Safer Management of acute Pain
Right Sizing Opioid Prescriptions Following Orthopedic Surgery Using Patient-Feedback Data and Electronic Medical Record Orderset Defaults
PI: Kit Delgado, MD, MS
The goal of this quality improvement project is to right-size the duration of opioid prescriptions following orthopedic surgery by collecting baseline patient feedback data on opioid tablets taken within 7-days. We will then deploy new evidence-based prescribing guidelines by procedure using new electronic medical record ordersets with default opioid quantities.
Using Default Options to Decrease Opioid Prescribing Durations
PI: Amol Navathe, MD, PhD; Mitesh Patel, MD, MBA, MS, University of Pennsylvania
The objective of this study is to conduct a pragmatic randomized, controlled trial to evaluate the effect of two scalable behavioral economics approaches to reduce physician opioid prescribing: electronic health record (EHR) default option for the number of pills per opioid prescription and providing monthly social comparison feedback to physicians on opioid prescribing patterns. We will compare EHR default options and social comparison feedback individually and in combination.
A scalable, patient-centered approach for “right-sizing” opioid prescribing.
PI: Kit Delgado, MD, MS; Anish Agarwal, MD, MPH; Zarina Ali, MD, MS, University of Pennsylvania
The objective of this study is to build upon prior telephone follow up and understand the ability of translating it to an automated bi-directional text messaging interface. We will integrate with, and expand upon, the ERAP Program to work across surgical specialties (orthopedics, sports medicine, neurosurgery) and emergency medicine.
Funded by NHLBI, NIDA, and NICHD
Several policymakers have suggested that the Affordable Care Act (ACA) has fueled the opioid epidemic by subsidizing opioid pain medications. Our objective was to determine the effect of the ACA’s young adult dependent coverage insurance expansion on emergency department (ED) encounters and out-of-hospital deaths from opioid overdose. Our findings do not support claims that the ACA has fueled the prescription opioid epidemic.
Funded by the Leonard Davis Institute
Curbing excessive prescribing is part of a multipronged strategy for combating the opioid epidemic. Although prescribing limits seem like a commonsense approach to reducing exposure, adoption of these policies is outpacing the evidence. We do not yet know whether mandating a duration of 3 versus 5 versus 7 days meaningfully reduces either the amount of opioid supplied or the incidence of long-term use. Evaluation of existing prescribing limits is needed to determine whether they achieve the intended goals while minimizing unintended consequences.
Funded by NIDA and the NICHD
We describe the variation in emergency department (ED) opioid prescribing for a common minor injury, ankle sprain, and determine the association between initial opioid prescription intensity and transition to prolonged opioid use.Opioid prescribing for ED patients treated for ankle sprains is common and highly variable. Although infrequent in this population, prescriptions greater than 225 MME were associated with higher rates of prolonged opioid use. This is concerning because these prescriptions could still fall within 5- or 7-day supply limit policies aimed at promoting safer opioid prescribing.
Funded by NIDA and the NICHD
Under Dr. Delgado, this study evaluated the effect of prescribing behavior associated with the implementation of an EMR opioid default supply quantity. The 41 weeks of EMR data in two Philadelphia hospitals were used to test for differences in the mean and median number of tablets supplied per week and to determine differences in proportions of prescription quantities. Results supported that a lower-than-baseline default opioid quantity for acute pain is potentially a widely scalable approach for changing prescribing behavior, while still preserving clinician autonomy.