Abstract
Electronic health records are a potentially valuable source of information for identifying patients with opioid use disorder (OUD). To evaluate whether proxy measures from electronic health record data can be used reliably to identify patients with probable OUD based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. This retrospective cross-sectional study analyzed individuals within the Geisinger health system who were prescribed opioids between December 31, 2000, and May 31, 2017, using a mixed-methods approach. The cohort was identified from 16 253 patients enrolled in a contract-based, Geisinger-specific medication monitoring program (GMMP) for opioid use, including patients who maintained or violated contract terms, as well as a demographically matched control group of 16 253 patients who were prescribed opioids but not enrolled in the GMMP. Substance use diagnoses and psychiatric comorbidities were assessed using automated electronic health record summaries. A manual medical record review procedure using DSM-5 criteria for OUD was completed for a subset of patients. The analysis was conducted beginning from June 5, 2017, until May 29, 2020. The primary outcome was the prevalence of OUD as defined by proxy measures for DSM-5 criteria for OUD as well as the prevalence of comorbidities among patients prescribed opioids within an integrated health system. Among the 16 253 patients enrolled in the GMMP (9309 women [57%]; mean [SD] age, 52 [14] years), OUD diagnoses as defined by diagnostic codes were present at a much lower rate than expected (291 [2%]), indicating the necessity for alternative diagnostic strategies. The DSM-5 criteria for OUD can be assessed using manual medical record review; a manual review of 200 patients in the GMMP and 200 control patients identifed a larger percentage of patients with probable moderate to severe OUD (GMMP, 145 of 200 [73%]; and control, 27 of 200 [14%]) compared with the prevalence of OUD assessed using diagnostic codes. These results suggest that patients with OUD may be identified using information available in the electronic health record, even when diagnostic codes do not reflect this diagnosis. Furthermore, the study demonstrates the utility of coding for DSM-5 criteria from medical records to generate a quantitative DSM-5 score that is associated with OUD severity.
Highlights
Opioid use disorder (OUD) is an epidemic that has been escalating in the United States for the past 2 decades
Among the 16 253 patients enrolled in the Geisinger-specific medication monitoring program (GMMP) (9309 women [57%]; mean [SD] age, 52 [14] years), OUD diagnoses as defined by diagnostic codes were present at a much lower rate than expected (291 [2%]), indicating the necessity for alternative diagnostic strategies
The study demonstrates the utility of coding for Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria from medical records to generate a quantitative DSM-5 score that is associated with OUD severity
Summary
Opioid use disorder (OUD) is an epidemic that has been escalating in the United States for the past 2 decades. The rate of prescribing opioid analgesics has been decreasing since 2012,1 the number of synthetic opioid–related deaths has been exponentially increasing,[2] and this trend is anticipated to continue. Most patients with OUD use heroin and/or fentanyl,[3,4,5,6] but 50% to 90% of patients with OUD were exposed to a prescription opioid first.[7,8] The prevalence estimate of OUD in the US in 2018 is 2 million individuals,[9] similar to the previous year’s prevalence estimates.[10] OUD is likely underdiagnosed within the health system setting. This underdiagnosis may be due, in part, to the reticence of practitioners who lack the specialized training in addiction medicine required to diagnose and treat OUD despite the fact that the most common source of opioid prescriptions is from primary care settings.[11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
