Efficiency And Quality In Post-Surgical Pain Therapy After Discharge - EQUIPPED

出院后术后疼痛治疗的效率和质量 - EQUIPPED

• 批准号: 10662394
• 负责人: Karsten Bartels
• 金额: $ 39.03万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662394
• 关键词: Efficiency; Quality; Post; Surgical; Pain

Abstract Compassionate and effective pain management after surgery represents a foundation of humane medical care. Opioids still present the mainstay of post-surgical pain therapy: more than 80% of patients are prescribed opioids for use following surgery. During one year in the U.S., more than 17% of Americans fill at least one opioid prescription, and, per prescription, the average daily amount exceeded 45 milligram morphine equivalents. In addition to common side effects, serious risks of opioids include addiction, abuse, and overdose. Prescription overdose deaths contribute to more than one-third of all opioid overdose deaths and remain five-fold higher than in 1999. Over-prescription of opioids remains extremely common, with up to 90% of patients after common surgical procedures reporting leftover opioids. Unused opioids are stored in unsecured locations in 75% of cases and can create a reservoir that fuels the ongoing opioid epidemic. Most large-scale efforts, such as the CDC guidelines for prescribing opioids, have focused on chronic opioid use. There is an urgent need to increase access to high-quality, safe, and scalable interventions to reduce our reliance on opioids for effective post- surgical pain management at discharge. A diverse team with expertise in pain medicine, perioperative outcomes, clinical trials, biostatistics, and health economics has been assembled to conduct the Efficiency And Quality In Post-Surgical Pain Therapy After Discharge “EQUIPPED” study. Our central hypothesis is that pain therapy after surgery can and should be prescribed in a safer, patient-centered fashion, as opposed to current “one-size-fits- all” methods. To test this hypothesis, three aims are proposed: Specific Aim 1 will test a provider-facing EHR- based decision support tool that suggests outpatient opioid prescriptions based on inpatient opioid requirements. This aim will utilize a pragmatic randomized cluster multiple crossover controlled trial design in about 39,000 patients in four hospitals. Specific Aim 2 will test a patient-facing health informatics app that encourages non- opioid pain management strategies. This aim employs a randomized controlled trial design in 600 surgical patients. Two separate clinical trials are proposed because of different outcomes (amount of opioids prescribed vs. opioids used) and scopes of implementation (multisite vs. single site). The provider-facing tool will be incorporated into the trial of the patient-facing app using a 2x2 design that facilitates a detailed evaluation of the individual effects of these interventions, as well as any interactions when using the interventions together. Finally, Specific Aim 3 will include a cost-effectiveness analysis and compare the individual and combined cost- effectiveness of a provider-facing and a patient-facing intervention. Completion of this project will demonstrate that the amounts of opioids prescribed and opioids taken after discharge following surgery can be reduced while ensuring effective treatment of pain. Increasing access to safe, affordable, and high-quality pain therapy for surgical patients will drive the positive impact of this application, which directly addresses Special Emphasis Notice: AHRQ Announces Interest in Health Services Research to Address the Opioids Crisis (NOT-HS-18-015).

