Evaluating Policy Interventions to Decrease Excessive and Risky Perioperative Opioid Prescribing

评估政策干预措施以减少围手术期阿片类药物的过度和高风险处方

基本信息

批准号：
10569291
负责人：
Kao-Ping Chua
金额：
$ 68.06万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10569291
关键词：
Accounting Acute Pain Adult Adverse event Affect Automobile Driving Benzodiazepines Caring Characteristics Coupled Data Databases Day Surgery Development Equilibrium Frequencies Future Heterogeneity Hospitals Institution Insurance Carriers Interruption Intervention Knowledge Link Medicaid Medical Medicare Medicare/Medicaid Methods Michigan Morbidity - disease rate Operative Surgical Procedures Opioid Outcome Overdose Pain Pain management Patient Outcomes Assessments Patients Pattern Perioperative Pharmacy facility Play Policies Population Postoperative Pain Procedures Quasi-experiment Registries Risk Role Sample Size Surgeon System Time Series Analysis United States Variant addiction base comorbidity design dosage high risk innovation mortality novel opioid epidemic opioid overdose opioid policy opioid use opioid use disorder patient population perioperative morbidity prescription drug abuse prescription monitoring program prescription opioid satisfaction surgical pain

项目摘要

PROJECT SUMMARY At least 15.4 million opioid prescriptions in the United States are provided each year during surgical care. Excessive and risky perioperative opioid prescribing patterns are common and increase the risk of opioid overdose, addiction, diversion, and persistent opioid use. To mitigate these harms, policymakers and payers in most states have enacted policies that restrict opioid prescribing for acute pain or mandate clinicians to review prescription drug monitoring program databases before prescribing opioids (PDMP use mandates). To date, few studies have rigorously assessed the intended and unintended effects of these policies in the context of surgical care. In this 4-year study, we will use quasi-experimental methods to examine the impact of opioid prescribing limits and PDMP use mandates on perioperative opioid prescribing, high-risk prescribing, opioid-related adverse events, and patient-reported outcomes. First, we will use commercial, Medicare, and Medicaid claims databases to evaluate the effect of state opioid prescribing limits and to assess variation in effects by policy feature, patient population, procedure, and prescriber (Aim 1). Second, we will evaluate the effect of state PDMP use mandates and examine heterogeneity in effects using the same claims databases (Aim 2). Finally, we will determine the impact of a major Michigan insurer’s opioid prescribing limit and Michigan’s PDMP use mandate on opioid prescribing and patient-reported outcomes after surgery, using a novel linkage between a statewide registry of surgical patients and the state PDMP database (Aim 3). Our findings will directly inform efforts to mitigate morbidity from perioperative opioid prescribing and close critical knowledge gaps needed to optimize future policy design. For example, if opioid prescribing limits and PDMP use mandates have reduced perioperative opioid prescribing with minimal unintended effects, policymakers should consider implementing these policies more broadly. However, if the policies have not reduced perioperative opioid prescribing or have had substantial unintended effects, other approaches may be needed. Ultimately, this proposal will contribute to the development of well-designed policies that balance the need for safe opioid prescribing with the need for effective postoperative pain management.

项目摘要在外科护理期间，每年在美国提供至少1540万个OOID处方。过度和风险的周期性溶因类药物处方模式很常见，并增加了绿核酸的风险过量，成瘾，转移和持续的阿片类药物使用。为了减轻这些危害，政策制定者和付款人大多数州制定了限制阿片类药物处方急性疼痛或授权临床医生进行审查的政策处方药物数据库处方药之前（PDMP使用授权）。迄今为止，很少研究严格评估了这些政策在手术背景下的预期和意外影响关心。在这项为期四年的研究中，我们将使用准实验方法来检查阿片类药物的影响限制和PDMP使用授权在周期性的阿片类药物处方，高风险处方，与阿片类药物相关的敌人事件和患者报告的结果。首先，我们将使用商业，医疗保险和医疗补助索赔数据库为了评估国家阿片类药物处方限制的影响并评估策略特征的影响变化，患者人口，程序和处方者（AIM 1）。其次，我们将评估状态PDMP使用授权的效果并使用相同的主张数据库检查效果的异质性（AIM 2）。最后，我们将确定密歇根州主要保险公司的阿片类药物处方限制和密歇根州的PDMP使用授权对阿片类药物的影响手术后开处方和患者报告的结果，使用全州范围内的注册表之间的新型联系手术患者和状态PDMP数据库（AIM 3）。我们的发现将直接努力减轻定期性阿片类药物处方和紧密的关键知识差距的发病率，以优化未来政策设计。例如，如果阿片类药物处方限制和PDMP使用授权减少了定期阿片类药物的处方具有最小的意外效果，决策者应考虑实施这些政策更广泛。但是，如果这些政策尚未减少周期性的阿片类药物处方或有实质性的规定意外效果，可能需要其他方法。最终，该提议将有助于发展精心设计的政策，平衡了安全阿片类药物处方的需求与有效的需求术后疼痛管理。