Pain is a symptom that drives hospital admissions, and pain management is required by most patients during their hospital stay. Further, the use of medications such as opioids can lead to upward-spiraling doses, especially among chronic pain patients whose resource utilization rates are high. Many initiatives aim to reduce the costs of these "high-resource utilizing" patients. One exciting aspect of improving the management of pain is that this may help prevent patients from ever becoming high-cost in the first place. The purpose of this study is to examine the impacts of an early and sustained intervention pathway, in comparison to the current standard of care, for the treatment of pain in opioid tolerant patients. It is hypothesized that patients randomized to the intervention pathway, in comparison to the control, will lead to decreased costs of care, a reduction in opioid usage within 3 and 6 months, and decrease in hospital readmission rates.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
60
University of California, Irvine Medical Center
Orange, California, United States
Duke University Medical Center
Durham, North Carolina, United States
Returns to Acute Care
Hospital Readmissions and Emergency Department Utilizations
Time frame: Discharge through 90 days post-discharge
Opioid Analgesic Use
Quantification of opioid analgesic use over time
Time frame: Discharge through 90 days post-discharge
Opioid Analgesic Use
Quantification of opioid analgesic use over time
Time frame: Admission through 12 months post-discharge
Opioid Tolerance Status
Opioid tolerance as inferred from opioid prescription and usage per FDA exposure threshold definition for opioid tolerance.
Time frame: Admission through 12 months post-discharge
Pain at Discharge
Patient-reported pain at the time of discharge from index hospitalization
Time frame: Measured upon day of discharge from index hospitalization; up to 18 months from the date of randomization
Hospital Length of Stay
Duration of index inpatient hospitalization.
Time frame: Measured upon day of discharge from index hospitalization; up to 18 months from the date of randomization
Latency to Hospital Readmission
Time between discharge from index hospitalization to readmission
Time frame: Discharge through 12 months post-discharge
Returns to Acute Care
Hospital Readmissions and Emergency Department Utilizations at an extended time horizon
Time frame: Discharge through 12 months post-discharge
Healthcare Expenditures
Inpatient and outpatients costs
Time frame: Admission through 12 months post-discharge
Use of Rescue Drugs
Antagonist usages for the reversal of index drug effects (opioid and benzodiazepine)
Time frame: Admission through 12 months post-discharge
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