60: Large variation in discharge opioid prescribing following vaginal births across hospitals in Tennessee

Abstract

Listen

Translate article

To describe hospital variation in discharge opioid prescribing following vaginal birth and identify characteristics associated with differential prescribing We conducted a cross-sectional study of Medicaid-enrolled women in Tennessee aged 15-44 years with a vaginal birth in 2014-2015. Women were continually enrolled in Tennessee Medicaid and had no evidence of opioid use disorders in the 180 days prior to birth. For each of 62 Tennessee hospitals with ≥50 annual births, we calculated the discharge opioid prescribing rate as the percentage of all vaginal births with an opioid prescription fill within 5 days of hospital discharge. A sensitivity analysis excluded complicated vaginal births. Multivariable linear regression models evaluated whether discharge opioid prescribing rates were associated with hospital-level characteristics including teaching status, hospital ownership, region within state, rurality, average age and proportion white race among study patients, and proportion of all births covered by Medicaid. We identified 26,428 vaginal births (19,841 uncomplicated) that met the inclusion criteria. Among 62 hospitals, opioid prescribing rates after vaginal birth varied more than 20-fold, from 4% to 88% (median 53%, interquartile range [IQR] 31-69%) (Figure). After exclusion of complicated births, the rates ranged from 0 to 91% (median 53%, IQR 30-69%). Discharge opioid prescribing rates were significantly associated with proportion of all births covered by Medicaid, adjusting for other hospital characteristics (Table). For every 10% increase in the proportion of births covered by Medicaid, the opioid prescribing rate decreased by 6.2% (95% confidence interval [CI] -9.2, -3.2). We found greater than 20-fold variation in discharge opioid prescribing after vaginal births across 62 Tennessee hospitals, which was not explained by birth complications. Greater proportion of births covered by Medicaid at the hospital-level was associated with lower opioid prescribing rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)