Acute Pain
Conditions
Keywords
Opioids, Nudges, Emergency Medicine, Urgent Care, Feedback
Brief summary
In this study, the investigators will evaluate the effect of a health system initiative aiming to change clinician opioid prescribing behaviors using two behavioral economic interventions - individual audit feedback and peer comparison feedback of clinicians.
Detailed description
Opioid-related abuse and overdose represent a growing national epidemic in the United States. Clinician practice patterns play an important role: opioid prescriptions impact the likelihood that patients will misuse or become dependent on these medications, with longer prescriptions leading to greater sustained use. In this study, we will evaluate a Sutter Health System quality improvement initiative using monthly individual audit feedback and/or monthly peer comparison feedback to clinicians to change opioid prescribing patterns. In partnership with Sutter Health System, this will be conducted using randomization to evaluate its effect. We will also conduct a process evaluation to understand factors associated with better or worse performance at the clinician level.
Interventions
BEHAVIORALIndividual audit feedback
Practice sites randomly assigned to have individual audit feedback will be sent information by email to each clinician at the site each month for the duration of the intervention period. The email will inform the clinician that the health system is doing monthly audits and provide them the number of patients in the last month for whom they prescribed 30 opioid pills per prescription or higher.
BEHAVIORALPeer comparison feedback
Practice sites randomly assigned to have peer comparison feedback will be sent information by email to each clinician at the site each month for the duration of the intervention period. Data on the mean number of opioid pills per prescription and the proportion of visits with an opioid prescription will be delivered using a 3-month rolling average as follows: a) If clinician is above median: informed how their data compares to the median; b) If clinician is below median but above 10th percentile: informed how their data compares to the 10th percentile; c) If clinician is 10th percentile or below: informed of their data and commended for being a low prescriber.
Sponsors
Donaghue Medical Research Foundation
Sutter Health
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Clinicians 1\. Practiced primarily at participating emergency department or urgent care center * Patients 1. Presented to a participating emergency department or urgent care center during the study period 2. Discharged to home from the visit
Exclusion criteria
* Clinicians 1. Saw less than 100 patients in the prior year 2. Practiced primarily at another site that is not in the main trial 3. Did not practice at Sutter Health in the prior 90 days * Patients 1. Currently pregnant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in the mean number of pills per opioid prescription | Six months | The primary outcome is the change in the mean number of pills prescribed per opioid prescription from baseline to the intervention period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in proportion of patient visits with an opioid prescription | Six months | The secondary outcome is the change in proportion of patient visits in which an opioid is prescribed from baseline to the intervention period. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in morphine milligram equivalents per opioid prescription | Six months | The change in morphine milligram equivalents per opioid prescription from baseline to the intervention period. |
| Change in mean number of opioid pills per patient-visit | Six months | The change in the mean number of opioid pills per patient-visit from baseline to the intervention period. |
| Change in proportion of patient-visits with non-opioid pain prescription | Six months | The change in proportion of patient-visits with non-opioid pain prescriptions (e.g., ibuprofen, acetaminophen, celecoxib, or muscle relaxants such as cyclobenzaprine, baclofen or tizanidine) from baseline to the intervention period. |
Countries
United States
Outcome results
None listed