Engaging rural surgeons to enhance opioid stewardship

项目总结/摘要 2018年，超过46，000人死于阿片类药物过量，另有1140万人滥用处方 阿片类药物。这导致宣布国家公共卫生紧急状态，以解决阿片类药物危机。过量 包括外科医生在内的医疗保健提供者开出的阿片类药物处方在当前的流行病中发挥了重要作用。 针对手术人群中阿片类药物处方的干预措施仅取得了适度的结果， 专门为农村外科病人设计的。农村健康差距加剧了 农村手术患者的阿片类药物流行病，需要在这方面开发新的干预措施。 人口该项目将描述导致农村地区过量阿片类药物处方的独特因素 手术患者和适应多方面的干预，以减少过度处方。 该项目提出了以下目标：1）确定与阿片类药物相关的患者，外科医生和系统因素 在农村环境中进行手术后处方，2）描述外科医生和患者对因素的感知 与农村外科医生围手术期阿片类药物处方相关，3）适应和试点测试行为 改善农村外科医生阿片类药物管理的干预措施。通过指导研究和职业生涯 发展活动，Borza博士将准备作为一个独立的卫生服务研究员的职业生涯 通过开发、评估和传播 为手术质量、实践模式和政策评估提供信息的定制干预和研究。他将 获得以下方面的专业知识：1）农村外科的绩效评估，2）定性设计和分析，3） 干预措施的设计和开发，以及4）负责任的研究行为。 作为一名拥有医疗保健研究硕士学位的外科医生，Borza博士是唯一有资格进行这项工作的人。 工作该提案解决了教育和职业发展方面的差距，这对确保独立至关重要。 通过多学科指导方案提供资金，专家在绩效衡量、农村卫生、 药物滥用、定性研究、干预措施的设计和发展以及质量改进， 外科合作他得到了威斯康星州大学强大的研究基础设施的支持， 泌尿外科在国立卫生研究院的资助中排名第十二， 外科威斯康星州外科结果研究计划促进健康的合作和成功 服务研究人员和威斯康星州的外科协作提供了一个完善的，参与网络 的外科医生。在解决农村外科医生过量的阿片类药物处方方面，该奖项满足了公众的迫切需求。 在提供教育和指导研究经验的同时， 这对Borza博士发展成为全国农村外科质量和独立健康的领导者至关重要 服务研究员。

PROJECT SUMMARY/ABSTRACT Over 46,000 people died from opioid overdose in 2018 and an additional 11.4 million abused prescription opioids. This led to the declaration of a national public health emergency to address the opioid crisis. Excess opioid prescribing by healthcare providers, including surgeons, has played a major role in the current epidemic. Interventions targeting opioid prescribing in surgical populations have had only modest results, with none of these specifically designed for rural surgical patients. Rural health disparities compound the complexity of the opioid epidemic for rural surgical patients, necessitating the development of novel interventions in this population. This project will characterize unique factors contributing to excess opioid prescribing in rural surgical patients and adapt a multifaceted intervention to decrease excess prescribing. The project proposes the following aims: 1) Identify patient, surgeon and system factors associated with opioid prescribing following surgery in rural settings, 2) Characterize surgeon and patient perceptions of factors associated with perioperative opioid prescribing among rural surgeons, and 3) Adapt and pilot-test a behavioral intervention to improve opioid stewardship in rural surgeons. Through mentored research and career development activities, Dr. Borza will prepare for a career as an independent health services researcher focused on improving quality of care in rural surgery through the development, evaluation and dissemination of tailored interventions and research informing surgical quality, practice patterns and policy evaluations. He will acquire expertise in 1) performance measurement in rural surgery, 2) qualitative design and analysis, 3) intervention design and development, and 4) responsible conduct of research. As a surgeon with a Master’s degree in Healthcare Research, Dr. Borza is uniquely qualified to conduct this work. This proposal addresses educational and career development gaps critical to securing independent funding through a multidisciplinary mentored program with experts in performance measurement, rural health, substance abuse, qualitative research, intervention design and development and quality improvement through surgical collaboratives. He is supported by the robust research infrastructure at the University of Wisconsin, where the Department of Urology ranks twelfth in National Institutes of Health funding, the Department of Surgery Wisconsin Surgical Outcomes Research Program promotes the collaboration and success of health services researchers and the Surgical Collaborative of Wisconsin offers a well-established, engaged network of surgeons. In addressing excess opioid prescribing by rural surgeons, this award meets an urgent public health need in an underserved population while affording the education and mentored research experience critical for Dr. Borza’s development into a national leader on rural surgical quality and independent health services researcher.