Evaluating the implementation and effectiveness of a multi-component intervention to reduce post-surgical opioid prescribing: Study protocol of a mixed-methods design

Jonah James Stulberg*, Willemijn L.A. Schäfer, Meagan L. Shallcross, Bruce L. Lambert, Reiping Huang, Jane Louise Holl, Karl Y Bilimoria, Julie Johnson

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction Opioids prescribed after surgery accounted for 5% of the 191 million opioid prescriptions filled in 2017. Approximately 80% of the opioid pills prescribed by surgical care providers remain unused, leaving a substantial number of opioids available for non-medical use. We developed a multi-component intervention to address surgical providers' role in the overprescribing of opioids. Our study will determine effective strategies for reducing post-surgical prescribing while ensuring adequate post-surgery patient-reported pain-related outcomes, and will assess implementation of the strategies. Methods and analysis The Minimising Opioid Prescribing in Surgery study will implement a multi-component intervention, in an Illinois network of six hospitals (one academical, two large community and three small community hospitals), to decrease opioid analgesics prescribed after surgery. The multi-component intervention involves four domains: (1) patient expectation setting, (2) baseline assessment of opioid use, (3) perioperative pain control optimisation and (4) post-surgical opioid minimisation. Four surgical specialities (general, orthopaedics, urology and gynaecology) at the six hospitals will implement the intervention. A mixed-methods approach will be used to assess the implementation and effectiveness of the intervention. Data from the network's enterprise data warehouse will be used to evaluate the intervention's effect on post-surgical prescriptions and a survey will collect pain-related patient-reported outcomes. Intervention effectiveness will be determined using a triangulation design, mixed-methods approach with staggered speciality-specific implementation for contemporaneous control of opioid prescribing changes over time. The Consolidated Framework for Implementation Research will be used to evaluate the site-specific contextual factors and adaptations to achieve implementation at each site. Ethics and dissemination The study aims to identify the most effective hospital-type and speciality-specific intervention bundles for rapid dissemination into our 56-hospital learning collaborative and in hospitals throughout the USA. All study activities have been approved by the Northwestern University Institutional Review Board (ID STU00205053).

Original languageEnglish (US)
Article numbere030404
JournalBMJ open
Volume9
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Opioid Analgesics
Pain
Prescriptions
Research Ethics Committees
Community Hospital
Urology
Gynecology
Ethics
Orthopedics
Learning
Research

Keywords

  • cfir
  • diversion
  • implementation
  • mixed methods
  • opioids
  • overprescribing

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{5777d1872f3040b2a1bc46af6d1ca13e,
title = "Evaluating the implementation and effectiveness of a multi-component intervention to reduce post-surgical opioid prescribing: Study protocol of a mixed-methods design",
abstract = "Introduction Opioids prescribed after surgery accounted for 5{\%} of the 191 million opioid prescriptions filled in 2017. Approximately 80{\%} of the opioid pills prescribed by surgical care providers remain unused, leaving a substantial number of opioids available for non-medical use. We developed a multi-component intervention to address surgical providers' role in the overprescribing of opioids. Our study will determine effective strategies for reducing post-surgical prescribing while ensuring adequate post-surgery patient-reported pain-related outcomes, and will assess implementation of the strategies. Methods and analysis The Minimising Opioid Prescribing in Surgery study will implement a multi-component intervention, in an Illinois network of six hospitals (one academical, two large community and three small community hospitals), to decrease opioid analgesics prescribed after surgery. The multi-component intervention involves four domains: (1) patient expectation setting, (2) baseline assessment of opioid use, (3) perioperative pain control optimisation and (4) post-surgical opioid minimisation. Four surgical specialities (general, orthopaedics, urology and gynaecology) at the six hospitals will implement the intervention. A mixed-methods approach will be used to assess the implementation and effectiveness of the intervention. Data from the network's enterprise data warehouse will be used to evaluate the intervention's effect on post-surgical prescriptions and a survey will collect pain-related patient-reported outcomes. Intervention effectiveness will be determined using a triangulation design, mixed-methods approach with staggered speciality-specific implementation for contemporaneous control of opioid prescribing changes over time. The Consolidated Framework for Implementation Research will be used to evaluate the site-specific contextual factors and adaptations to achieve implementation at each site. Ethics and dissemination The study aims to identify the most effective hospital-type and speciality-specific intervention bundles for rapid dissemination into our 56-hospital learning collaborative and in hospitals throughout the USA. All study activities have been approved by the Northwestern University Institutional Review Board (ID STU00205053).",
keywords = "cfir, diversion, implementation, mixed methods, opioids, overprescribing",
author = "Stulberg, {Jonah James} and Sch{\"a}fer, {Willemijn L.A.} and Shallcross, {Meagan L.} and Lambert, {Bruce L.} and Reiping Huang and Holl, {Jane Louise} and Bilimoria, {Karl Y} and Julie Johnson",
year = "2019",
month = "6",
day = "1",
doi = "10.1136/bmjopen-2019-030404",
language = "English (US)",
volume = "9",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "6",

}

Evaluating the implementation and effectiveness of a multi-component intervention to reduce post-surgical opioid prescribing : Study protocol of a mixed-methods design. / Stulberg, Jonah James; Schäfer, Willemijn L.A.; Shallcross, Meagan L.; Lambert, Bruce L.; Huang, Reiping; Holl, Jane Louise; Bilimoria, Karl Y; Johnson, Julie.

