The Relationship Between Postoperative Prescriber Networks and Opioid Prescribing Discoordination

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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.