{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:27:16Z","timestamp":1760218036603,"version":"3.37.3"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T00:00:00Z","timestamp":1650585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100007188","name":"Uniformed Services University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007188","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc","award":["#HU00011920042"],"award-info":[{"award-number":["#HU00011920042"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the current cutoff score and a recalibrated adaptation of the Veterans Health Administration (VHA) Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose (RIOSORD) in active duty service members.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective case-control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Military Health System.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects<\/jats:title>\n                  <jats:p>Active duty service members dispensed \u2265 1 opioid prescription between January 1, 2018, and December 31, 2019.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Service members with a documented opioid overdose were matched 1:10 to controls. An active duty-specific (AD) RIOSORD was constructed using the VHA RIOSORD components. Analyses examined the risk stratification and predictive characteristics of two RIOSORD versions (VHA and AD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Cases (n\u2009=\u200995) were matched with 950 controls. Only 6 of the original 17 elements were retained in the AD RIOSORD. Long-acting or extended-release opioid prescriptions, antidepressant prescriptions, hospitalization, and emergency department visits were associated with overdose events. The VHA RIOSORD had fair performance (C-statistic 0.77, 95% CI 0.75, 0.79), while the AD RIOSORD did not demonstrate statistically significant performance improvement (C-statistic 0.78, 95% CI, 0.77, 0.80). The DoD selected cut point (VHA RIOSORD &amp;gt; 32) only identified 22 of 95 ORD outcomes (Sensitivity 0.23), while an AD-specific cut point (AD RIOSORD &amp;gt; 16) correctly identified 53 of 95 adverse events (Sensitivity 0.56).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Results highlight the need to continually recalibrate predictive models and to consider multiple measures of performance. Although both models had similar overall performance with respect to the C-statistic, an AD-specific index threshold improves sensitivity. The calibrated AD RIOSORD does not represent an end-state, but a bridge to a future model developed on a wider range of patient variables, taking into consideration features that capture both care received, and care that was not received.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pm\/pnac064","type":"journal-article","created":{"date-parts":[[2022,4,19]],"date-time":"2022-04-19T19:23:29Z","timestamp":1650396209000},"page":"1902-1907","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of an Opioid Overdose Composite Risk Score Cutoff in Active Duty Military Service Members"],"prefix":"10.1093","volume":"23","author":[{"given":"Jacob R","family":"Dunham","sequence":"first","affiliation":[{"name":"Enterprise Intelligence and Data Solutions (EIDS) Program Office, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS) , San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3815-2571","authenticated-orcid":false,"given":"Krista B","family":"Highland","sequence":"additional","affiliation":[{"name":"Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University , Bethesda, Maryland, USA"},{"name":"Department of Military and Emergency Medicine, Uniformed Services University , Bethesda, Maryland, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4554-3802","authenticated-orcid":false,"given":"Ryan C","family":"Costantino","sequence":"additional","affiliation":[{"name":"Enterprise Intelligence and Data Solutions (EIDS) Program Office, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS) , San Antonio, Texas, USA"},{"name":"Department of Military and Emergency Medicine, Uniformed Services University , Bethesda, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W","family":"Cliff Rutter","sequence":"additional","affiliation":[{"name":"Enterprise Intelligence and Data Solutions (EIDS) Program Office, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS) , San Antonio, Texas, USA"},{"name":"Department of Military and Emergency Medicine, School of Medicine, Uniformed Services University , Bethesda, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander G","family":"Rittel","sequence":"additional","affiliation":[{"name":"Enterprise Intelligence and Data Solutions (EIDS) Program Office, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS) , San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William H","family":"Kazanis","sequence":"additional","affiliation":[{"name":"Enterprise Intelligence and Data Solutions (EIDS) Program Office, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS) , San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory