Using Default Opioid Prescription Settings to Limit Excessive Opioid Prescribing to Adolescents and Young Adults

项目总结/摘要 候选人：Kao-Ping Chua，医学博士，博士，是一名普通儿科医生和卫生服务研究人员，旨在 成为儿童和年轻人适当阿片类药物处方的国家领导者。 研究背景：青少年和年轻人的处方阿片类药物使用率最高 任何年龄组的滥用和先前处方的剩余阿片类药物是这种滥用的关键驱动因素。 因此，确保阿片类药物处方的数量符合青少年的需求至关重要， 年轻人该提案将使用默认阿片类药物试行基于电子健康记录的干预措施 处方设置，以限制对青少年和年轻人过度使用阿片类药物， 扁桃体切除术和/或腺样体切除术（切除扁桃体和/或腺样体），这是常见的手术 与阿片类药物处方的高比率和数量有关。在初步研究中，默认设置为 根据基线患者报告的术后阿片类药物消费数据， 这些设置反映患者需求的可能性。 具体目的：1）在以下人群中使用默认阿片类药物处方设置进行行为干预试验： 在密歇根大学接受扁桃体切除术和/或腺样体切除术的青少年和年轻人; 2） 通过评估提供者在默认设置方面的经验，改进干预措施，以便将来进行研究;以及 3)确定默认设置干预措施的其他高优先级程序和条件。 研究计划：Chua博士将使用默认阿片类药物处方设置设计和实施干预措施 对于青少年和年轻的成年人进行扁桃体切除术和/或腺样体切除术， 密歇根Chua博士将使用中断的时间序列分析来评估干预对患者的影响。 初始术后阿片类药物处方的给药和患者报告的结局，此外， 采访提供者，评估他们的干预经验。以确定其他潜在目标 对于未来的R 01赠款中的默认设置干预措施，蔡博士将分析青少年的索赔， 由密歇根州蓝十字蓝盾和密歇根州医疗补助保险的年轻人，以确定其他 阿片类药物处方率和数量高的程序和条件。 职业发展计划：蔡博士将在1）定性和混合方法研究; 2） 实施研究;和3）阿片类药物处方和药物滥用。他的职业发展将是 通过密切的指导，先进的课程，和研究会议/研讨会的支持。 环境：密歇根大学为蔡博士提供了理想的环境， 他的成功得益于知名导师和跨学科机构的出色指导。

PROJECT SUMMARY / ABSTRACT Candidate: Kao-Ping Chua, MD, PhD, is a general pediatrician and health services researcher who aims to become a national leader in appropriate opioid prescribing to children and young adults. Research Context: Adolescents and young adults collectively have the highest rates of prescription opioid misuse of any age group, and leftover opioids from prior prescriptions are a key driver of this misuse. Therefore, it is crucial to ensure that quantities in opioid prescriptions match the needs of adolescents and young adults. This proposal will pilot an electronic health record-based intervention using default opioid prescription settings to limit excessive opioid prescribing to adolescents and young adults undergoing tonsillectomy and/or adenoidectomy (removal of the tonsils and/or adenoids), which are common surgeries associated with high rates and quantities of opioid prescribing. In the pilot study, the default settings will be informed by data on baseline patient-reported post-operative opioid consumption, thereby increasing the likelihood that these settings reflect patient need. Specific Aims: 1) To pilot a behavioral intervention using default opioid prescription settings among adolescents and young adults undergoing tonsillectomy and/or adenoidectomy at the University of Michigan; 2) To refine the intervention for future research by assessing providers’ experiences with the default settings; and 3) To identify additional high-priority procedures and conditions for default setting interventions. Research Plan: Dr. Chua will design and implement an intervention using default opioid prescription settings for adolescents and young adults undergoing tonsillectomy and/or adenoidectomy at the University of Michigan. Dr. Chua will use an interrupted time series analysis to evaluate the effect of the intervention on the dosing of the initial post-operative opioid prescription and patient-reported outcomes, and will additionally interview providers to assess their experiences with the intervention. To determine additional potential targets for future default setting interventions in an R01 grant, Dr. Chua will analyze claims from adolescents and young adults insured by Blue Cross Blue Shield of Michigan and Michigan Medicaid to identify other procedures and conditions with high rates and quantities of opioid prescribing. Career Development Plan: Dr. Chua will develop expertise in 1) Qualitative and mixed methods research; 2) Implementation research; and 3) Opioid prescribing and substance misuse. His career development will be supported by close mentorship, advanced coursework, and research meetings/seminars. Environment: The University of Michigan offers the ideal environment for Dr. Chua to pursue this training, with the outstanding guidance of well-established mentors and interdisciplinary institutes dedicated to his success.