A Cluster-randomized Trial of Modifying Electronic Health Record Defaults to Reduce the Prescribed Quantity of Opioid Analgesics in Primary Care and Emergency Department Settings
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 15,000
- 主要终点
- Initial prescription <= 10 pills (y/n)
研究概览
简要总结
The goal of this research is to investigate the impact of changing opioid analgesic prescribing defaults on the quantity of opioids prescribed for acute non-cancer pain in adult primary care and emergency department settings. We will change prescribing defaults for select short-acting opioid analgesics including immediate release oxycodone and hydrocodone as well as codeine and tramadol, including their co-formulations with acetaminophen. In a cluster-randomized trial of matched pairs of Montefiore Medical Center clinical sites, stratified by specialty and teaching status, we will evaluate the impact of this intervention on patient-level outcomes using 18 months of data (6 months pre-intervention and 12 months post-intervention).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Clinical Site Inclusion Criteria:
- •Primary care clinic (internal medicine, family medicine, or urgent care) or emergency department within Montefiore Medical Center
- •Patient Inclusion Criteria:
- •Received a new opioid analgesic prescription, defined as no opioid analgesic prescription in the preceding 6 months
排除标准
- •Cancer diagnosis code within the past 1 year
研究组 & 干预措施
Intervention
The intervention condition consists of a change to the electronic health record so that new opioid analgesic prescriptions automatically default to 10 pills (i.e., the "quantity dispensed" field is pre-populated). This value is modifiable by providers who can tailor the prescription based on clinical factors.
干预措施: Change in electronic health record default for new opioid analgesic prescriptions (Other)
Standard of care
The control condition will be the usual electronic health record interface. The default number of pills varies by medication, most medications currently have either a blank default or a default of 30 pills.
结局指标
主要结局
Initial prescription <= 10 pills (y/n)
时间窗: Through study completion (18 months)
Extracted from the electronic medical record
次要结局
- Initial prescription number of pills(Through study completion (18 months))
- Initial prescription morphine milligram equivalents(Through study completion (18 months))
- Total morphine milligram equivalents prescribed, including re-orders(Within 30 days after the initial prescription)
- Opioid analgesic re-order (y/n)(Within 30 days after the initial prescription)
- Hospitalizations(Within 30 days after the initial prescription)
- Outpatient visits(Within 30 days after the initial prescription)
- Total opioid analgesic pills prescribed, including re-orders(Within 30 days after the initial prescription)
- Emergency department visits(Within 30 days after the initial prescription)
研究者
Marcus Bachhuber
Assistant Professor
Montefiore Medical Center