REDUCING INAPPROPRIATE PRESCRIPTION OPIOID PRESCRIBING AT HOSPITAL DISCHARGE

减少出院时不适当的阿片类药物处方

• 批准号: 10017035
• 负责人: Katherine E Watkins
• 金额: $ 60.08万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017035
• 关键词: Address; Applied Research; Architecture; Area; Behavior; Behavioral; Behavioral Research; Benefits and Risks; Caring; Chronic; Clinical; Cluster randomized trial; Cognitive; Decision Making; Development; Discipline; Electronic Health Record; Electronic Mail; Feedback; Freedom; Geography; Goals; Guidelines; Health; Heroin; Hospitals; Incentives; Individual; Inpatients; Intervention; Judgment; Light; Link; Methodology; Modeling; Morphine; Motivation; Operative Surgical Procedures; Opiate Addiction; Opioid; Overdose; Pain management; Patients; Physicians; Postoperative Period; Provider; Psychologist; Public Health; Qualitative Evaluations; Research; Risk Factors; Sample Size; Social Psychology; Testing; Text; Thinking; Time; Uncertainty; Variant; Vendor; Work; base; behavior change; behavioral economics; behavioral health; comparative effectiveness; cost effective; design; experience; falls; health care settings; health economics; health goals; incentive-based intervention; individual patient; insight; milligram; morphine equivalent; operation; opioid mortality; opioid overdose; opioid use; opioid use disorder; peer; prescription opioid; randomized trial; social; social norm; treatment as usual; usability

Enter the text here that is the new abstract information for your application. This section must be no longer than 30 lines of text. Project Summary/Abstract Physician opioid prescribing practices are a major upstream contributor to increases in chronic opioid use, opioid addiction and overdose deaths. Opioid prescribing after surgery is an important intervention target, as opioids are commonly overprescribed after surgery, post-operative opioid prescribing is a risk factor for chronic opioid use, and unused opioids prescribed for patients after surgery are an important reservoir of opioids available for misuse and diversion. The scientific premise of our study is research in social psychology and behavioral economics that suggest that people are strongly motivated by social approbation, which makes them want to adhere to prevailing social norms. In other settings, social norms have been used to successfully influence decision making, but have rarely been tested in the healthcare setting and have never been applied in the inpatient setting or with opioid prescribing across a range of conditions. We propose a cluster randomized trial to investigate the extent to which normative information, conveyed through “nudges” within the electronic health record (EHR), can change post-surgical opioid prescribing behavior, and whether the behavior change persists when the nudge is turned off. We will test and compare to usual care different ways of conveying and reinforcing social norms around opioid prescribing, including: (1) providing an injunctive norm at the time of prescribing (prescribing behavior compared to national guidelines); (2) providing the injunctive norm and cumulative feedback on prescribing behavior relative to the norm (i.e., whether or not the provider is a “top performer”) through a monthly email outside of the EHR. To our knowledge, no previous study has investigated the extent to which normative information, conveyed within the EHR, can change opioid prescribing behavior, an important public health goal. By examining the comparative effectiveness of different ways of conveying and reinforcing normative information for diverse practice areas, we also address a scientifically significant research question and advance applied research in social psychology and behavioral economics. With 23 hospitals located in diverse geographic settings and using a common EHR vendor (Epic), our clinical partner, Sutter Health, provides the institutional commitments and sample sizes to deploy and test the proposed nudges in a scientifically rigorous fashion.

在此处输入文本，这是您的应用程序的新摘要信息。此部分不得超过30行文本。 项目总结/摘要 医生的阿片类药物处方做法是慢性阿片类药物使用、阿片类药物成瘾和过量死亡增加的主要上游因素。手术后阿片类药物处方是一个重要的干预目标，因为阿片类药物在手术后通常被过度处方，手术后阿片类药物处方是阿片类药物长期使用的一个风险因素，为手术后患者处方的未使用的阿片类药物是可供误用和转移的阿片类药物的重要储存库。我们研究的科学前提是社会心理学和行为经济学的研究，这些研究表明，人们受到社会认可的强烈激励，这使他们想要坚持主流的社会规范。在其他环境中，社会规范已被用于成功地影响决策，但很少在医疗保健环境中进行测试，从未应用于住院环境或在一系列条件下使用阿片类药物处方。我们提出了一项群集随机试验，以调查通过电子健康记录（EHR）中的“轻推”传达的规范信息在多大程度上可以改变手术后阿片类药物处方行为，以及当轻推关闭时，行为变化是否持续。我们将测试和比较常规护理传达和加强阿片类药物处方社会规范的不同方式，包括：（1）在处方时提供禁令规范（与国家指南相比的处方行为）;（2）提供禁令规范和相对于规范的处方行为的累积反馈（即，无论提供者是否是“最佳执行者”）通过EHR之外的每月电子邮件。据我们所知，以前没有研究调查EHR中传达的规范信息可以改变阿片类药物处方行为的程度，这是一个重要的公共卫生目标。通过研究不同的方式传达和加强规范信息的不同实践领域的比较有效性，我们还解决了一个科学上重要的研究问题，并推进了社会心理学和行为经济学的应用研究。我们的临床合作伙伴Sutter Health拥有23家位于不同地理位置的医院，并使用共同的EHR供应商（Epic），提供机构承诺和样本量，以科学严谨的方式部署和测试拟议的推动。