Evaluation of state-mandated acute and post-surgical pain-specific CDC opioid prescribing guidelines

项目总结 2016年，处方阿片类药物过量在美国夺走了17,087人的生命，比以往任何时候都多 年。此外，美国每天都会经历1000多次急诊科就诊 处方类阿片类药物的并发症。这些不利的结果反映了美国目前的高患病率 阿片类药物处方。请注意，每年约有20%的美国成年人收到一张或多张阿片类药物处方。在……里面 2016年3月，疾病控制和预防中心(CDC)发布了国家阿片类药物处方 慢性非癌症疼痛指南，以解决阿片类药物的过度处方问题。这些指导方针包括 针对急性疼痛的具体指南建议，对于大多数急性疼痛，3天门诊处方 阿片类止痛药(OPR)应该足够，很少需要超过7天。美国疾病控制与预防中心 准则包括呼吁对准则的执行效果进行评估。2017年6月，北方 卡罗莱纳州加强阿片类药物滥用预防(STOP)法案强制疾控中心急性和后遗症指南 手术疼痛，2018年1月1日生效。该法案在立法上将首次门诊处方限制为a)≤5 用于急性疼痛的天数，以及b)用于手术后疼痛的≤7天。这项研究的总体目标是进行 北卡罗来纳州对疾控中心阿片类药物处方指南的立法授权的影响和过程评估 用于急性和手术后疼痛。其他五个州也通过了类似的法律，北卡罗来纳州(北卡罗来纳州) 为检查此阿片类药物处方指南的效果提供了最佳设置，因为NC的停止行为 处方任务与CDC阿片类药物急性疼痛处方指南最为一致。在这 研究中，我们将使用混合方法进行1)准实验影响评价和2)定性 国家疾控中心阿片类药物处方指南实施过程评价 正常对照组术后疼痛。我们将使用现有的电子健康记录数据，来自三个大型综合 北卡罗来纳州和田纳西州(田纳西州)的医疗服务系统。我们将从以下位置链接NC和TN电子健康记录 2010年至2020年到每个州的处方药监测计划和死亡记录。&gt；2中的链接数据 一百万接受阿片类药物止痛的急性疼痛和手术后疼痛患者将被用于对照研究 中断的时间序列分析。基本上，我们将进行两组政策前/后评估，其中之一 状态(NC)将用作前/后干预，而另一状态(TN)将用作控制(TN没有 类似的政策)。我们将使用潜在类别增长分析来模拟医生阿片类药物处方的异质性 国家疾病预防控制中心阿片类药物处方指南实施前后的模式。我们还将 进行流程评估，以了解多系统级别的资源、战略和合作伙伴关系 可能有助于指导方针的实施。使用Wandermann的交互系统框架，结果 从影响和过程评估将用来制定指导立法的建议 在其他州实施疾病预防控制中心的其他阿片类药物处方指南。

PROJECT SUMMARY Prescription opioid overdoses claimed 17,087 lives in the United States in 2016, more than in any previous year. In addition, the US experiences more than 1,000 emergency department visits every day from complications from prescription opioids. These adverse outcomes reflect the US's current high prevalence of opioid prescribing. Note that about 20% of the US adults receive one or more opioid prescriptions each year. In March 2016, the Centers for Disease Control and Prevention (CDC) released national opioid prescribing guidelines for chronic non-cancer pain to address the overprescribing of opioids. The guidelines include a specific guideline for acute pain recommending that for most acute pain, a prescription of 3 days of outpatient opioid pain reliever (OPR) should be sufficient and more than 7 days would rarely be needed. The CDC guidelines include a call to evaluate the effect of implementation of the guidelines. In June 2017, North Carolina's STrengthen Opioid Misuse Prevention (STOP) act mandated CDC guidelines for acute and post- surgical pain, effective January 1 2018. This act legislatively limited first outpatient OPR prescriptions to a) ≤ 5 days for acute pain, and b) ≤ 7 days for post-surgical pain. The overall goal of this study is to conduct an impact and process evaluation of North Carolina's legislative mandate of the CDC opioid prescribing guidelines for acute and post-surgical pain. While five other states have also adopted similar laws, North Carolina (NC) provides an optimal setting for examining the effect of this opioid prescribing guideline because NC's STOP act prescribing mandate is most closely aligned with the CDC opioid prescribing guideline for acute pain. In this study, we will used mixed methods to conduct 1) a quasi-experimental impact evaluation and 2) a qualitative process evaluation of the implementation of state mandated CDC opioid prescribing guideline for acute and post-surgical pain in NC. We will use existing electronic health records data from three large integrated healthcare delivery systems in NC and Tennessee (TN). We will link NC and TN electronic health records from 2010 to 2020 to each state's prescription drug monitoring program and death records. The linked data from >2 million acute and post-surgical pain patients who received opioids for pain control will be used in a comparative interrupted time series analysis. Essentially, we will conduct 2-group pre/post policy evaluation in which one state (NC) will serve as pre/post intervention and the other state (TN) will serve as control (TN does not have a similar policy). We will use latent class growth analysis to model heterogeneity in physicians' opioid prescribing patterns before and after implementation of the state-mandated CDC opioid prescribing guideline. We will also conduct a process evaluation to understand the multi-system level resources, strategies, and partnerships that may aid the implementation of the guidelines. Using Wandermann's interactive systems framework, the results from the impact and process evaluations will be used to develop recommendations to guide the legislative implementation of other CDC opioid prescribing guidelines in other states.