Clinical Practice Guidelines for Postoperative Pain in Pregnancy: Evidence, Dissemination, and Impact

项目总结 美国每年有超过400万新生儿出生，阿片类药物处方治疗急性疼痛 怀孕和分娩是常见的，也是高度可变的。指导阿片类药物处方的指南 怀孕和分娩稀少，导致处方过多，增加阿片类药物过量的风险， 上瘾、转移注意力和持续使用阿片类药物。在这项为期3年的研究中，我们将创建以证据为基础的、耐心的 支持孕妇分娩期间急性术后疼痛管理的中心指南 还有手术。我们会研究在临床和病人方面实施这些指引的成效。 在一个由68家医院组成的大型全州联盟中报告了合作质量的结果 密歇根州的改进计划。我们将召集一个由患者、提供者、生殖系统 正义倡导者、卫生公平专家和卫生系统领导人指导所有活动。首先，我们将使用 兰德/加州大学洛杉矶分校将系统性文献审查与专家意见相结合的适当性方法 创建面向提供者和患者的指南，指导阿片类药物处方，整合阿片类药物替代品和 对特殊人群的考虑(高危妊娠、合并症、先前的阿片类药物暴露、 阿片类药物和药物使用障碍)，并包括促进健康公平和患者- 居中(阶段1)。我们将为中央人民政府的传播和实施制定有针对性的战略，使用 国家和设施一级实施科学的最新技术(第二阶段)。最后，我们会 在密歇根州的68家医院进行一项增强的非应答者随机试验，以确定 在围产期护理期间为阿片类药物处方提供信息的CPG的有效性以及创新、 医院一级的适应性实施干预措施(第三阶段)。我们的主要成果将包括 孕妇在手术和分娩期间处方阿片类药物的比率和数量。我们还将 检查患者报告的结果(例如，术后疼痛、阿片类药物使用、满意度)作为次要结果。 我们将具体审查CPG在边缘群体中的影响，以确保该指导方针 实施不会加剧术后疼痛管理方面的现有差异。我们的发现将 通过严格创建实用的、以患者为中心的指导方针，直接影响产科护理 术后阿片类药物处方是根据怀孕和分娩个人的独特需求量身定做的。 鉴于强大的协作医院系统网络为不同的怀孕人群提供服务 在密歇根州，我们的发现将为指导指南传播的最佳策略提供关键证据 并在全美范围内实施。

PROJECT SUMMARY Over 4 million births occur in the United States each year, and opioid prescribing for acute pain during pregnancy and childbirth is common and highly variable. Guidelines to direct opioid prescribing during pregnancy and birth are sparse, leading to excessive prescribing and increasing the risk of opioid overdose, addiction, diversion, and persistent opioid use. In this 3 year study, we will create evidence-based, patient- centered guidelines to support acute postoperative pain management for pregnant individuals during childbirth and surgery. We will examine the effectiveness of implementing these guidelines on clinical and patient- reported outcomes in a large, state-wide consortium of 68 hospitals within the Collaborative Quality Improvement programs in Michigan. We will convene a national panel of patients, providers, reproductive justice advocates, health equity experts, and health system leaders to guide all activities. First, we will use the RAND/UCLA Appropriateness methodology to merge a systematic literature review with expert opinion to create provider- and patient-facing guidelines that direct opioid prescribing, integrate opioid-alternatives and considerations for unique populations (high-risk pregnancies, comorbid conditions, prior opioid exposure, opioid and substance use disorders), and include best practices to promote health equity and patient- centeredness (Phase 1). We will create tailored strategies for CPG dissemination and implementation using state of the art techniques in implementation science at the national and facility level (Phase 2). Finally, we will conduct an enhanced, non-responder randomized trial across 68 hospitals in Michigan to determine the effectiveness of CPGs that inform opioid prescribing during peripartum care as well as the impact of innovative, adaptive implementation interventions at the hospital level (Phase 3). Our primary outcomes will include the rate and amount of opioid prescribed among pregnant individuals during surgery and childbirth. We will also examine patient-reported outcomes (e.g., postoperative pain, opioid use, satisfaction) as secondary outcomes. We will specifically examine the effect of CPGs across marginalized groups to ensure that guideline implementation does not exacerbate existing disparities in postoperative pain management. Our findings will directly impact obstetric care by rigorously creating pragmatic, patient-centered guidelines to direct postoperative opioid prescribing that are tailored to the unique needs of pregnant and birthing individuals. Given the robust network of Collaborative hospital systems caring for a diverse cohort of pregnant individuals in Michigan, our findings will provide critical evidence to direct optimal strategies for guideline dissemination and implementation across the United States.