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

项目摘要/摘要 候选人：蔡高平，医学博士，普通儿科医生和卫生服务研究员，目标是 在儿童和年轻人的适当阿片类药物处方方面成为全国领先者。 研究背景：青少年和年轻人的处方阿片类药物使用率最高 滥用任何年龄组，以及先前处方中遗留的阿片类药物是这种滥用的关键驱动因素。 因此，至关重要的是确保阿片类药物处方的数量符合青少年和 年轻人。这项提案将试点使用默认阿片类药物的基于电子健康记录的干预 处方设置，以限制过量阿片类药物处方给青少年和正在接受 扁桃体切除和/或腺样体切除(扁桃体和/或腺样体切除)，这是常见的手术 与高比率和高数量的阿片类药物处方有关。在试点研究中，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，从而增加 这些设置可能反映了患者的需求。 具体目标：1)使用以下默认阿片类药物处方设置试点行为干预 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下的体验来完善未来研究的干预措施；以及 3)确定默认设置干预的其他高优先级程序和条件。 研究计划：蔡博士将使用默认的阿片类药物处方设置设计和实施干预 适用于在加州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 密歇根州。蔡博士将使用中断的时间序列分析来评估干预对 手术后初始阿片类药物处方的剂量和患者报告的结果，并将另外 访谈提供者以评估他们在干预方面的经验。确定其他潜在目标 对于未来R01拨款中的默认设置干预，蔡博士将分析青少年和 由密歇根蓝十字蓝盾和密歇根医疗补助保险的年轻人识别其他 阿片类药物处方使用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方面发展专长；2) 实施研究；3)阿片类药物处方和药物滥用。他的职业发展将是 在密切的指导、高级课程和研究会议/研讨会的支持下。 环境：密歇根大学为蔡博士继续进行这项培训提供了理想的环境， 著名导师和致力于他成功的跨学科机构的杰出指导。

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.