comparison of parametric propensity score-based methods for causal inference with multiple treatments and a binary outcome.

We consider comparative effectiveness research (CER) from observational data with two or more treatments. In observational studies, the estimation of causal effects is prone to bias due to confounders related to both treatment and outcome. Methods based on propensity scores are routinely used to correct for such confounding biases.

Microrandomized Trial Design for Evaluating Just-in-Time Adaptive Interventions Through Mobile Health Technologies for Cardiovascular Disease.

Smartphone and wearable device use is rising broadly and can be leveraged for chronic disease management. Just-in-time adaptive interventions promise to deliver personalized, dynamic interventions directly to patients through use of push notifications from mobile devices. Although just-in-time adaptive interventions are a powerful tool for shaping health behavior, their application to cardiovascular disease management has been limited as they can be challenging to design.

Assessing reasons for decreased primary care access for individuals on prescribed opioids: an audit study.

Many primary care clinics are resistant to accept new patients taking prescription opioids for chronic pain. It is unclear how much of this practice is specific to individuals who may be perceived to have aberrant opioid use. This study sought to determine whether clinics are more or less willing to accept and prescribe opioids to patients depending on whether their history is more or less suggestive of aberrant opioid use by conducting an audit survey of primary care clinics in 9 states from May to July 2019.

Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol.

Background: Use of direct oral anticoagulants (DOAC) is rapidly growing for treatment of atrial fibrillation and venous thromboembolism. However, incorrect dosing of these medications is common and puts patients at risk of adverse drug events. One way to improve safe prescribing is the use of population health tools, including interactive dashboards built into the electronic health record (EHR).

Prehospital and Posthospital Fall Injuries in Older US Adults.

Importance: To date, measurement and treatment of older adult fall injury has been siloed within specific care settings, such as a hospital or within a nursing home or community. Little is known about changes in fall risk across care settings. Understanding the occurrence of falls across settings has implications for measuring and incentivizing high-value care across care settings.

Development of the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN) in randomized controlled trials and meta-analyses.

Background: Most randomized controlled trials (RCTs) and meta-analyses of RCTs examine effect modification (also called a subgroup effect or interaction), in which the effect of an intervention varies by another variable (e.g., age or disease severity).

Care Coordination for Patients on Chronic Opioid Therapy Following Surgery: A Cohort Study.

Objective: To describe if patients with chronic opioid use with a consistent usual prescriber (UP) prior to surgery and if early return to that UP (<30 d) would be associated with fewer high risk prescribing events in the postoperative period.

Summary Background Data: Over 10 million people each year are prescribed opioids for chronic pain. There is little evidence regarding coordination of opioid management and best practices for patients on long-term opioid therapy patients following surgery.

Life expectancy estimates for patients diagnosed with prostate cancer in the Veterans Health Administration.

Purpose: Accurate life expectancy estimates are required to inform prostate cancer treatment decisions. However, few models are specific to the population served or easily implemented in a clinical setting. We sought to create life expectancy estimates specific to Veterans diagnosed with prostate cancer.

Opioid prescribing history prior to heroin overdose among commercially insured adults.

Background: Since 2010, heroin-related overdoses have risen sharply, coinciding with policies to restrict access to prescription opioids. It is unknown if patients tapered or discontinued off prescription opioids transitioned to riskier heroin use. This study examined opioid prescribing, including long-term opioid therapy (LTOT) and discontinuation, prior to heroin overdose.

Factors associated with 30-day readmission for patients hospitalized for seizures.

Background: We sought to determine the cumulative incidence of readmissions after a seizure-related hospitalization and identify risk factors and readmission diagnoses.

Methods: We performed a retrospective cohort study of adult patients hospitalized with a primary discharge diagnosis of seizure ( codes 345.xx and 780.

Privacy Gaps for Digital Cardiology Data: Big Problems With Big Data.

Mr. M is a 55 year-old man who suffers an acute myocardial infarction (MI) and undergoes coronary stenting. Following hospitalization, he completes cardiac rehabilitation.