National Hospital Care Survey Demonstration Projects: Opioid-involved Emergency Department Visits, Hospitalizations, and Deaths.

Abstract

Objective-This report demonstrates the utility of linking the restricted-use 2014 National Hospital Care Survey (NHCS), 2014-2015 National Death Index (NDI), and 2014-2015 Drug-Involved Mortality (DIM) data to study opioid-involved emergency department (ED) visits, hospitalizations, and mortality within 1 year post-discharge. Example research questions and unweighted results are presented. Results are not nationally representative. Methods-Patient records from the 2014 NHCS with sufficient identifying information were linked to the 2014-2015 NDI and DIM data. Visits were considered opioid-involved if they had International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 304.00-304.02, 304.70-304.72, 305.50-305.52, 760.72, 965.00-965.02, 965.09, 970.1, or E850.0-E850.2 in any diagnosis or external cause of injury code field. Opioid-involved drug overdose deaths were deaths with an International Classification of Diseases, 10th Revision (ICD-10) underlying cause-of-death code of X40-44, X60-64, X85, or Y10-Y14 and a multiple cause code of T40.0-T40.4 or T40.6. Results-In the 2014 NHCS, there were 15,495 patients with an opioid-involved ED-only visit and 24,059 patients with an opioid-involved hospitalization. Of the 20,962 patients with an opioid-involved hospitalization eligible to be linked to NDI, 1,805 died (9%) within 1 year of discharge. Of these deaths, 341 (19%) resulted from a drug overdose. Of drug overdose deaths, 243 (71%) involved an opioid, where 12% died within 30 days post-discharge, 19% within 31-90 days, and 69% within 91-365 days. Opioids most frequently mentioned included heroin (46%), fentanyl (20%), oxycodone (13%), methadone (12%), and morphine (12%). These categories are not mutually exclusive because a death may involve more than one drug. For approximately 22% of patients who died of an opioid-involved drug overdose in 2014, their last ED-only visit or hospitalization was opioid-involved. Conclusion-While the NHCS data are not nationally representative, these unlinked and linked National Center for Health Statistics data allow for exploratory analyses of ED visits, hospitalizations, and associated mortality outcomes.