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.

项目概要 2016 年，美国因处方阿片类药物过量导致 17,087 人死亡，比以往任何一年都要多 年。此外，美国每天有超过 1,000 例急诊就诊 处方阿片类药物引起的并发症。这些不利结果反映了美国目前的高患病率 阿片类药物处方。请注意，每年约有 20% 的美国成年人接受一种或多种阿片类药物处方。在 2016年3月，美国疾病控制与预防中心（CDC）发布了全国阿片类药物处方 慢性非癌症疼痛指南，以解决阿片类药物的过度处方问题。该指南包括 急性疼痛的具体指南建议，对于大多数急性疼痛，门诊处方为 3 天 阿片类止痛药 (OPR) 应该足够了，很少需要超过 7 天。疾病预防控制中心 准则包括呼吁评估准则的实施效果。 2017年6月，北 卡罗来纳州的《强化阿片类药物滥用预防 (STOP)》法案强制规定 CDC 针对急性和后期阿片类药物滥用的指南 手术疼痛，2018 年 1 月 1 日生效。该法案通过立法将首次门诊 OPR 处方限制为 a) ≤ 5 急性疼痛的天数，以及 b) 术后疼痛的 ≤ 7 天。本研究的总体目标是进行 北卡罗来纳州疾病预防控制中心阿片类药物处方指南立法授权的影响和过程评估 用于急性疼痛和手术后疼痛。虽然其他五个州也通过了类似的法律，但北卡罗来纳州 (NC) 由于 NC 的 STOP 法案，为检查该阿片类药物处方指南的效果提供了最佳设置 处方授权与疾病预防控制中心针对急性疼痛的阿片类药物处方指南最为一致。在这个 研究中，我们将使用混合方法进行 1）准实验影响评估和 2）定性评估 国家规定的疾病预防控制中心阿片类药物处方指南实施情况的过程评估 NC 术后疼痛。我们将使用来自三大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) 的医疗保健提供系统。我们将链接 NC 和 TN 电子健康记录 2010年至2020年每个州的处方药监测计划和死亡记录。来自 >2 的链接数据 接受阿片类药物控制疼痛的 100 万急性和术后疼痛患者将被用于比较 中断时间序列分析。本质上，我们将进行两组政策前/后评估，其中一组 状态（NC）将作为干预前/干预后的状态，另一个状态（TN）将作为控制（TN 没有 类似政策）。我们将使用潜在类别增长分析来模拟医生阿片类药物处方的异质性 国家规定的疾病预防控制中心阿片类药物处方指南实施前后的模式。我们还将 进行流程评估，以了解多系统级资源、战略和伙伴关系 可能有助于指南的实施。使用 Wandermann 的交互式系统框架，结果 根据影响和过程评估将用于制定建议来指导立法 在其他州实施其他疾病预防控制中心阿片类药物处方指南。