The Relationship Between Postoperative Prescriber Networks and Opioid Prescribing Discoordination

术后处方者网络与阿片类药物处方不协调之间的关系

• 批准号: 10533934
• 负责人: Elizabeth Nilsen
• 金额: $ 5.18万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10533934
• 关键词: Acute pain management; Affect; Attention; Benchmarking; Benzodiazepines; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic; Clinical; Clinical Research; Clinical Skills; Communication; Complement; Development; Dose; Drug Prescriptions; Electronic Health Record; Event; Fellowship; Goals; Guidelines; Health Personnel; Health Policy; Health Services Research; Health system; Healthcare Systems; Individual; Insurance Carriers; Literature; Logistic Regressions; Longterm Follow-up; Measures; Mentorship; Methodology; Modeling; Morphine; National Institute of Drug Abuse; Network-based; Nurses; Operative Surgical Procedures; Opioid; Outcome; Outpatients; Overdose; Pain; Pain management; Pathway Analysis; Patients; Pharmacy facility; Poisoning; Policy Maker; Postoperative Care; Postoperative Period; Procedures; Provider; Recommendation; Reporting; Research; Research Personnel; Research Proposals; Risk; Role; Sampling; Scientist; Secure; Social Network; Specialist; Structure; Substance Use Disorder; Surgeon; Training; Trauma; United States; Vulnerable Populations; Weight; Work; acute care; adverse outcome; chronic pain; cohort; comorbidity; density; evidence base; high risk; interoperability; medical specialties; milligram; novel; opioid therapy; opioid use; policy recommendation; prescription opioid; reduced substance use; severe mental illness; skill acquisition; skills

Following common surgical procedures, nearly all patients in the United States will be prescribed an opioid. Although these are intended for short-term use, a growing body of literature is demonstrating that a significant portion of patients will continue to use opioids for greater than three months following their procedure, increasing the risk for opioid-related harm. To mitigate this risk, the CDC Guidelines for Prescribing Opioids for Chronic Pain recommend providers only prescribe cumulative doses greater than 90 morphine milligram equivalents (MME)/day with careful justification and avoiding concurrent opioid and benzodiazepine prescriptions. However, patients are more likely to exceed the 90 MME/day benchmark through discoordinated prescribing from multiple prescribers than single high-dose prescriptions. With a high likelihood of receiving an opioid prescription following a surgical procedure, postoperative opioid prescribing may be unintentionally contributing to opioid-related harm, especially for vulnerable populations such as those with a serious mental illness (SMI), a substance use disorder (SUD), or with chronic prescription opioid use. To date, most research has focused on initial postoperative opioid prescribing, with little attention to the role of prescribing discoordination (i.e. prescribing in accordance with CDC guideline recommendations) between outpatient and surgical providers. Prescribers may be able to more effectively coordinate prescriptions if they are more connected (i.e. have shared clinical attributes such as shared patients, patient referrals, or practice within the same provider group). For example, a pain management specialist who shares a practice with a surgeon may be able to more easily view current prescriptions (via direct communication or the electronic health record) and can plan ongoing therapy accordingly. Social network analysis (SNA) is a quantitative approach that identifies and measures connections between prescribers. These connections are quantified and used to calculate network measures that describe each network. Using claims from a single nation-wide commercial insurer, the goal of this study is to (1) build and characterize patient-prescriber networks of patients undergoing surgery, and (2) identify network and prescriber characteristics associated with prescribing discoordination. Policy makers and healthcare providers can use these findings to target policy recommendations that would enhance prescriber connection, such as changes to reimbursement structures and enhanced interoperability of electronic health systems. Activities directed under this fellowship will provide the applicant with methodologic skills in SNA, clinical skills in the care and management of patients in the acute care settings, and professional development skills to facilitate new clinical and research partnerships. The applicant has curated a mentorship team with expertise in these domains to enable her development as an independent nurse scientist.

在普通的外科手术之后，美国几乎所有的病人都会被开一张处方。 阿片类药物。尽管这些都是短期使用的，但越来越多的文献表明， 相当大一部分患者将继续使用阿片类药物超过三个月 程序，增加了阿片类药物相关伤害的风险。为了降低这一风险，疾控中心的预描述指南 阿片类药物治疗慢性疼痛建议提供者仅开出累积剂量大于90吗啡的处方 毫克当量(MME)/天，仔细说明理由并避免同时使用阿片类药物和苯二氮卓类药物 处方。然而，通过不协调，患者更有可能超过90MME/天的基准 由多个处方医生开出的处方比单张大剂量处方的处方要少。很有可能收到一份 阿片类药物处方在外科手术后，术后可能无意中开出阿片类药物 造成与阿片类药物相关的伤害，特别是对弱势群体，如有严重精神障碍的人 疾病(SMI)、物质使用障碍(SUD)或长期使用处方阿片类药物。 到目前为止，大多数研究都集中在术后早期阿片类药物的处方上，而对术后早期阿片类药物的应用关注较少。 处方不协调的作用(即根据疾控中心指南建议进行处方) 门诊部和外科医生之间的关系。开处方的人或许能够更有效地协调 如果处方之间的关联性更强(即具有共享的临床属性，如共享患者、患者 转诊，或在同一提供者小组内执业)。例如，一位疼痛管理专家分享 与外科医生合作可以更容易地查看当前的处方(通过直接交流或 电子健康记录)，并可以相应地计划正在进行的治疗。社交网络分析(SNA)是 一种量化方法，用于识别和测量处方医生之间的联系。这些连接是 量化并用于计算描述每个网络的网络度量。使用来自单个 全国性的商业保险公司，本研究的目标是(1)建立和描述患者处方者 接受手术的患者的网络，以及(2)确定相关的网络和处方者特征 开出不协调的处方。政策制定者和医疗保健提供者可以利用这些发现来确定政策目标 将加强与处方者联系的建议，例如改变报销结构 以及增强电子医疗系统的互操作性。 根据该研究金指导的活动将为申请人提供国民账户体系的方法技能， 在急诊护理环境中护理和管理病人的临床技能，以及职业发展 促进新的临床和研究伙伴关系的技能。申请者已经策划了一个导师团队， 在这些领域的专业知识，使她能够发展成为一名独立的护士科学家。