Honors Theses

Date of Award

Spring 4-30-2021

Document Type

Undergraduate Thesis


Chemistry and Biochemistry

First Advisor

Yi Yang

Second Advisor

Sujith Ramachandran

Third Advisor

John Bentley

Relational Format



The purpose of this study was to define continuity of care and prescriber characteristics among older adults with chronic non-cancer pain who are on long-term opioid therapy. Also, it will evaluate the connection between continuity of care and prescriber characteristics on the risk of opioid-related adverse events among older adults on chronic opioid therapy. The main goal is to observe the relationship between continuity and the related adverse events that may arise.

This study utilized a nested case-control using a 5% random sample of the National Medicare data between 2012 and 2016. This data used a random sample of beneficiaries in the United States and included a plethora of information regarding their provider visits. The control group was defined as those who entered the study cohort but did not experience any related adverse events or death. There were two numerical ways to determine COC (COCI and HI). Statistical comparisons through a Chi-Square test and Conditional logistic regression models were used to visually compare COC and opioid-related adverse events.

The mean COCI score was 0.65 in the 6-month period prior to cohort entry. Those with low COC were found to have higher odds of the outcome compared to those with higher COC. Those seeing a pain specialist had lower odds of the composite outcome. The adjusted results showed similar findings that were expected.

It was found that there was a positive correlation between continuity of care and having less opioid-related adverse events for patients with CNCP. Also, provider specialty was not as significant to COC.


This study stems from the research provided by Dr. Yi Yang, Dr. Sujith Ramachandran, Dr. John Bentley, Dr. Kaustuv Bhattacharya, and Ph.D. Candidate Monika Salkar.



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