The Relationship Between Postoperative Prescriber Networks and Opioid Prescribing Discoordination

在普通的外科手术之后，几乎所有的美国患者都将接受 阿片类药物虽然这些都是短期使用，越来越多的文献表明， 相当一部分患者将继续使用阿片类药物超过三个月后， 这增加了阿片类药物相关危害的风险。为了降低这种风险，CDC处方指南 阿片类药物治疗慢性疼痛建议供应商只开累积剂量大于90吗啡 毫克当量（MME）/天，仔细说明理由，避免同时使用阿片类药物和苯二氮卓类药物 处方然而，患者更有可能通过不协调而超过90 MME/天的基准。 从多个处方者处开药，而不是单一的高剂量处方。很有可能会收到 手术后开阿片类药物，术后开阿片类药物可能是无意的 导致阿片相关伤害，特别是对脆弱人群，如患有严重精神疾病的人 疾病（SMI）、物质使用障碍（SUD）或慢性处方阿片类药物使用。 到目前为止，大多数研究都集中在术后初始阿片类药物处方，很少关注 处方不协调的作用（即根据CDC指南建议处方） 门诊病人和外科医生之间的联系开处方者可以更有效地协调 处方，如果它们是更多连接的（即，具有共享的临床属性，例如共享的患者、患者 （或在同一提供者组内的实践）。例如，一位疼痛管理专家， 具有外科医生的实践能够更容易地查看当前的处方（通过直接通信或 电子健康记录）并且可以相应地计划正在进行的治疗。社会网络分析（Social Network Analysis，SNA） 识别和测量处方者之间联系的定量方法。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，本研究的目的是（1）建立和特点的病人处方 接受手术的患者的网络，以及（2）识别网络和处方者相关特征 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制定政策 加强处方者联系的建议，如报销结构的变化 以及增强电子医疗系统的互操作性。 根据这项研究金指导的活动将为申请人提供SNA的方法技能， 急性护理环境中患者护理和管理的临床技能以及专业发展 促进新的临床和研究伙伴关系的技能。申请人已经策划了一个导师团队， 在这些领域的专业知识，使她成为一个独立的护士科学家的发展。

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.