Non-pharmacological Options in postoperative Hospital-based And Rehabilitation pain Management (NOHARM) pragmatic clinical trial

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ABSTRACT Prescriptions for narcotic pain relief after surgery result in unintended prolonged opioid use for hundreds of thousands of Americans. That trend fuels an excess supply of opioids that can lead to dependence, addiction, diversion, and overdoses on a national scale. Non- pharmacological pain care is effective and recommended by guidelines for perioperative pain while offering a more favorable risk benefit ratio. However, nonpharmacological pain care is rarely used as first or second-line therapy after surgery. Patient and clinician decision support interventions are effective in encouraging patient centered and guideline-concordant care, but these strategies have not been tested pragmatically as a bundle in every day postoperative pain care. The NOHARM trial will first confirmed the feasibility of patient-facing as well as clinician- facing decision support components of an EHR-imbedded evidence-based bundle (Aim 1). Then we will test our bundle in a step-wedge, cluster randomized trial at 18 sites in 4 Health Systems (Aim 2) affiliated with one national healthcare organization that uses a common EHR platform. We will test a sustainable system strategy that could change the paradigm of perioperative pain management toward nonpharmacological options in a manner that preserves patient function, honors patient values and maintains availability of opioids as a last resort. This could serve as a model for healthcare organizations nationally and could be disseminated through our institution’s ongoing partnership with the largest national EHR vendor. To ensure our approach is sustainable, we will also study what worked and what did not at all study sites (Aim 3), focusing on high-risk patients within a parent organization that has expressed a high- level commitment to addressing the opioid crisis.