Understanding infectious disease among home healthcare patients with a history of opioid use disorder

Public Health; Immunology and Infectious Disease; Epidemiology

The study will help understand the prevalence and cost of infectious diseases among home healthcare patients with opioid use disorder history postdischarge from a hospital with a venous access device.

A significant number of post-hospital patients are discharged to home with a venous access device (VAD). These home healthcare patients are at risk for developing various infectious diseases including skin and soft tissue infections, sepsis, and endocarditis. The risk is higher among those with a past or current history of opioid use disorders.  However, little is known about the prevalence and the cost of infectious diseases in this vulnerable population.

In order to bridge this knowledge gap, we will analyze one-year period of electronic health records (EHRs) of all home healthcare patients in a large home healthcare agency using statistical and big-data analytic methods. This will involve thoroughly exploring, identifying and operationally defining study variables such as opioid use disorder history, venous access device use status from complex EHRs, using extensive clinical and health services knowledge. Currently, this information singly or multiply exists throughout multidisciplinary EHR features (multiple sources of clinical, sociodemographic, and administrative data in an EHR system) while potentially conflicting each other depending on which discipline records such information and what stage of healthcare process the case is at. One patient often has multiple admissions to a home healthcare agency in a year, which requires longitudinal examination of EHRs. We will explore and utilize traditional statistical analysis methods and modern big-data analytic methods to best understand and summarize the data.

Despite the challenge of analyzing such complex EHR data, the study will be high-reward. This is a timely study with respect to current opioid overdose crisis and increasing number of health care services in the community. The study results will be foundational for our future larger study that will quantitatively determine risk factors and vulnerable subgroups in the population. Ultimately, this will inform the development of an intervention to reduce infectious diseases among home healthcare patients with a history of opioid use disorder and a VAD. Two management staff at the home health care agency will work as collaborators on this project to inform the study and enable translation of the study findings into practice. 

Desired outcomes

We will conduct a study with the following aims:

1.     Create a taxonomy of major study variables (e.g. opioid use disorder history, venous access device use status, etc.) in a widely-used, complex EHR system and identify a systematic process of collecting them.

2.     Describe the prevalence of home healthcare patients with a history of opioid use disorder, who are discharged from a hospital with VAD.

3.     Describe and compare the prevalence of infectious diseases among the population with that among the patients without a history of opioid use disorder. 

4.     Describe and compare 30-day emergency room admission and hospital readmission rates among the population with that among home healthcare patients without a history of opioid use disorder.