Clinical Dashboard Development for Opioid-Related Adverse Drug Events in Surgical Patients Using a National Administrative Claims Database
Introduction: National attention to opioid-related adverse drug events (ORADES) is growing as efforts to combat the opioid crisis intensify. ORADES include a wide range of c omplications, from respiratory depression and arrest to opioid induced ileus and urinary retention.1,2Previous studies estimate ORADES rates ranging between 10-35% in surgery patients who received opioids.2ORADES correlate to morbidity, mortality, increased length of hospital stay (LOS) and increased hospitalization costs.3We created an innovative dashboard using the Centers for Medicare and Medicaid Services(CMS) administrative claims database that allows hospitals to utilize their ORADES data to facilitate more widespread quality improvement efforts.
Material and Methods: This study was reviewed and deemed exempt by the Brigham and Women’s Hospital Institutional Review board. We utilized data from Centers for Medicare and Medicaid Services(CMS) administrative claims database, which contains data from all hospitals in the United States that care for Medicare patients. The claim data includes key fields such as Hospital NPI, ICD codes, present on admission indicator flags, admission and discharge dates, and MS DRG classifications. This dataset represents 30-35% of all hospital discharges. In addition, a literature search was conducted to collect previously published ICD-9 codes that were used to define ORADES and convert these to ICD-10 codes. Common surgical procedures were captured and defined using diagnostic relate groups (DRG) codes. An in-depth data analysis was performed using the detailed claims data, the ICD codes in the literature, and the surgical procedure groups to show ORADE quality outcomes by hospital.
Results:We developeda dashboard that could present meaningful data on ORADES to frontline clinicians and hospital leadership on key quality outcomes. The dashboard allows hospitals to compare local data on ORADES rates to other hospitals both regionally and nationally.
Figure 1:a sample hospital’s ORADES rate in comparison to national rates, as well as differences in LOS for cohorts with and without an ORADE. Filtering diagnostic related groups allows search refinement by surgery type (e.g. colorectal, thoracic) or primary affected organ system (e.g. respiratory, gastrointestinal).
Figure 2: an example screenshot of historical monthly ORADES rates (in red) and average length of stay (LOS) for patients with ORADES (in blue) vs patients without ORADES (in green).
Figure 3: a sample dashboard display comparing hospital and national trends for ORADES along with associated LOS and discharge rates.
Figure 4: data tables for each hospital are available to view and download for offline analysis.
•Innovative interface using national administrative claims data
•Clinically meaningful tool to improve patient safety
•Benchmark against national trends
•Allows hospital systems to leverage ORADES data into widespread quality improvement efforts
•Reduce opioid-related complications following inpatient surgery
•Risk stratify patients for research investigations
1. OderdaGM, GanTJ, Johnson BH, Robinson SB. Effect of Opioid-Related Adverse Events on Outcomes in Selected Surgical Patients.J Pain PalliatCare Pharmacother. 2013;27(1):62-70. doi:10.3109/15360288.2012.751956.
2. Wheeler M, OderdaGM, Ashburn MA, LipmanAG. Adverse events associated with postoperative opioid analgesia: A systematic review.J Pain. 2002;3(3):159-180. doi:10.1054/jpai.2002.123652.
3. Kessler ER, Shah M, GruschkusSK, Raju A. Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes.Pharmacotherapy. 2013;33(4):383-391. doi:10.1002/phar.1223.