oPIOIDS: Prevention of Iatrogenic Opioid Dependence after Surgery

项目总结 在美国，与处方阿片类药物相关的发病率和死亡率正在加速。现有战略可实现 解决处方类阿片滥用主要针对慢性阿片依赖的下游影响，如 非医疗处方类阿片类药物和海洛因滥用。然而，确定导致新阿片类药物的因素 阿片类药物幼稚患者的依赖是减少处方阿片类药物依赖和 无意中转移视线。在美国，大多数依赖阿片类药物的人都会收到 他们在手术(择期手术、急诊手术和创伤)后的第一个阿片类药物处方； 然而，目前还没有临床指南来指导术后适当的阿片类药物使用。[我们假设 可测量的患者因素将预测术后阿片类药物使用量的增加，而且大多数患者将 被处方的阿片类药物远远超过他们的需要]。我们进一步假设，目前的阿片类药物处方 模式与患者报告的疼痛没有很好的相关性，并且是基于外科医生的经验和 偏好。[在这种情况下，向提供者提供有关阿片类药物的个性化数据的干预 与患者报告的阿片类药物相结合的处方和消费(如类型、药片数量、补充量) 消费将减少不适当的阿片类药物处方和转移到非预期用户。在这个混杂的- 方法研究中，我们将考察与术后疼痛和阿片类药物相关的患者因素。 在一组接受五种常见的选择性腹部手术的患者中消耗。] [此外，我们将确定导致术后阿片类药物变化的提供者特征 处方实践，并将设计和实施提供者指导的干预措施，以优化术后 阿片类药物处方。为了做到这一点，我们将利用密歇根外科质量的现有基础设施 协作计划，由73家医院组成的全州联盟，由蓝十字和蓝盾资助 (密歇根的BCBS)。]这项由临床医生主导的协作性质量改进计划几乎涉及所有供应商 世卫组织在进行大型住院普通外科和血管外科手术时有一个坚固的框架，配备有 收集详细的临床信息，确定最佳实践和改进机会，并迅速 传播质量倡议。这项多方面、以人群为基础的研究结果将告知患者和 关于手术后阿片类药物依赖的风险，并将建立以患者为中心的数据 基础设施，就适当的阿片类药物处方做法向提供者提供持续反馈。 随着处方类阿片流行的加剧，预防新的阿片依赖的战略具有最大的意义 有可能减少阿片类药物相关的发病率和死亡率。这项为期5年的计划将产生必要的 提供有关有效和适当的术后疼痛管理指南的证据，并将 确定降低手术后医源性阿片类药物依赖风险和患病率的机会 将处方阿片类药物转移给非预期使用者。

PROJECT SUMMARY Morbidity and mortality related to prescription opioids is accelerating in the United States. Existing strategies to address prescription opioid misuse primarily target the downstream effects of chronic opioid dependence, such as non-medical prescription opioid and heroin abuse. However, identifying the factors that lead to new opioid dependence among opioid naïve patients is a critical opportunity to reduce prescription opioid dependence and unintended diversion. In the United States, the majority of individuals who become opioid dependent receive their first opioid prescription following surgical procedures (elective surgery, emergent surgery, and trauma); yet, there are no clinical guidelines to inform appropriate postoperative opioid use. [We hypothesize that measurable patient factors will predict increased postoperative opioid consumption and that most patients will be prescribed opioids far in excess of their needs]. We further hypothesize that current opioid prescribing patterns do not correlate well with patient-reported pain, and are predicated upon surgeon experience and preferences. [In this context, an intervention that provides personalized data to providers regarding opioid prescribing and consumption (e.g. type, number of pills, refills) coupled with patient-reported opioid consumption will reduce inappropriate opioid prescriptions and diversion to unintended users. In this mixed- methods study, we will examine the patient factors that are associated with postoperative pain and opioid consumption among a cohort of patients undergoing five common, elective, abdominal procedures.] [Additionally, we will identify the provider characteristics that underlie the variation in postoperative opioid prescribing practices, and will design and implement a provider-directed intervention to optimize postoperative opioid prescribing. To do this, we will leverage the existing infrastructure of the Michigan Surgical Quality Collaborative program, a state-wide consortium of 73 hospitals that is funded by Blue Cross and Blue Shield (BCBS) of Michigan.] This clinician-led collaborative quality improvement program engages nearly all providers who perform major inpatient general and vascular surgery procedures with a robust framework equipped to collect detailed clinical information, identify best practices and opportunities for improvement, and rapidly disseminate quality initiatives. Findings from this multifaceted, population-based study will inform patients and providers regarding the risk of opioid dependence following surgery, and will establish a patient-centered data infrastructure that yields continuous feedback to providers regarding appropriate opioid prescribing practices. As the prescription opioid epidemic intensifies, strategies to prevent new opioid dependence have the greatest potential to reduce opioid-associated morbidity and mortality. This 5-year project will derive the necessary evidence to inform guidelines regarding effective and appropriate postoperative pain management, and will identify opportunities to both reduce the risk of iatrogenic opioid dependence following surgery and prevalence of prescription opioid diversion to unintended users.