Postoperative Nudges to Reduce Opioid Prescribing

Not Applicable

Completed

Interventions: Behavioral: Guideline-Based (Injunctive Norm) Nudges
Behavioral: Peer-Based (Social Norm) Nudges

Brief Summary: 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.

Recruitment & Eligibility

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Arm && Interventions

Group	Intervention	Description
Guideline-Based Nudges	Guideline-Based (Injunctive Norm) Nudges	-
Peer-Based Nudges	Peer-Based (Social Norm) Nudges	-

Primary Outcome Measures

Name	Time	Method
Proportion of Discharges With Opioid Prescriptions Above Prescribing Guidelines	12 months	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.

Secondary Outcome Measures

Name	Time	Method
Morphine Milligram Equivalents (MMEs) Prescribed at Discharge	12 months	Continuous measure of the total morphine milligram equivalents prescribed at discharge
Days' Supply of Opioids Prescribed at Discharge	12 months	Continuous variable indicating the number of days' supply of opioids prescribed at discharge
Proportion of Discharges Where Any Opioid Was Prescribed	12 months	Derived from a binary variable indicating whether any opioid was prescribed at discharge
Proportion of Patients on Opioids for Greater Than 3 Months Post-discharge	3-6 months post-discharge	Derived from a binary variable indicating whether the patient has any opioid prescriptions between 3 and 6 months after surgery
Number of 30-day All-cause Emergency Department Visits	0-30 days post-discharge	Number of emergency department visits the post-operative patient has in the 30 days after the initial procedure
Number of 30-day All-cause Hospitalizations	0-30 days post-discharge	Number of hospital admissions the post-operative patient has in the 30 days after the initial procedure
Proportion of Discharge Opioid Prescriptions Above Prescribing Guidelines in the Year After the Intervention Ends	12 months (months 13-24 of the study)	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.