Summary of the Study:
Harnessing the innovative and advanced group-based trajectory modeling, or GBTM, approach, the proposed study aims at developing an innovative, real-time “Predicting Risky Opioid-Benzodiazepine Trajectory e–Care Tool, or PROTeCT” for identifying and predicting subgroups of older adults with potentially unsafe patterns of OPI-BZD use. To overcome the gaps in the prior studies using arbitrary thresholds of duration and dose alone, the PROTeCT platform developed from the proposed study has the ability to simultaneously examine dose and duration thresholds or other patterns most relevant to outcomes and incorporate prescription data in a prospective manner. The findings and PROTeCT platform will better guide clinical care on co-prescribing opioids and benzodiazepines and inform concurrent opioid and benzodiazepine use related policies and interventions implemented by the Centers for Medicare & Medicaid Services, or CMS, and their partners and state programs.
Using national Medicare claims and Arizona and Florida Medicaid data from 2013-2016, Aim 1 focuses on identifying distinct trajectories of OPI-BZD use. Lo Ciganic will also identify predictors associated with specific trajectories or patterns. In Aim 2, her team will identify the distinct trajectories or patterns of OPI-BZD use that are the most closely associated with two separate outcomes (i.e., overdoses; falls and fractures). Finally, they propose to develop a beta-version of a real-time PROTeCT platform capable of prospectively and iteratively predicting patients with unsafe patterns of OPI-BZD use by prospectively analyzing more recent data from the 2017-2019 Medicaid in Arizona and Florida. The infrastructure of their findings and tool may be generalizable to Medicare, Medicaid programs in other states or other healthcare data systems with similar data structures.