Safe Opioid Prescription Practice

描述（由申请人提供）：给创伤住院出院的受伤患者开阿片类药物处方几乎无处不在；然而，高达26%的慢性疼痛患者滥用阿片类药物，使他们过量服用和过量死亡的风险增加。通过涉及患者和提供者的机构级方法解决这一问题，包括改变医生处方行为和直接干预患者以增加对阿片类药物滥用和过量风险的认识，为我们提供了解决这一不断升级的公共卫生问题的最佳机会。采用准实验设计，我们将比较一级创伤服务团队与一级创伤服务团队实施标准护理相比，采用和实施安全阿片类药物处方实践（SOPP）协议的效果。两个站点的提供者将完成基于网络的调查，以评估与安全处方实践相关的基线知识、态度和障碍。干预现场将以完成技术援助活动为主导

DESCRIPTION (provided by applicant): Prescribing opioids to injured patients who are discharged from an inpatient trauma admission is almost ubiquitous; however up to 26% of patients prescribed opioids for chronic pain abuse them leaving them at an increased risk of overdose and overdose fatality. Addressing this problem through an institutional level approach involving both patients and providers, including changes in physician prescription behaviors and directly intervening with the patients to increase knowledge of risks of opioid misuse and overdose, affords us the best opportunity to address this escalating public health concern. Using a quasi-experimental design we will compare the effect of adopting and implementing a Safe Opioid Prescription Practice (SOPP) protocol within a Level 1 trauma service team compared to a Level 1 trauma service team implementing standard care. Providers at both sites will complete web-based surveys to assess baseline knowledge, attitudes and barriers related to safe prescription practices. The intervention site will complete technical assistance activities to lead to the adoption and implementation of a SOPP protocol. The control site will continue to offer standard care to trauma patients throughout all phases. To measure institutional level changes, chart reviews will be conducted at both sites using a blinded medical review of discharged trauma service patients at baseline, early implementation, implementation and maintenance phases. To measure patient level changes, we will assess patient perception of the discharge experience at both sites during the adoption phase (Cohort 1=100); implementation phase (Cohort 2=100) and maintenance phase (Cohort 3=100) via telephone interview within 7 days post discharge. Three month interviews will also be conducted with Cohort 2 to assess patient opioid usage, pain management strategies and Naloxone usage among Cohort 2. The aims of the proposed research study are to 1) examine and measure the adoption, implementation and maintenance of the SOPP protocol in the intervention site compared to standard care site and 2) to assess patient level outcomes of the SOPP protocol. The secondary aim of this study is to assess the effect the SOPP protocol on provider prescribing practices comparing the average dosage (in morphine milligram equivalents) and duration of dose from the chart review at baseline to the early implementation, implementation and maintenance phases of the study. The findings from this study will allow us to better understand the translation of a safe opioid prescription practice and has the potential to impact best practices for patient discharge within Level 1 trauma centers.