Efficiency And Quality In Post-Surgical Pain Therapy After Discharge - EQUIPPED

出院后术后疼痛治疗的效率和质量 - EQUIPPED

• 批准号: 10298491
• 负责人: Karsten Bartels
• 金额: $ 39.92万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10298491
• 关键词: Efficiency; Quality; Post; Surgical; Pain

Abstract Compassionate and effective pain management after surgery represents a foundation of humane medical care. Opioids still present the mainstay of post-surgical pain therapy: more than 80% of patients are prescribed opioids for use following surgery. During one year in the U.S., more than 17% of Americans fill at least one opioid prescription, and, per prescription, the average daily amount exceeded 45 milligram morphine equivalents. In addition to common side effects, serious risks of opioids include addiction, abuse, and overdose. Prescription overdose deaths contribute to more than one-third of all opioid overdose deaths and remain five-fold higher than in 1999. Over-prescription of opioids remains extremely common, with up to 90% of patients after common surgical procedures reporting leftover opioids. Unused opioids are stored in unsecured locations in 75% of cases and can create a reservoir that fuels the ongoing opioid epidemic. Most large-scale efforts, such as the CDC guidelines for prescribing opioids, have focused on chronic opioid use. There is an urgent need to increase access to high-quality, safe, and scalable interventions to reduce our reliance on opioids for effective post- surgical pain management at discharge. A diverse team with expertise in pain medicine, perioperative outcomes, clinical trials, biostatistics, and health economics has been assembled to conduct the Efficiency And Quality In Post-Surgical Pain Therapy After Discharge “EQUIPPED” study. Our central hypothesis is that pain therapy after surgery can and should be prescribed in a safer, patient-centered fashion, as opposed to current “one-size-fits- all” methods. To test this hypothesis, three aims are proposed: Specific Aim 1 will test a provider-facing EHR- based decision support tool that suggests outpatient opioid prescriptions based on inpatient opioid requirements. This aim will utilize a pragmatic randomized cluster multiple crossover controlled trial design in about 39,000 patients in four hospitals. Specific Aim 2 will test a patient-facing health informatics app that encourages non- opioid pain management strategies. This aim employs a randomized controlled trial design in 600 surgical patients. Two separate clinical trials are proposed because of different outcomes (amount of opioids prescribed vs. opioids used) and scopes of implementation (multisite vs. single site). The provider-facing tool will be incorporated into the trial of the patient-facing app using a 2x2 design that facilitates a detailed evaluation of the individual effects of these interventions, as well as any interactions when using the interventions together. Finally, Specific Aim 3 will include a cost-effectiveness analysis and compare the individual and combined cost- effectiveness of a provider-facing and a patient-facing intervention. Completion of this project will demonstrate that the amounts of opioids prescribed and opioids taken after discharge following surgery can be reduced while ensuring effective treatment of pain. Increasing access to safe, affordable, and high-quality pain therapy for surgical patients will drive the positive impact of this application, which directly addresses Special Emphasis Notice: AHRQ Announces Interest in Health Services Research to Address the Opioids Crisis (NOT-HS-18-015).

摘要 富有同情心和有效的术后疼痛管理是人性化医疗的基础。 阿片类药物仍然是手术后疼痛治疗的中流砥柱：超过80%的患者使用处方阿片类药物 供手术后使用。在美国的一年里，超过17%的美国人至少服用一种阿片类药物 根据处方，每天的平均剂量超过45毫克吗啡当量。在……里面 除了常见的副作用外，阿片类药物的严重风险还包括成瘾、滥用和过量。方剂 过量死亡占所有阿片类药物过量死亡的三分之一以上，并且仍然是 在1999年。过量开阿片类药物仍然非常普遍，高达90%的患者在服用阿片类药物后 外科手术报告了残留的阿片类药物。在75%的病例中，未使用的阿片类药物储存在不安全的位置 并能创造一个蓄水池，为正在进行的阿片类药物流行提供燃料。大多数大规模的努力，如疾控中心 阿片类药物处方指南侧重于慢性阿片类药物的使用。迫切需要增加 获得高质量、安全和可扩展的干预措施，以减少我们对阿片类药物的依赖，以实现有效的术后干预 出院时的外科疼痛管理。一个多元化的团队，在止痛药，围手术期结果， 临床试验、生物统计学和卫生经济学已经汇集在一起，以进行效率和质量在 手术后疼痛治疗出院后装备研究。我们的中心假设是疼痛治疗后 手术可以而且应该以更安全、以患者为中心的方式开出处方，而不是目前的“一刀切”。 所有“方法。为了验证这一假设，提出了三个目标：特定目标1将测试面向提供商的EHR- 基于决策支持工具，根据住院患者的阿片类药物需求建议门诊阿片类药物处方。 这一目标将在大约39,000人中利用实用的随机群组多交叉对照试验设计 四家医院的病人。特定目标2将测试一款面向患者的健康信息学应用程序，该应用程序鼓励非 阿片类疼痛管理策略。这一目标采用随机对照试验设计，在600名外科医生中 病人。由于结果不同(阿片类药物的处方数量)，建议进行两项单独的临床试验 与使用的阿片类药物相比)和实施范围(多站点与单站点)。面向提供商的工具将是 使用2x2设计整合到面向患者的应用程序的试用中，该设计有助于对 这些干预措施的单独影响，以及当这些干预措施一起使用时的任何交互作用。最后， 具体目标3将包括成本效益分析，并比较单独和综合成本-- 面向提供者和面向患者的干预措施的有效性。该项目的完成将证明 手术后出院后处方和服用阿片类药物的数量可以减少，同时 确保有效治疗疼痛。增加获得安全、负担得起的高质量疼痛治疗的机会 手术患者将推动这一应用的积极影响，它直接针对特别强调 通知：AHRQ宣布对卫生服务研究感兴趣，以解决阿片类药物危机(NOT-HS-18-015)。