A Randomized Trial of Behavioral Economic Approaches to Reduce Unnecessary Opioid Prescribing

Study Overview
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Brief Summary
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In this study, the investigators will evaluate the effect of a health system initiative aiming to change clinician opioid prescribing behaviors using two behavioral economic interventions - individual audit feedback and peer comparison feedback of clinicians.

Detailed Description
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Opioid-related abuse and overdose represent a growing national epidemic in the United States. Clinician practice patterns play an important role: opioid prescriptions impact the likelihood that patients will misuse or become dependent on these medications, with longer prescriptions leading to greater sustained use. In this study, we will evaluate a Sutter Health System quality improvement initiative using monthly individual audit feedback and/or monthly peer comparison feedback to clinicians to change opioid prescribing patterns. In partnership with Sutter Health System, this will be conducted using randomization to evaluate its effect. We will also conduct a process evaluation to understand factors associated with better or worse performance at the clinician level.

Official Title
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A Randomized Trial of Behavioral Economic Approaches to Reduce Unnecessary Opioid Prescribing

Conditions
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Acute Pain

Intervention / Treatment
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* Behavioral: Individual audit feedback
* Behavioral: Peer comparison feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinicians 1. Practiced primarily at participating emergency department or urgent care center Patients Presented to a participating emergency department or urgent care center during the study period Discharged to home from the visit Exclusion Criteria: Clinicians Saw less than 100 patients in the prior year Practiced primarily at another site that is not in the main trial Did not practice at Sutter Health in the prior 90 days Patients Currently pregnant

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>No intervention | |
| Experimental: Individual Audit<br>Clinicians will receive individual audit feedback informing them of their performance. | Behavioral: Individual audit feedback<br>* Practice sites randomly assigned to have individual audit feedback will be sent information by email to each clinician at the site each month for the duration of the intervention period. The email will inform the clinician that the health system is doing monthly audits and provide them the number of patients in the last month for whom they prescribed 30 opioid pills per prescription or higher.<br>|
| Experimental: Peer Comparison<br>Clinicians will receive peer comparison feedback informing them of how their performance compares to their peers. | Behavioral: Peer comparison feedback<br>* Practice sites randomly assigned to have peer comparison feedback will be sent information by email to each clinician at the site each month for the duration of the intervention period. Data on the mean number of opioid pills per prescription and the proportion of visits with an opioid prescription will be delivered using a 3-month rolling average as follows: a) If clinician is above median: informed how their data compares to the median; b) If clinician is below median but above 10th percentile: informed how their data compares to the 10th percentile; c) If clinician is 10th percentile or below: informed of their data and commended for being a low prescriber.<br>|
| Experimental: Individual Audit and Peer Comparison<br>Clinicians will receive individual audit feedback informing them of their performance and peer comparison feedback informing them of how their performance compares to their peers. | Behavioral: Individual audit feedback<br>* Practice sites randomly assigned to have individual audit feedback will be sent information by email to each clinician at the site each month for the duration of the intervention period. The email will inform the clinician that the health system is doing monthly audits and provide them the number of patients in the last month for whom they prescribed 30 opioid pills per prescription or higher.<br>Behavioral: Peer comparison feedback<br>* Practice sites randomly assigned to have peer comparison feedback will be sent information by email to each clinician at the site each month for the duration of the intervention period. Data on the mean number of opioid pills per prescription and the proportion of visits with an opioid prescription will be delivered using a 3-month rolling average as follows: a) If clinician is above median: informed how their data compares to the median; b) If clinician is below median but above 10th percentile: informed how their data compares to the 10th percentile; c) If clinician is 10th percentile or below: informed of their data and commended for being a low prescriber.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the mean number of pills per opioid prescription | The primary outcome is the change in the mean number of pills prescribed per opioid prescription from baseline to the intervention period. | Six months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in proportion of patient visits with an opioid prescription | The secondary outcome is the change in proportion of patient visits in which an opioid is prescribed from baseline to the intervention period. | Six months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Opioids, Nudges, Emergency Medicine, Urgent Care, Feedback