抽象的 手术后的富有同情心有效的疼痛管理代表了人类医疗的基础。 阿片类药物仍然是手术后疼痛疗法的中流tay柱：超过80％的患者被处方阿片类药物 用于手术后使用。在美国的一年中，超过17％的美国人至少填补了一个Ooid 处方，按处方，平均每日数量超过45毫克吗啡当量。 除了常见的副作用外，阿片类药物的严重风险包括成瘾，滥用和过量。处方 过量死亡导致所有阿片类药物过量死亡的三分之一以上，并且比 1999年。阿片类药物的过度处方仍然非常普遍，多达90％的患者在常见之后 报告剩余阿片类药物的手术程序。未使用的阿片类药物在75％的情况下存储在无抵押位置 并可以创建一个为正在进行的阿片类药物流行的储层。大多数大规模的努力，例如CDC 处方阿片类药物的指南已重点介绍慢性阿片类药物的使用。迫切需要增加 获得高质量，安全和可扩展的干预措施，以减少我们对阿片类药物的保留率，以有效 出院时的手术疼痛管理。一支拥有疼痛医学专家的潜水团队，时期成果， 已经组装了临床试验，生物统计学和健康经济学以进行效率和质量 出院后的手术后疼痛疗法。我们的中心假设是之后的疼痛疗法 手术可以并且应该以更安全，以患者为中心的方式进行处方 所有“方法”。为了检验这一假设，提出了三个目的：特定目标1将测试面向提供商的EHR- 基于基于住院阿片类药物要求的门诊阿片类药物处方的基于决策支持工具。 这个目标将利用大约39,000的务实的随机群集多重交叉控制试验设计 四家医院的患者。具体目标2将测试面向患者的健康信息应用程序，以鼓励非 - Oopioid疼痛管理策略。此目标在600手术中采用随机对照试验设计 患者。提出了两个单独的临床试验，因为结果不同（规定的阿片类药物量） 与所使用的OIOID相比）和实施范围（多站点与单个站点）。面向提供商的工具将是 使用2x2设计纳入了面向患者的应用程序的试验，该设计有助于详细评估 这些干预措施的个人影响以及一起使用干预措施时的任何相互作用。最后， 特定目标3将包括成本效益分析，并比较个人和组合成本 - 面向提供者和面向患者的干预的有效性。该项目的完成将证明 可以减少手术后出院后处方的阿片类药物和阿片类药物的数量，同时还可以减少 确保有效治疗疼痛。增加获得安全，负担得起和高质量的疼痛疗法的机会 外科患者将推动该应用的积极影响，该应用程序直接解决了特殊重点 注意：AHRQ宣布对卫生服务研究的兴趣解决阿片类药物危机（NOT-HS-18-015）。

项目成果

Perioperative Quality Improvement: Opportunities and Challenges for Pragmatic Trial Designs.

围手术期质量改进：务实试验设计的机遇和挑战。

• DOI: 10.1213/ane.0000000000006838
• 发表时间: 2024
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Bartels,Karsten;Conroy,JoanneM;Gan,TongJ
• 通讯作者: Gan,TongJ

Modulating the Cardiac Autonomic Nervous System: Stay Close to My Heart or Keep Your Distance?

调节心脏自主神经系统：靠近我的心还是保持距离？

• DOI: 10.1097/aln.0000000000004529
• 发表时间: 2023
• 期刊: Anesthesiology
• 影响因子: 8.8
• 作者: Bartels,Karsten;Fox,AmandaA
• 通讯作者: Fox,AmandaA

Meeting Report: First Cardiovascular Outcomes Research in Perioperative Medicine Conference.

会议报告：首届围手术期医学心血管结果研究会议。

• DOI: 10.1213/ane.0000000000006248
• 发表时间: 2023
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Bartels,Karsten;Howard-Quijano,Kimberly;Prin,Meghan;Shaefi,Shahzad;Steppan,Jochen;Sun,EricC;Williams,Brittney;Fox,AmandaA;Namuyonga,Judith;Shaw,AndrewD;Vavilala,MonicaS;Sessler,DanielI
• 通讯作者: Sessler,DanielI

Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): A Cluster Randomized Multiple Crossover Trial.

通过住院患者阿片类药物摄入量来减少手术后阿片类药物处方的最佳实践警报（之前）：集群随机多次交叉试验。

• DOI: 10.1097/aln.0000000000004607
• 发表时间: 2023
• 期刊: Anesthesiology
• 影响因子: 8.8
• 作者: Rolfzen,MeganL;Wick,Abraham;Mascha,EdwardJ;Shah,Karan;Krause,Martin;Fernandez-Bustamante,Ana;Kutner,JeanS;Ho,PMichael;Sessler,DanielI;Bartels,Karsten
• 通讯作者: Bartels,Karsten

Risk Scores to Improve Quality and Realize Health Economic Gains in Perioperative Care.

• DOI: 10.1213/ane.0000000000005563
• 发表时间: 2021-09-01
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7