The Relationship Between Postoperative Prescriber Networks and Opioid Prescribing Discoordination

术后处方者网络与阿片类药物处方不协调之间的关系

• 批准号: 10700876
• 负责人: Elizabeth Nilsen
• 金额: $ 5.27万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10700876
• 关键词: Accidents; Acute pain management; Affect; Attention; Benchmarking; Benzodiazepines; Caring; Characteristics; Chronic; Clinical; Clinical Skills; Communication; Complement; Credentialing; Development; Dose; Drug Prescriptions; Electronic Health Record; Event; Fellowship; Goals; Guidelines; Health Personnel; Health Policy; Health Services Research; Healthcare Systems; Individual; Insurance Carriers; Literature; Logistic Regressions; Longterm Follow-up; Measures; Mentorship; Methodology; Modeling; Morphine; National Institute of Drug Abuse; Network-based; Nurses; Operative Surgical Procedures; Opioid; Outcome; Outpatients; Overdose; Pain; Pain management; Pathway Analysis; Patients; Pharmacy facility; Poisoning; Policy Maker; Postdoctoral Fellow; Postoperative Care; Postoperative Period; Procedures; Provider; Recommendation; Reporting; Research; Research Personnel; Research Proposals; Risk; Role; Sampling; Scientist; Secure; Social Network; Specialist; Structure; Substance Use Disorder; Surgeon; Training; Trauma; United States; Vulnerable Populations; Weight; Work; acute care; adverse outcome; chronic pain; cohort; comorbidity; density; electronic health system; evidence base; high risk; interoperability; medical specialties; milligram; novel; opioid therapy; opioid use; overdose death; policy recommendation; prescription opioid; reduced substance use; risk mitigation; severe mental illness; skill acquisition; skills

Following common surgical procedures, nearly all patients in the United States will be prescribed an opioid. Although these are intended for short-term use, a growing body of literature is demonstrating that a significant portion of patients will continue to use opioids for greater than three months following their procedure, increasing the risk for opioid-related harm. To mitigate this risk, the CDC Guidelines for Prescribing Opioids for Chronic Pain recommend providers only prescribe cumulative doses greater than 90 morphine milligram equivalents (MME)/day with careful justification and avoiding concurrent opioid and benzodiazepine prescriptions. However, patients are more likely to exceed the 90 MME/day benchmark through discoordinated prescribing from multiple prescribers than single high-dose prescriptions. With a high likelihood of receiving an opioid prescription following a surgical procedure, postoperative opioid prescribing may be unintentionally contributing to opioid-related harm, especially for vulnerable populations such as those with a serious mental illness (SMI), a substance use disorder (SUD), or with chronic prescription opioid use. To date, most research has focused on initial postoperative opioid prescribing, with little attention to the role of prescribing discoordination (i.e. prescribing in accordance with CDC guideline recommendations) between outpatient and surgical providers. Prescribers may be able to more effectively coordinate prescriptions if they are more connected (i.e. have shared clinical attributes such as shared patients, patient referrals, or practice within the same provider group). For example, a pain management specialist who shares a practice with a surgeon may be able to more easily view current prescriptions (via direct communication or the electronic health record) and can plan ongoing therapy accordingly. Social network analysis (SNA) is a quantitative approach that identifies and measures connections between prescribers. These connections are quantified and used to calculate network measures that describe each network. Using claims from a single nation-wide commercial insurer, the goal of this study is to (1) build and characterize patient-prescriber networks of patients undergoing surgery, and (2) identify network and prescriber characteristics associated with prescribing discoordination. Policy makers and healthcare providers can use these findings to target policy recommendations that would enhance prescriber connection, such as changes to reimbursement structures and enhanced interoperability of electronic health systems. Activities directed under this fellowship will provide the applicant with methodologic skills in SNA, clinical skills in the care and management of patients in the acute care settings, and professional development skills to facilitate new clinical and research partnerships. The applicant has curated a mentorship team with expertise in these domains to enable her development as an independent nurse scientist.

经过常见的外科手术后，几乎所有美国患者都会接受处方治疗 阿片类药物。尽管这些都是为了短期使用，但越来越多的文献表明， 很大一部分患者在治疗后将继续使用阿片类药物超过三个月 程序，增加阿片类药物相关伤害的风险。为了减轻这种风险，CDC 处方指南 用于治疗慢性疼痛的阿片类药物建议提供者仅开出累积剂量大于 90 吗啡的处方 毫克当量 (MME)/天，并仔细论证并避免同时使用阿片类药物和苯二氮卓类药物 处方。然而，患者更有可能因不协调而超过 90 MME/天基准。 与单一高剂量处方相比，多个处方者开出的处方更有效。收到的可能性很大 手术后阿片类药物处方，术后阿片类药物处方可能是无意的 造成与阿片类药物相关的伤害，特别是对于弱势群体，例如患有严重精神疾病的人 疾病 (SMI)、物质使用障碍 (SUD) 或长期使用处方阿片类药物。 迄今为止，大多数研究都集中在术后最初的阿片类药物处方上，而很少关注术后的阿片类药物处方。 处方不协调的作用（即根据 CDC 指南建议进行处方） 门诊患者和手术提供者之间。处方者或许能够更有效地协调 处方，如果它们联系更紧密（即具有共享的临床属性，例如共享患者、患者 推荐，或在同一提供者组内练习）。例如，一位疼痛管理专家分享了 与外科医生一起执业可能能够更轻松地查看当前的处方（通过直接沟通或 电子健康记录），并可以相应地计划正在进行的治疗。社会网络分析（SNA）是 识别和衡量处方者之间联系的定量方法。这些连接是 量化并用于计算描述每个网络的网络度量。使用单个声明 全国性商业保险公司，本研究的目标是 (1) 建立并描述患者处方者 接受手术的患者网络，以及 (2) 确定相关的网络和处方者特征 与处方不协调。政策制定者和医疗保健提供者可以利用这些发现来制定政策 加强处方者联系的建议，例如改变报销结构 并增强电子卫生系统的互操作性。 该奖学金指导的活动将为申请人提供国民账户体系的方法技能， 急症护理环境中患者护理和管理的临床技能以及专业发展 促进新的临床和研究伙伴关系的技能。申请人组建了一个导师团队 这些领域的专业知识使她能够发展成为一名独立的护士科学家。