H","family":"Palmrose","sequence":"additional","affiliation":[{"name":"Pharmacy Operations Division, Defense Health Agency , San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,4,22]]},"reference":[{"year":"2019","author":"Centers for Disease Control and Prevention","key":"2023042203071272500_pnac064-B1"},{"issue":"15","key":"2023042203071272500_pnac064-B2","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC guideline for prescribing opioids for chronic pain\u2014United States, 2016","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA"},{"year":"2017","author":"US Department of Veterans Affairs, Department of Defense. VA\/DoD Clinical Practice Guidelines for Management of Opioid Therapy for Chronic Pain","key":"2023042203071272500_pnac064-B3"},{"issue":"8","key":"2023042203071272500_pnac064-B4","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1111\/pme.12777","article-title":"Development of a risk index for serious prescription opioid-induced respiratory depression or overdose in Veterans' health administration patients","volume":"16","author":"Zedler","year":"2015","journal-title":"Pain Med"},{"issue":"1","key":"2023042203071272500_pnac064-B5","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1093\/pm\/pnx009","article-title":"Validation of a screening risk index for serious prescription opioid-induced respiratory depression or overdose in a US commercial health plan claims database","volume":"19","author":"Zedler","year":"2018","journal-title":"Pain Med"},{"issue":"1","key":"2023042203071272500_pnac064-B6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1093\/pm\/pnx038","article-title":"Risk factors for serious prescription opioid-induced respiratory depression or overdose: Comparison of commercially insured and Veterans health affairs populations","volume":"19","author":"Nadpara","year":"2018","journal-title":"Pain Med"},{"key":"2023042203071272500_pnac064-B7","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.trsl.2021.03.012","article-title":"Assessing opioid overdose risk: A review of clinical prediction models utilizing patient-level data","volume":"234","author":"Tseregounis","year":"2021","journal-title":"Transl Res"},{"issue":"1","key":"2023042203071272500_pnac064-B8","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1093\/ajhp\/zxab206","article-title":"Development, implementation, and evaluation of a clinical decision support tool to improve naloxone coprescription within military health system pharmacies","volume":"79","author":"Rittel","year":"2022","journal-title":"Am J Health-Syst Pharm"},{"issue":"24","key":"2023042203071272500_pnac064-B9","doi-asserted-by":"crossref","first-page":"2957","DOI":"10.1001\/jama.1993.03510240069035","article-title":"A new simplified acute physiology score (SAPS II) based on a European\/North American multicenter study","volume":"270","author":"Le Gall","year":"1993","journal-title":"Jama"},{"issue":"1","key":"2023042203071272500_pnac064-B10","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1186\/s12913-021-06536-8","article-title":"Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System","volume":"21","author":"Adams","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2023042203071272500_pnac064-B11","first-page":"h2698","article-title":"Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: Case-cohort study","volume":"350","author":"Park","year":"2015","journal-title":"BMJ (Clin Res Ed)"},{"issue":"2","key":"2023042203071272500_pnac064-B12","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1001\/jamapediatrics.2019.4878","article-title":"Association of opioid prescribing patterns with prescription opioid overdose in adolescents and young adults","volume":"174","author":"Chua","year":"2020","journal-title":"JAMA Pediatr"},{"issue":"2","key":"2023042203071272500_pnac064-B13","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1007\/s11606-019-05490-w","article-title":"Risk factors for severe opioid-related adverse events in a national cohort of medical hospitalizations","volume":"35","author":"Herzig","year":"2020","journal-title":"J Gen Intern Med"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/painmedicine\/advance-article-pdf\/doi\/10.1093\/pm\/pnac064\/43684528\/pnac064.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/23\/11\/1902\/46685166\/pnac064.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/23\/11\/1902\/46685166\/pnac064.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,22]],"date-time":"2023-04-22T03:07:39Z","timestamp":1682132859000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/23\/11\/1902\/6572351"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,22]]},"references-count":13,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,4,22]]},"published-print":{"date-parts":[[2022,10,29]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnac064","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"type":"print","value":"1526-2375"},{"type":"electronic","value":"1526-4637"}],"subject":[],"published-other":{"date-parts":[[2022,11,1]]},"published":{"date-parts":[[2022,4,22]]}}}