Aging, Surgery
Conditions
Brief summary
Over 21 million surgical procedures take place among adults aged 65 and older in the US each year, and most older surgical patients in the US now receive benzodiazepines (e.g., midazolam, lorazepam) during anesthesia care. This occurs despite recommendations to avoid these medications in older patients due to associated medical risks and lack of demonstrated benefit. In other words, routine benzodiazepine administration to older surgical patients is likely to represent low-value care that is a suitable target for de-adoption. In this study, we will evaluate a United States Anesthesia Partners (USAP, Dallas, TX) quality improvement initiative using peer comparison feedback to clinicians and/or mailed informational letters to patients as strategies to encourage physician de-adoption of routine preoperative benzodiazepine administration to older surgical patients. In partnership with USAP, this study will be conducted using randomization to evaluate its effect.
Interventions
BEHAVIORALPeer Comparison Feedback
USAP anesthesia providers will receive monthly alerts via USAP's smartphone-based practice management application, text message, or email presenting individual-level data on their benzodiazepine administration patterns versus other USAP providers, using data from the USAP clinical and quality data warehouse.
BEHAVIORALPatient Informational Letter
Breif informational letters will be distributed to eligible patients within the 2 weeks prior to surgery. Letters will be produced on USAP letterhead and signed by the USAP Chief Quality Officer. Letter text will state USAP's commitment to brain health and avoiding potentially unnecessary medications for patients undergoing surgery. It will also include a statement encouraging patients to discuss anesthesia plans with their clinicians at the time of surgery to aid tailoring of care to individual needs. Letters will be distributed directly to patients via text link, email, or hard copy as a component of standard pre-operative instructional communications and other educational and patient outreach materials related to clinical care.
Sponsors
US Anesthesia Partners
Donaghue Medical Research Foundation
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All anesthesia clinicians employed by USAP will be included in the evaluation. Patients will be included if they are at least aged 65 and undergo an elective (scheduled) surgical or endoscopic procedure under general anesthesia.
Exclusion criteria
* Patients will be excluded if they are unscheduled (urgent/emergent) cases due to inability to reliably deliver study interventions to this group; if they did not receive general anesthesia; or if they received a nerve block procedure.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Benzodiazepine administration rate | Intraoperative period | The primary outcome measure is the change in the rate of benzodiazepine administration among eligible surgical cases. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient satisfaction | Up to 30 days after surgery | Change in patient satisfaction with care, as measured by Anesthesiologist Patient Satisfaction Questionnaire Composite Satisfaction Score, Version 2 (APSQ2). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Hospital length of stay | Length of stay will be evaluated at approximately 30 days after surgery | Time from surgery to hospital discharge in days |
| Postoperative pulmonary complications | Up to 30 days after surgery | Postoperative pulmonary complications as identified by ICD-10 codes for patients undergoing hospitalization after surgery |
| Postoperative Delirium | Up to 30 days after surgery | Postoperative delirium as identified by ICD-10 codes for patients undergoing hospitalization after surgery |
Countries
United States
Outcome results
None listed