Postoperative Nudges to Reduce Opioid Prescribing

RAND640 enrolled

Overview

This study tests the effectiveness of two email-based behavioral nudges, one based on peer behavior and one based on best practice guidelines, in reducing excessive opioid prescriptions after surgery. It will be conducted in three surgical specialties (general surgery, orthopedic surgery, and obstetric/gynecological surgery) at 19 hospitals within one healthcare system. These specialties will each be randomized to a control group or one of two nudge groups. Each month for one year, surgeons in the nudge groups will receive emails comparing their opioid prescribing either to their peers' prescribing or to prescribing guidelines. Both types of email-based nudges are expected to reduce opioid prescribing after surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Enrollment

640

Conditions

Opioid Prescribing

Interventions

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed. Dear Dr. \[Name\], In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amounts recommended by safety guidelines for these procedures. For patient safety, Sutter Health recommends prescribing within the ranges below for these procedures. Doing so will also meet best-practice safety guidelines for post-operative opioid prescribing. We will continue to send you opioid prescribing safety reports. Sincerely, \[Signature\] \[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\]

Peer-Based (Social Norm) NudgesBEHAVIORAL

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed. Dear Dr. \[Name\], In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amount prescribed by YY% of your peers for these procedures. YY% of \[specialty\] surgeons at Sutter Health prescribe within the ranges below for these procedures. We will continue to send you opioid prescribing safety reports. Sincerely, \[Signature\] \[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\] The ranges of 5mg oxycodone tablets displayed will be the same as the ranges stipulated by the prescribing guidelines, but this nudge will not mention guidelines.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

The nudges that a surgeon in either intervention arm will receive are based on that surgeon's eligible discharge opioid prescriptions in the previous month. Eligible prescriptions meet all of the following criteria: * the patient is at least 18 years old at the date of surgery * the patient is discharged to their home * the surgical procedure has an applicable post-operative opioid prescribing guideline * the surgical procedure is the only surgical procedure performed during the patient's hospital stay * the prescription is for an opioid taken orally (tablets, capsules, or liquid solution) To avoid contamination between the intervention arms, surgeons who operate across multiple surgical specialties (defined as surgeons who performed less than 90% of their total procedures in one specialty between June 2020 and May 2021) will not be eligible.

Outcomes

Primary Outcomes

Proportion of Discharges With Opioid Prescriptions Above Prescribing Guidelines

Prescriptions will be compared to prescribing guidelines via morphine milligram equivalents (MMEs) and coded as within or above guidelines. If no opioid is prescribed at discharge, this will be coded as within guidelines.

Time frame: 12 months

Secondary Outcomes

Morphine Milligram Equivalents (MMEs) Prescribed at Discharge

Continuous measure of the total morphine milligram equivalents prescribed at discharge

Time frame: 12 months

Days' Supply of Opioids Prescribed at Discharge

Continuous variable indicating the number of days' supply of opioids prescribed at discharge

Time frame: 12 months

Proportion of Discharges Where Any Opioid Was Prescribed

Derived from a binary variable indicating whether any opioid was prescribed at discharge

Time frame: 12 months

Proportion of Patients on Opioids for Greater Than 3 Months Post-discharge

Derived from a binary variable indicating whether the patient has any opioid prescriptions between 3 and 6 months after surgery

Time frame: 3-6 months post-discharge

Number of 30-day All-cause Emergency Department Visits

Number of emergency department visits the post-operative patient has in the 30 days after the initial procedure

Time frame: 0-30 days post-discharge

Number of 30-day All-cause Hospitalizations

Number of hospital admissions the post-operative patient has in the 30 days after the initial procedure

Time frame: 0-30 days post-discharge

Proportion of Discharge Opioid Prescriptions Above Prescribing Guidelines in the Year After the Intervention Ends

Time frame: 12 months (months 13-24 of the study)

Postoperative Nudges to Reduce Opioid Prescribing

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes