The overarching purpose of this study is to generate robust pilot data toward a future R01-level proposal that will implement a multifaceted intervention to reduce excess prescription opioids in the community. In the state of Michigan, mortality related to prescription opioids is accelerating even more rapidly than the national average and was 20% higher than the national average in recent years.11 At the University of Michigan, the Acute Care Surgery services cares for over 1,300 (1,100 trauma, 200 burn) patients each year who suffer major trauma, burn injuries, or require emergent procedures for non-elective surgical conditions (e.g., necrotizing fasciitis, intestinal perforation). In this mixed-methods study, we will examine the match between opioid prescribing and consumption after discharge, conduct a needs-assessment among providers caring for patients with major injury, and develop an intervention targeted to providers designed to align reach opioid prescribing and consumption.
Aim 1: Assess opioid prescribing and consumption following hospital discharge following major trauma, burn injury, or emergent surgical procedure. Over a 12-month period, we will recruit adult patients discharged from the University of Michigan Acute Care Surgery (ACS) service and collect daily assessments using interactive voice response technology (IVR) and text-messaging. We will prospectively collect patient-reported pain and opioid consumption among individuals discharged from the hospital following traumatic injury over a 2-week period. Participants who stop taking opioids will be given a brief message about safe disposal. From this, we will obtain normative data regarding patient-reported pain and opioid requirements, which will be measured against medications prescribed at discharged.
Aim 2: Qualitatively examine provider preferences regarding postoperative opioid prescribing. We will conduct semi-structured interviews of ACS providers (resident physicians, physician assistants, nurse practitioners, fellows, attending surgeons) to describe attitudes, knowledge, and prescribing patterns with respect to outpatient pain management and prescription opioid prescribing. Interviews will begin with open-ended questions regarding pain management, with follow-up questions regarding the factors that influence decision-making regarding choice of opioid, dose, duration and number of pills prescribed, knowledge of opioid disposal, as well as alternative opioid analgesics.
Aim 3: Develop and pilot a provider-based feedback intervention regarding opioid prescribing and consumption. We will constructive a normative feedback intervention (i.e. dashboard) that integrates opioid prescribing (gathered from the medical record) with opioid consumption, pain, and opioid disposal (gathered from patient surveys), and constructed at monthly intervals. Information will be displayed in aggregate across all providers on the ACS service, and circulated at monthly quality control conference meetings. We will examine the change over time in overall prescribing, opioid consumption, and patient-reported pain. We hypothesize that provider feedback will result in a reduction in overall opioid prescriptions dispensed, a closer match between opioid prescribing and consumption, without an increase in patient-reported pain. These de-identified aggregate dashboards will be circulated in order to highlight awareness of opioid prescribing practices.