Study objective

Reducing excessive opioid prescribing in emergency departments (ED) may prevent opioid addiction. We evaluated the largest personalized feedback and peer comparison intervention to date on emergency clinician opioid prescription rates in a national emergency clinician group.

Methods

This interrupted time series analysis of a quality improvement intervention included data from adults discharged from 102 EDs in 17 states from January 1, 2019, to July 31, 2021. From June 16, 2020, to November 30, 2020, site-level ED directors received emails on local opioid prescription rates. From December 1, 2020, to July 31, 2021, all clinicians were granted electronic dashboard access, which showed prescription rates compared with peers, and national ED leaders sent emails to high-prescribing clinicians and engaged in one-on-one conversations. The primary outcome was opioid prescriptions per 100 discharges.

Results

The study included 5,328,288 ED discharges from 924 physicians and 472 advanced practice providers. Opioid prescription rates did not change meaningfully in the site-level director feedback period (mean difference = −0.3, 95% confidence interval [CI] −0.6 to −0.1). During the direct clinician feedback period, opioid prescription rates declined from 10.4 per 100 discharges to 8.4 per 100 discharges (mean difference = −2.0, 95% CI −2.4 to −1.5), a 19% relative reduction. Among prescribers in the highest initial quintile, opioid prescribing reduced by 35% among physicians and 41% among advanced practice providers in the direct feedback period.

Conclusion

We demonstrated a large, sustained reduction in opioid prescribing by emergency clinicians using direct, personalized feedback to clinicians and an electronic dashboard for peer comparison.

中文翻译：

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在国家急诊部小组实施反馈计划后减少阿片类药物处方

学习目标

减少急诊科 (ED) 的过量阿片类药物处方可以防止阿片类药物成瘾。我们评估了迄今为止在国家急诊临床医生组中对急诊临床医生阿片类药物处方率的最大个性化反馈和同行比较干预。

方法

这种对质量改进干预的中断时间序列分析包括从 2019 年 1 月 1 日到 2021 年 7 月 31 日从 17 个州的 102 个急诊室出院的成年人的数据。从 2020 年 6 月 16 日到 2020 年 11 月 30 日，站点级急诊室主任收到有关当地阿片类药物处方率的电子邮件。从 2020 年 12 月 1 日到 2021 年 7 月 31 日，所有临床医生都获得了电子仪表板访问权限，该仪表板显示了与同行相比的处方率，国家 ED 负责人向高处方临床医生发送电子邮件并进行了一对一的对话。主要结果是每 100 次出院的阿片类药物处方。

结果

该研究包括来自 924 名医生和 472 名高级实践提供者的 5,328,288 名 ED 出院。在站点级主管反馈期间，阿片类药物处方率没有显着变化（平均差 = -0.3，95% 置信区间 [CI] -0.6 至 -0.1）。在临床医生直接反馈期间，阿片类药物处方率从每 100 次出院 10.4 次降至每 100 次出院 8.4 次（平均差 = -2.0，95% CI -2.4 至 -1.5），相对减少了 19%。在最高初始五分之一的处方者中，在直接反馈期间，医生的阿片类药物处方减少了 35%，高级实践提供者减少了 41%。

结论

我们通过向临床医生提供直接、个性化的反馈和用于同行比较的电子仪表板，证明了急诊临床医生的阿片类药物处方大幅持续减少。