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Accepted for/Published in: JMIR Formative Research

Date Submitted: Oct 9, 2023
Date Accepted: Sep 4, 2024

The final, peer-reviewed published version of this preprint can be found here:

Occurrence of Stigmatizing Documentation Among Hospital Medicine Encounters With Opioid-Related Diagnosis Codes: Cohort Study

Bradford WS, Bratches R, Porras H, Chen DR, Gagnon KW, Ascher SB

Occurrence of Stigmatizing Documentation Among Hospital Medicine Encounters With Opioid-Related Diagnosis Codes: Cohort Study

JMIR Form Res 2024;8:e53510

DOI: 10.2196/53510

PMID: 39447164

PMCID: 11544335

Stigmatizing Documentation is Common Among Hospital Medicine Encounters with Opioid-Related Diagnosis Codes: A Cohort Study

  • William S Bradford; 
  • Reed Bratches; 
  • Hollie Porras; 
  • David R Chen; 
  • Kelly W Gagnon; 
  • Simon B Ascher

ABSTRACT

Background:

Physician use of stigmatizing language in the clinical documentation of hospitalized adults with opioid use is common. However, patient factors associated with stigmatizing language in this setting remain poorly characterized.

Objective:

To determine whether specific demographic factors and clinical outcomes are associated with the presence of stigmatizing language by physicians in the clinical documentation of encounters with opioid-related ICD-10 codes.

Methods:

Hospital encounters with one or more associated opioid-related ICD-10 admission diagnoses on the hospital medicine service during the 2020 calendar year were analyzed for the presence of stigmatizing language in history and physical (H&P) and discharge summaries. Multivariable adjusted logistic regression models were used to determine associations of age, race/ethnicity, gender, medication for addiction treatment (MAT) use, against medical advice (AMA) discharge, homelessness, comorbid polysubstance use, comorbid psychiatric disorder, comorbid chronic pain, cost, and 30-day readmission with the presence of stigmatizing language.

Results:

A total of 221 encounters were identified. Sixty-four (29%) encounters had stigmatizing language present in physician documentation. Most stigmatizing language was due to use of “[substance] abuse” rather than the preferred term “[substance] use” (63/66 instances). Polysubstance use and homelessness were independently associated with the presence of stigmatizing language (aOR 7.83; 95% CI 3.42-19.24 and aOR 2.44; 95% CI 1.03-5.90) when controlling for chronic pain and other covariates.

Conclusions:

Among hospital medicine encounters with an opioid-related diagnosis, stigmatizing language by physicians in clinical documentation was common and independently associated with comorbid polysubstance use and homelessness.


 Citation

Please cite as:

Bradford WS, Bratches R, Porras H, Chen DR, Gagnon KW, Ascher SB

Occurrence of Stigmatizing Documentation Among Hospital Medicine Encounters With Opioid-Related Diagnosis Codes: Cohort Study

JMIR Form Res 2024;8:e53510

DOI: 10.2196/53510

PMID: 39447164

PMCID: 11544335

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