REDUCING INAPPROPRIATE PRESCRIPTION OPIOID PRESCRIBING AT HOSPITAL DISCHARGE

减少出院时不适当的阿片类药物处方

• 批准号: 10402368
• 负责人: Katherine E Watkins
• 金额: $ 59.61万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10402368
• 关键词: Address; Applied Research; Architecture; Area; Behavior; Behavioral; Behavioral Research; Benefits and Risks; Caring; Chronic; Clinical; Cluster randomized trial; Cognitive; Decision Making; Development; Discipline; Electronic Health Record; Electronic Mail; Feedback; Freedom; Geography; Goals; Guidelines; Health; Heroin; Hospitals; Incentives; Individual; Inpatients; Intervention; Judgment; Light; Link; Methodology; Modeling; Morphine; Motivation; Operative Surgical Procedures; Opiate Addiction; Opioid; Overdose; Pain management; Patients; Persons; Physicians; Postoperative Period; Provider; Psychologist; Public Health; Qualitative Evaluations; Research; Risk Factors; Sample Size; Social Psychology; Testing; Text; Thinking; Time; Uncertainty; Variant; Vendor; Work; base; behavior change; behavioral economics; behavioral health; comparative effectiveness; cost effective; design; experience; falls; health care settings; health economics; health goals; incentive-based intervention; individual patient; insight; milligram; morphine equivalent; operation; opioid mortality; opioid overdose; opioid use; opioid use disorder; peer; prescription opioid; randomized trial; social; social norm; treatment as usual; usability

Enter the text here that is the new abstract information for your application. This section must be no longer than 30 lines of text. Project Summary/Abstract Physician opioid prescribing practices are a major upstream contributor to increases in chronic opioid use, opioid addiction and overdose deaths. Opioid prescribing after surgery is an important intervention target, as opioids are commonly overprescribed after surgery, post-operative opioid prescribing is a risk factor for chronic opioid use, and unused opioids prescribed for patients after surgery are an important reservoir of opioids available for misuse and diversion. The scientific premise of our study is research in social psychology and behavioral economics that suggest that people are strongly motivated by social approbation, which makes them want to adhere to prevailing social norms. In other settings, social norms have been used to successfully influence decision making, but have rarely been tested in the healthcare setting and have never been applied in the inpatient setting or with opioid prescribing across a range of conditions. We propose a cluster randomized trial to investigate the extent to which normative information, conveyed through “nudges” within the electronic health record (EHR), can change post-surgical opioid prescribing behavior, and whether the behavior change persists when the nudge is turned off. We will test and compare to usual care different ways of conveying and reinforcing social norms around opioid prescribing, including: (1) providing an injunctive norm at the time of prescribing (prescribing behavior compared to national guidelines); (2) providing the injunctive norm and cumulative feedback on prescribing behavior relative to the norm (i.e., whether or not the provider is a “top performer”) through a monthly email outside of the EHR. To our knowledge, no previous study has investigated the extent to which normative information, conveyed within the EHR, can change opioid prescribing behavior, an important public health goal. By examining the comparative effectiveness of different ways of conveying and reinforcing normative information for diverse practice areas, we also address a scientifically significant research question and advance applied research in social psychology and behavioral economics. With 23 hospitals located in diverse geographic settings and using a common EHR vendor (Epic), our clinical partner, Sutter Health, provides the institutional commitments and sample sizes to deploy and test the proposed nudges in a scientifically rigorous fashion.

在此处输入文本，这是您应用程序的新摘要信息。本节必须不超过30行文本。 项目摘要/摘要 医师阿片类药物规定做法是增加慢性阿片类药物使用，阿片类药物成瘾和过量死亡的主要上游贡献者。手术后的阿片类药物处方是重要的干预靶标，因为阿片类药物通常在手术后通常过度处方，术后阿片类药物处方是使用晶状体的危险因素，并且在手术后针对患者处方的未使用阿片类药物是可用于滥用和转移的阿片类药物的重要储层。我们研究的科学前提是社会心理学和行为经济学的研究，这些研究表明人们是由社会方法强烈激励的，这使他们想坚持占上风社会规范。在其他环境中，社会规范已被用来成功影响决策，但很少在医疗保健环境中进行测试，并且从未在住院环境中或在各种条件下使用阿片类药物处方。提出了一项群集随机试验，以调查通过电子健康记录（EHR）中“轻推”传达的正常信息可以改变手术后的阿片类药物处方行为，以及在关闭轻推时的行为变化是否持续。我们将测试并与通常的护理相提并论，以不同的方式来传达和加强阿片类药物处方的社会规范，包括：（1）在处方时提供禁令性规范（与国家准则相比，处方行为）； （2）通过EHR以外的每月电子邮件提供有关规范行为的禁令和累积反馈。据我们所知，以前没有研究调查EHR中传达的正常信息可以改变阿片类药物处方行为的程度，这是一个重要的公共卫生目标。通过研究不同方法的不同方法，为潜水员实践领域传达和加强正常信息的比较有效性，我们还解决了科学重要的研究问题，并在社会心理学和行为经济学方面进行了进步的应用研究。我们的临床合作伙伴Sutter Health拥有23家医院，并使用常见的EHR供应商（EPIC），提供了机构承诺和样本量，以科学严格的方式部署和测试拟议的午睡。