Evaluation of state-mandated acute and post-surgical pain-specific CDC opioid prescribing guidelines

国家规定的急性和术后疼痛特定 CDC 阿片类药物处方指南的评估

• 批准号: 9789778
• 负责人: Shabbar I Ranapurwala
• 金额: $ 66.21万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789778
• 关键词: Evaluation; state; mandated; acute; post

PROJECT SUMMARY Prescription opioid overdoses claimed 17,087 lives in the United States in 2016, more than in any previous year. In addition, the US experiences more than 1,000 emergency department visits every day from complications from prescription opioids. These adverse outcomes reflect the US's current high prevalence of opioid prescribing. Note that about 20% of the US adults receive one or more opioid prescriptions each year. In March 2016, the Centers for Disease Control and Prevention (CDC) released national opioid prescribing guidelines for chronic non-cancer pain to address the overprescribing of opioids. The guidelines include a specific guideline for acute pain recommending that for most acute pain, a prescription of 3 days of outpatient opioid pain reliever (OPR) should be sufficient and more than 7 days would rarely be needed. The CDC guidelines include a call to evaluate the effect of implementation of the guidelines. In June 2017, North Carolina's STrengthen Opioid Misuse Prevention (STOP) act mandated CDC guidelines for acute and post- surgical pain, effective January 1 2018. This act legislatively limited first outpatient OPR prescriptions to a) ≤ 5 days for acute pain, and b) ≤ 7 days for post-surgical pain. The overall goal of this study is to conduct an impact and process evaluation of North Carolina's legislative mandate of the CDC opioid prescribing guidelines for acute and post-surgical pain. While five other states have also adopted similar laws, North Carolina (NC) provides an optimal setting for examining the effect of this opioid prescribing guideline because NC's STOP act prescribing mandate is most closely aligned with the CDC opioid prescribing guideline for acute pain. In this study, we will used mixed methods to conduct 1) a quasi-experimental impact evaluation and 2) a qualitative process evaluation of the implementation of state mandated CDC opioid prescribing guideline for acute and post-surgical pain in NC. We will use existing electronic health records data from three large integrated healthcare delivery systems in NC and Tennessee (TN). We will link NC and TN electronic health records from 2010 to 2020 to each state's prescription drug monitoring program and death records. The linked data from >2 million acute and post-surgical pain patients who received opioids for pain control will be used in a comparative interrupted time series analysis. Essentially, we will conduct 2-group pre/post policy evaluation in which one state (NC) will serve as pre/post intervention and the other state (TN) will serve as control (TN does not have a similar policy). We will use latent class growth analysis to model heterogeneity in physicians' opioid prescribing patterns before and after implementation of the state-mandated CDC opioid prescribing guideline. We will also conduct a process evaluation to understand the multi-system level resources, strategies, and partnerships that may aid the implementation of the guidelines. Using Wandermann's interactive systems framework, the results from the impact and process evaluations will be used to develop recommendations to guide the legislative implementation of other CDC opioid prescribing guidelines in other states.

项目摘要 处方阿片类药物过量释放在2016年在美国生命17,087人，比以前的任何人多 年。此外，美国每天都有1000多个急诊室访问 处方阿片类药物的并发症。这些不良后果反映了美国当前的高流行率 Ooid处方。请注意，每年约有20％的美国成年人接受一个或多个OOID处方。在 2016年3月，疾病控制与预防中心（CDC）发布了国家阿片类药物的处方 慢性非癌症疼痛指南，以解决阿片类药物的过度处方。指南包括 急性疼痛的具体指南建议，对于大多数急性疼痛，处方3天门诊就诊 Oopioid Pain Rescuer（OPR）应该足够，很少需要7天以上。 CDC 指南包括评估执行准则效果的呼吁。 2017年6月，北 卡罗来纳州的加强阿片类药物预防（Stop）法案授权的急性和后CDC指南 手术疼痛，自2018年1月1日起。该法案在立法上有限的首次门诊OPR处方为A）≤5 急性疼痛的天数，b）≤7天，手术后疼痛。这项研究的总体目标是进行 对北卡罗来纳州的CDC OOID处方指南的立法任务的影响和过程评估 用于急性和手术后疼痛。尽管其他五个州也采用了类似法律，但北卡罗来纳州（NC） 由于NC的停止ACT 处方授权与急性疼痛的CDC Oioid开处方指南最为紧密。在这个 研究，我们将使用混合方法进行1）准实验性影响评估和2）定性 对急性和 北卡罗来纳州手术后疼痛。我们将使用来自三个大型集成的现有电子健康记录数据 北卡罗来纳州和田纳西州（TN）的医疗保健系统。我们将链接NC和TN电子健康记录 2010年至2020年，每个州的处方药物监测计划和死亡记录。 > 2的链接数据 接受阿片类药物控制阿片类药物的百万急性和后手术后疼痛患者将用于比较 中断时间序列分析。本质上，我们将进行2组预/后政策评估 州（NC）将作为干预前/后干预，另一个州（TN）将作为控制（TN没有 类似政策）。我们将使用潜在的班级增长分析来模拟医师的阿片类药物处方中的异质性 实施国家规定的CDC阿片类药物处方指南之前和之后的模式。我们也会 进行过程评估以了解多系统级别的资源，策略和合作伙伴关系 可能有助于实施准则。使用Wandermann的交互式系统框架，结果 从影响和过程评估中，将用于制定建议以指导立法 在其他州实施其他CDC OOID处方指南。