In: BMJ open, Vol. 9, No. 6, e030404, 01.06.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evaluating the implementation and effectiveness of a multi-component intervention to reduce post-surgical opioid prescribing

T2 - Study protocol of a mixed-methods design

AU - Stulberg, Jonah James

AU - Schäfer, Willemijn L.A.

AU - Shallcross, Meagan L.

AU - Lambert, Bruce L.

AU - Huang, Reiping

AU - Holl, Jane Louise

AU - Bilimoria, Karl Y

AU - Johnson, Julie

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Introduction Opioids prescribed after surgery accounted for 5% of the 191 million opioid prescriptions filled in 2017. Approximately 80% of the opioid pills prescribed by surgical care providers remain unused, leaving a substantial number of opioids available for non-medical use. We developed a multi-component intervention to address surgical providers' role in the overprescribing of opioids. Our study will determine effective strategies for reducing post-surgical prescribing while ensuring adequate post-surgery patient-reported pain-related outcomes, and will assess implementation of the strategies. Methods and analysis The Minimising Opioid Prescribing in Surgery study will implement a multi-component intervention, in an Illinois network of six hospitals (one academical, two large community and three small community hospitals), to decrease opioid analgesics prescribed after surgery. The multi-component intervention involves four domains: (1) patient expectation setting, (2) baseline assessment of opioid use, (3) perioperative pain control optimisation and (4) post-surgical opioid minimisation. Four surgical specialities (general, orthopaedics, urology and gynaecology) at the six hospitals will implement the intervention. A mixed-methods approach will be used to assess the implementation and effectiveness of the intervention. Data from the network's enterprise data warehouse will be used to evaluate the intervention's effect on post-surgical prescriptions and a survey will collect pain-related patient-reported outcomes. Intervention effectiveness will be determined using a triangulation design, mixed-methods approach with staggered speciality-specific implementation for contemporaneous control of opioid prescribing changes over time. The Consolidated Framework for Implementation Research will be used to evaluate the site-specific contextual factors and adaptations to achieve implementation at each site. Ethics and dissemination The study aims to identify the most effective hospital-type and speciality-specific intervention bundles for rapid dissemination into our 56-hospital learning collaborative and in hospitals throughout the USA. All study activities have been approved by the Northwestern University Institutional Review Board (ID STU00205053).

AB - Introduction Opioids prescribed after surgery accounted for 5% of the 191 million opioid prescriptions filled in 2017. Approximately 80% of the opioid pills prescribed by surgical care providers remain unused, leaving a substantial number of opioids available for non-medical use. We developed a multi-component intervention to address surgical providers' role in the overprescribing of opioids. Our study will determine effective strategies for reducing post-surgical prescribing while ensuring adequate post-surgery patient-reported pain-related outcomes, and will assess implementation of the strategies. Methods and analysis The Minimising Opioid Prescribing in Surgery study will implement a multi-component intervention, in an Illinois network of six hospitals (one academical, two large community and three small community hospitals), to decrease opioid analgesics prescribed after surgery. The multi-component intervention involves four domains: (1) patient expectation setting, (2) baseline assessment of opioid use, (3) perioperative pain control optimisation and (4) post-surgical opioid minimisation. Four surgical specialities (general, orthopaedics, urology and gynaecology) at the six hospitals will implement the intervention. A mixed-methods approach will be used to assess the implementation and effectiveness of the intervention. Data from the network's enterprise data warehouse will be used to evaluate the intervention's effect on post-surgical prescriptions and a survey will collect pain-related patient-reported outcomes. Intervention effectiveness will be determined using a triangulation design, mixed-methods approach with staggered speciality-specific implementation for contemporaneous control of opioid prescribing changes over time. The Consolidated Framework for Implementation Research will be used to evaluate the site-specific contextual factors and adaptations to achieve implementation at each site. Ethics and dissemination The study aims to identify the most effective hospital-type and speciality-specific intervention bundles for rapid dissemination into our 56-hospital learning collaborative and in hospitals throughout the USA. All study activities have been approved by the Northwestern University Institutional Review Board (ID STU00205053).

KW - cfir

KW - diversion

KW - implementation

KW - mixed methods

KW - opioids

KW - overprescribing

UR - http://www.scopus.com/inward/record.url?scp=85066956458&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066956458&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2019-030404

DO - 10.1136/bmjopen-2019-030404

M3 - Article

C2 - 31164370

AN - SCOPUS:85066956458

VL - 9

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 6

M1 - e030404

ER -