Trends in Opioid-related Inpatient Stays Shifted After the US Transitioned to ICD-10-CM Diagnosis Coding in 2015

Heslin, Kevin C.; Owens, Pamela L; Karaca, Zeynal; Barrett, Marguerite L; Moore, Brian J.; Elixhauser, Anne

doi:10.1097/mlr.0000000000000805

Cited by 91 publications

(68 citation statements)

References 5 publications

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“…14 This study period comprises hospitals’ first full year of ICD-10-CM diagnosis coding, which may be more sensitive to identify opioid-related hospital stays. 15 …”

Section: Discussionmentioning

confidence: 99%

U.S. National 90-Day Readmissions After Opioid Overdose Discharge

Peterson

Yang

et al. 2019

American Journal of Preventive Medicine

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Introduction U.S. hospital discharges for opioid overdose increased substantially during the past two decades. This brief report describes 90-day readmissions among patients discharged from inpatient stays for opioid overdose. Methods In 2018, survey-weighted analysis of hospital stays in the 2016 Healthcare Cost and Utilization Project National Readmissions Database yielded the national estimated proportion of patients with opioid overdose stays that had all-cause readmissions within ≤90 days. A multivariable logistic regression model assessed index stay factors associated with readmission by type (opioid overdose or not). Number of readmissions per patient was assessed. Results More than 24% (n=14,351/58,850) of patients with non-fatal index stays for opioid overdose had at least one all-cause readmission ≤90 days of index stay discharge and 3% (n=1,658/ 58,850) of patients had at least one opioid overdose readmission. Less than 0.2% (n=104/58,850) of patients had more than one readmission for opioid overdose. Patient demographic characteristics (e.g., male, older age), comorbidities diagnosed during the index stay (e.g., drug use disorder, chronic pulmonary disease, psychoses), and other index stay factors (Medicare or Medicaid primary payer, discharge against medical advice) were significantly associated with both opioid overdose and non-opioid overdose readmissions. Nearly 30% of index stays for opioid overdose included heroin, which was significantly associated with opioid overdose readmissions. Conclusions A quarter of opioid overdose patients have ≤90 days all-cause readmissions, although opioid overdose readmission is uncommon. Effective strategies to reduce readmissions will address substance use disorder as well as comorbid physical and mental health conditions.

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“…14 This study period comprises hospitals’ first full year of ICD-10-CM diagnosis coding, which may be more sensitive to identify opioid-related hospital stays. 15 …”

Section: Discussionmentioning

confidence: 99%

U.S. National 90-Day Readmissions After Opioid Overdose Discharge

Peterson

Yang

et al. 2019

American Journal of Preventive Medicine

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“…36,37 Transition to ICD-10 in the later part of 2015 could account for about 14% of the increased rates observed during the transition, and 3.5% of the increased rates in 2016 owed to these coding changes. 61 Increased OP rates may be attributed to more individuals seeking care at the hospital during this period and may not be reflective of changing general population OP rates. Though rates for ZIP codes with small populations may not be stable with yearly variability, quartile analysis did not change quartiles for these ZIP codes.…”

Section: Limitationsmentioning

confidence: 98%

Geographic, Temporal, and Sociodemographic Differences in Opioid Poisoning

Schoenfeld

Leibowitz

Wang

et al. 2019

American Journal of Preventive Medicine

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Introduction: Not enough is known about the epidemiology of opioid poisoning to tailor interventions to help address the growing opioid crisis in the U.S. The objective of this study is to expand the current understanding of opioid poisoning through the use of data analytics to evaluate geographic, temporal, and sociodemographic differences of opioid poisoning− related hospital visits in a region of New York State with high opioid poisoning rates. Methods: This retrospective cohort study utilized patient-level New York State all-payer hospital data (2010−2016) combined with Census data to evaluate geographic, patient, and community factors for 9,714 Long Island residents with an opioid poisoning−related inpatient or outpatient hospital facility discharge. Temporal, 7-year opioid poisoning rates and trends were evaluated, and geographic maps were generated. Overall, significance tests and tests for linear trend were based upon logistic regression. Analyses were completed between 2017 and 2018. Results: Since 2010, Long Island and New York State opioid poisoning hospital visit rates have increased 2.5-to 2.7-fold (p<0.001). Opioid poisoning hospital visit rates decreased for men, white patients, and self-payers (p<0.001) and increased for Medicare payers (p<0.001). Communities with high opioid poisoning rates had lower median home values, higher percentages of high school graduates, were younger, and more often white patients (p<0.01). Maps displayed geographic patterns of communities with high opioid poisoning rates overall and by age group. Conclusions: Findings highlight the changing demographics of the opioid poisoning epidemic and utility of data analytics tools to identify regions and patient populations to focus interventions. These population identification techniques can be applied in other communities and interventions.

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“…To date, we are not aware of reporting that quantifies US prevalence of opioid use disorder (OUD) separate from overdoses using health services data, nor analysis of health services contacts (e.g., inpatient stay) during which patients were diagnosed with OUD in the absence of opioid overdose (Guy Jr., Pasalic, & Zhang, 2018; Heslin et al, 2017; Hsu, McCarthy, Stevens, & Mukamal, 2017; Tedesco et al, 2017; Weiss et al, 2016). Using the most recent five years of US national hospital discharge data, this brief report aimed to describe patient and clinical characteristics of discharges during which providers documented OUD among patients who were not treated for opioid overdose, opioid detoxification, or opioid rehabilitation during the inpatient stay.…”

Section: Introductionmentioning

confidence: 99%

US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015

Peterson

Mikosz

et al. 2018

Journal of Substance Abuse Treatment

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Background Understanding more about circumstances in which patients receive an opioid use disorder (OUD) diagnosis might illuminate opportunities for intervention and ultimately prevent opioid overdoses. This study aimed to describe patient and clinical characteristics of hospital discharges documenting OUD among patients not being treated for opioid overdose, detoxification, or rehabilitation. Methods We assessed patient, payer, and clinical characteristics of nationally-representative 2011–2015 National Inpatient Sample discharges documenting OUD, excluding opioid overdose, detoxification, and rehabilitation. Discharges were clinically classified by Diagnostic Related Group (DRG) for analysis. Results Annual discharges grew 38%, from 347,137 (2011) to 478,260 (2015), totaling 2 million discharges during the study period. The annual discharge rate increased among all racial/ethnic groups, but was highest among the non-Hispanic black population until 2015, when non-Hispanic whites had a slightly higher rate (164 versus 162 per 100,000 population). Female patients and Medicaid and Medicare as primary payer accounted for an increasing annual proportion of discharges. Just 14 DRGs accounted for nearly 50% of discharges over the study period. The most prevalent primary treatment received during OUD inpatient stays was for psychoses (DRG 885; 16% of discharges) and drug and alcohol abuse or dependence symptoms (including withdrawal) or (non-opioid) poisoning (DRG 894, 897, 917, 918; 12% of discharges). Conclusions Now nearly half a million yearly US hospital discharges for a range of primary treatment include patients’ diagnosis of OUD without opioid overdose, detoxification, or rehabilitation services. Inpatient stays present an important opportunity to link OUD patients to treatment to reduce opioid-related morbidity and mortality.

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Trends in Opioid-related Inpatient Stays Shifted After the US Transitioned to ICD-10-CM Diagnosis Coding in 2015

Cited by 91 publications

References 5 publications

U.S. National 90-Day Readmissions After Opioid Overdose Discharge

U.S. National 90-Day Readmissions After Opioid Overdose Discharge

Geographic, Temporal, and Sociodemographic Differences in Opioid Poisoning

US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015

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