Opioid overdose continues to be a public health problem of unprecedented scale in the United States. Our team is currently conducting randomized pragmatic trials of novel naloxone distributions approaches in two large health systems -- Kaiser Permanente Colorado and Denver Health. The parent grant (R01DA042059) for this diversity supplement has been designed to reduce opioid overdose risk behavior and overdose among patients prescribed chronic opioid therapy. The primary outcome is patient-reported risk behavior, measured by a survey instrument which includes several established scales. However, it is not known how well these survey measures of risk behavior predict risk behavior measures derived from the electronic health record (EHR), such as overdose, substance use treatment admissions, and urine toxicology results. In addition to the survey and EHR data, we have identified a need to consider social and environmental factors that may contribute to opioid risk behavior and overdose. In our parent trial, such social and environmental data could be available for all patients based on address. However, the predictive properties of these data on individual level opioid risk behavior have not been evaluated. Exploring the use of these data with this supplement will enhance the parent trial and represent an innovative training opportunity for a postdoctoral trainee. The scientific goals of this supplement are to: (1) augment the parent intervention trial database of EHR and survey data with global environmental data on social determinants of health (e.g., income, education, drug arrests at the county or census tract level); (2) determine the predictive validity of risk behavior survey measures by examining associations between survey responses and measures of risk behavior derived from the EHR; and (3) identify predictors of opioid risk behavior in trial eligible patients in the two large health care systems that are study sites of parent grant. We will employ data linkage and hierarchical statistical models to accomplish these aims. This supplement also has three career development goals for Dr. Anh Nguyen, a promising postdoctoral trainee with a background in Sociology: (1) to acquire expertise on the determinants of opioid risk behavior; (2) advance his knowledge and skills in epidemiologic study design, health systems interventions, EHR analytics and hierarchical modeling; and (3) to learn to present at local and national meetings, lead (first-author) peer-reviewed manuscripts, and write a grant proposal. Our research group includes mentors who possess the substantive knowledge and technical expertise essential to achieve Dr. Nguyen?s career development goals, including Drs. Ingrid Binswanger, Jason Glanz and Stan Xu.

Public Health Relevance

Opioid overdose continues to be a public health problem of unprecedented scale in the United States. Our team is currently conducting randomized pragmatic trials of novel naloxone distributions approaches in two large health systems -- Kaiser Permanente Colorado and Denver Health. The primary outcome for these trials is patient-reported opioid risk behavior, measured by a survey instrument which includes several established scales. For this diversity supplement, we will augment the parent trial (R01DA042059) by exploring environmental and social factors associated with risk behaviors among participants enrolled in the trials.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA042059-03S1
Application #
9663230
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Thomas, David A
Project Start
2016-08-01
Project End
2021-04-30
Budget Start
2018-05-01
Budget End
2019-04-30
Support Year
3
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
150829349
City
Oakland
State
CA
Country
United States
Zip Code
94612
Binswanger, Ingrid A; Glanz, Jason M (2018) Potential Risk Window for Opioid Overdose Related to Treatment with Extended-Release Injectable Naltrexone. Drug Saf 41:979-980
Calcaterra, S L; Scarbro, S; Hull, M L et al. (2018) Prediction of Future Chronic Opioid Use Among Hospitalized Patients. J Gen Intern Med 33:898-905
Binswanger, Ingrid A; Joseph, Nicole; Hanratty, Rebecca et al. (2018) Novel Opioid Safety Clinic Initiative to Deliver Guideline-Concordant Chronic Opioid Therapy in Primary Care. Mayo Clin Proc Innov Qual Outcomes 2:309-316
Glanz, Jason M; Narwaney, Komal J; Mueller, Shane R et al. (2018) Prediction Model for Two-Year Risk of Opioid Overdose Among Patients Prescribed Chronic Opioid Therapy. J Gen Intern Med 33:1646-1653
Peglow, Stephanie Lee; Binswanger, Ingrid A (2018) Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists. Med Clin North Am 102:621-634
Binswanger, Ingrid A (2017) Commentary on Hsu et al. (2017): A systems approach to improving health services for overdose in the hospital and across the continuum of care-an unmet need. Addiction 112:1565-1566