Clinical Practice Guidelines for Postoperative Pain in Pregnancy: Evidence, Dissemination, and Impact

妊娠期术后疼痛的临床实践指南：证据、传播和影响

• 批准号: 10675810
• 负责人: Michelle Helena Moniz
• 金额: $ 200万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675810
• 关键词: Clinical; Practice; Guidelines; Postoperative; Pain

PROJECT SUMMARY Over 4 million births occur in the United States each year, and opioid prescribing for acute pain during pregnancy and childbirth is common and highly variable. Guidelines to direct opioid prescribing during pregnancy and birth are sparse, leading to excessive prescribing and increasing the risk of opioid overdose, addiction, diversion, and persistent opioid use. In this 3 year study, we will create evidence-based, patient- centered guidelines to support acute postoperative pain management for pregnant individuals during childbirth and surgery. We will examine the effectiveness of implementing these guidelines on clinical and patient- reported outcomes in a large, state-wide consortium of 68 hospitals within the Collaborative Quality Improvement programs in Michigan. We will convene a national panel of patients, providers, reproductive justice advocates, health equity experts, and health system leaders to guide all activities. First, we will use the RAND/UCLA Appropriateness methodology to merge a systematic literature review with expert opinion to create provider- and patient-facing guidelines that direct opioid prescribing, integrate opioid-alternatives and considerations for unique populations (high-risk pregnancies, comorbid conditions, prior opioid exposure, opioid and substance use disorders), and include best practices to promote health equity and patient- centeredness (Phase 1). We will create tailored strategies for CPG dissemination and implementation using state of the art techniques in implementation science at the national and facility level (Phase 2). Finally, we will conduct an enhanced, non-responder randomized trial across 68 hospitals in Michigan to determine the effectiveness of CPGs that inform opioid prescribing during peripartum care as well as the impact of innovative, adaptive implementation interventions at the hospital level (Phase 3). Our primary outcomes will include the rate and amount of opioid prescribed among pregnant individuals during surgery and childbirth. We will also examine patient-reported outcomes (e.g., postoperative pain, opioid use, satisfaction) as secondary outcomes. We will specifically examine the effect of CPGs across marginalized groups to ensure that guideline implementation does not exacerbate existing disparities in postoperative pain management. Our findings will directly impact obstetric care by rigorously creating pragmatic, patient-centered guidelines to direct postoperative opioid prescribing that are tailored to the unique needs of pregnant and birthing individuals. Given the robust network of Collaborative hospital systems caring for a diverse cohort of pregnant individuals in Michigan, our findings will provide critical evidence to direct optimal strategies for guideline dissemination and implementation across the United States.

项目摘要 在美国，每年有超过400万的新生儿出生， 怀孕和分娩是常见的，而且变化很大。指导阿片类药物处方的指南 怀孕和分娩稀少，导致过度处方和增加阿片类药物过量的风险， 成瘾、转移和持续使用阿片类药物。在这项为期3年的研究中，我们将创建基于证据的，患者- 集中指南，以支持分娩期间孕妇的急性术后疼痛管理 还有手术我们会研究在临床和病人方面实施这些指引的成效， 在协作质量管理体系内，一个由68家医院组成的大型全州联盟报告了结果 密歇根州的改善计划。我们将召集一个全国性的专家小组， 司法倡导者、卫生公平专家和卫生系统领导人指导所有活动。首先，我们将使用 兰德公司/加州大学洛杉矶分校适当的方法，将系统性文献综述与专家意见相结合， 制定面向提供者和患者的指导方针，指导阿片类药物处方，整合阿片类药物替代品， 特殊人群的考虑因素（高风险妊娠、合并症、既往阿片类药物暴露， 类阿片和药物使用障碍），并包括促进健康公平和患者 第一阶段（Phase 1）。我们将为CPG的传播和实施制定量身定制的战略， 在国家和设施一级实施科学的最新技术水平（第2阶段）。最后我们将 在密歇根州的68家医院进行一项增强的无应答随机试验，以确定 在围产期护理期间告知阿片类药物处方的CPG的有效性以及创新， 在医院一级采取适应性实施干预措施（第3阶段）。我们的主要成果将包括 手术和分娩期间孕妇处方阿片类药物的比例和数量。我们还将 检查患者报告的结果（例如，术后疼痛、阿片类药物使用、满意度）作为次要结局。 我们会特别检视中央政策对边缘化社群的影响，以确保 实施不会加剧术后疼痛管理中的现有差异。我们的发现将 通过严格制定务实的、以患者为中心的指导方针，直接影响产科护理， 根据孕妇和分娩个体的独特需求定制的术后阿片类药物处方。 考虑到协作医院系统的强大网络， 在密歇根州，我们的研究结果将为指导指南传播的最佳策略提供关键证据 并在美国各地实施。