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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：
10687002
负责人：
Kao-Ping Chua
金额：
$ 67.36万
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/10687002
关键词：
Accounting Acute Pain Adult Adverse event Affect Automobile Driving Benzodiazepines Caring Characteristics Coupled Data Databases Day Surgery Development Equilibrium Exclusion Frequencies Future Harm Reduction Heterogeneity Hospitals Institution Insurance Carriers Interruption Intervention Knowledge Link Medicaid Medical Medicare Methods Michigan Morbidity - disease rate Operative Surgical Procedures Opioid Outcome Overdose Pain Pain management Patient Outcomes Assessments Patients Pattern Perioperative Pharmacy facility Play Policies Policy Maker Population Postoperative Pain Privatization Procedures Quasi-experiment Registries Risk Role Sample Size Surgeon System Time Series Analysis United States Variant Writing addiction 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.

项目摘要在美国，每年至少有1540万阿片类药物处方在手术护理期间提供。围手术期过量和危险的阿片类药物处方模式很常见，并会增加阿片类药物的风险过量，成瘾，转移和持续使用阿片类药物。为了减轻这些危害，政策制定者和支付者大多数州都制定了政策，限制阿片类药物用于急性疼痛或要求临床医生审查处方阿片类药物前的处方药监测计划数据库（Pestival使用授权）。迄今为止，很少有研究严格评估了这些政策在外科手术背景下的预期和非预期影响，在乎在这项为期4年的研究中，我们将使用准实验方法来检查阿片类药物处方的影响围手术期阿片类药物处方、高风险处方、阿片类药物相关不良反应事件和患者报告的结局。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，并评估政策特征、患者人群、程序和处方者（目标1）。第二，我们将评估国家使用汞的影响，并使用相同的索赔数据库检查效应的异质性（目标2）。最后，我们将确定密歇根州一家主要保险公司阿片类药物处方限制和密歇根州阿片类药物使用授权的影响处方和术后患者报告的结果，使用全州登记处之间的新联系，外科手术患者和国家数据库（目标3）。我们的研究结果将直接为减轻围手术期阿片类药物处方的发病率以及优化未来所需的关键知识差距政策设计例如，如果阿片类药物处方限制和阿片类药物使用规定减少了围手术期阿片类药物处方，最小的意外影响，政策制定者应考虑实施这些政策更广泛地说。然而，如果这些政策没有减少围手术期阿片类药物处方或有大量的可能需要其他方法。最终，这一建议将有助于发展设计良好的政策，平衡安全阿片类药物处方的需要与有效的术后疼痛管理

项目成果

期刊论文数量（7）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Changes in Surgical Opioid Prescribing and Patient-Reported Outcomes After Implementation of an Insurer Opioid Prescribing Limit.

DOI：
10.1001/jamahealthforum.2023.3541
发表时间：
2023-10-06
期刊：
JAMA HEALTH FORUM
影响因子：
0
作者：
Chua, Kao-Ping;Nguyen, Thuy D.;Brummett, Chad M.;Bohnert, Amy S.;Gunaseelan, Vidhya;Englesbe, Michael J.;Waljee, Jennifer F.
通讯作者：
Waljee, Jennifer F.

Antidepressant Dispensing to US Adolescents and Young Adults: 2016-2022.

向美国青少年和年轻人发放抗抑郁药：2016-2022 年。

DOI：
10.1542/peds.2023-064245
发表时间：
2024
期刊：
Pediatrics
影响因子：
8
作者：
Chua,Kao-Ping;Volerman,Anna;Zhang,Jason;Hua,Joanna;Conti,RenaM
通讯作者：
Conti,RenaM

Surgeons' Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems.

外科医生对电子健康记录系统中阿片类药物处方的默认剂量数量的看法。

DOI：
10.1001/jamanetworkopen.2023.15633
发表时间：
2023-05-01
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Chua, Kao-Ping;Thorne, Marc C.;Brummett, Chad M.;DeJonckheere, Melissa
通讯作者：
DeJonckheere, Melissa

Opioid Prescribing by US Surgeons, 2016-2022.

DOI：
10.1001/jamanetworkopen.2023.46426
发表时间：
2023-12-01
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Zhang, Jason;Waljee, Jennifer F.;Nguyen, Thuy D.;Bohnert, Amy S.;Brummett, Chad M.;Bicket, Mark C.;Chua, Kao-Ping
通讯作者：
Chua, Kao-Ping

Association Between State Opioid Prescribing Limits and Duration of Opioid Prescriptions From Dentists.

DOI：
10.1001/jamanetworkopen.2022.50409
发表时间：
2023-01-03
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Chua, Kao-Ping;Nguyen, Thuy D.;Waljee, Jennifer F.;Nalliah, Romesh P.;Brummett, Chad M.
通讯作者：
Brummett, Chad M.