M Reinhorn1, T Dews2, J A Warren3. 1. Boston Hernia & Pilonidal Center, Tufts University School of Medicine, Newton-Wellesley Hospital, 201 Walnut St, Ste 100, Wellesley, MD, 02481, USA. 2. Cleveland Clinic Pain Management, Anesthesiology Institute, Cleveland Clinic Euclid Hospital, Case Western Reserve University, Cleveland Clinic Lerner College of Medicine, Cleveland, USA. 3. Department of Surgery, Prisma Health Upstate, University of South Carolina School of Medicine Greenville, 701 Grove Rd, ST 3, Greenville, SC, 29605, USA. Jeremy.warren@prismahealth.org.
Abstract
PURPOSE: Despite progress toward curtailing opioid prescribing, physicians are often slow to adopt new prescribing practices. Using the Abdominal Core Health Quality Collaborative (ACHQC), we aimed to demonstrate the ability of a national, disease-specific, personalized registry to impact opioid prescribing. METHODS: Using a collaborative and iterative process, a module was developed to capture surgeon opioid prescribing, patient-reported consumption, and risk factors for opioid use. Study reported according to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. RESULTS: Six months after implementation of the ACHQC opioid module, we assessed participation, prescribing and patient consumption patterns. For ventral hernia repair (VHR; n = 398), 23 surgeons reported prescribing > 20 pills (43%), 11-20 (40%), and < 10 (18%). In contrast, patients (n = 217) reported taking < 10 pills in 65% and only 20% reported taking > 15. For inguinal hernia repair (IHR; n = 443) 37 surgeons reported prescribing > 20 tablets (22%), 11-20 (32%), and < 10 (44%). Patients (n = 277) reported taking < 10 pills in 81% of cases, including 50% reporting zero, and only 13% taking > 15. We identified barriers to practice change and developed a strategy for education, provision of individualized data, and encouraging participation. Surgeon participation has since increased significantly (n = 65 for VHR; n = 53 for IHR), and analysis of the impact of this process is ongoing. CONCLUSION: Quality improvement requires physician engagement, which can be facilitated by meaningful and actionable data. The specificity of the ACHQC and the ability to provide surgeons with individualized data is a model method to incite change in physician behavior and improve patient outcomes.
PURPOSE: Despite progress toward curtailing opioid prescribing, physicians are often slow to adopt new prescribing practices. Using the Abdominal Core Health Quality Collaborative (ACHQC), we aimed to demonstrate the ability of a national, disease-specific, personalized registry to impact opioid prescribing. METHODS: Using a collaborative and iterative process, a module was developed to capture surgeon opioid prescribing, patient-reported consumption, and risk factors for opioid use. Study reported according to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. RESULTS: Six months after implementation of the ACHQC opioid module, we assessed participation, prescribing and patient consumption patterns. For ventral hernia repair (VHR; n = 398), 23 surgeons reported prescribing > 20 pills (43%), 11-20 (40%), and < 10 (18%). In contrast, patients (n = 217) reported taking < 10 pills in 65% and only 20% reported taking > 15. For inguinal hernia repair (IHR; n = 443) 37 surgeons reported prescribing > 20 tablets (22%), 11-20 (32%), and < 10 (44%). Patients (n = 277) reported taking < 10 pills in 81% of cases, including 50% reporting zero, and only 13% taking > 15. We identified barriers to practice change and developed a strategy for education, provision of individualized data, and encouraging participation. Surgeon participation has since increased significantly (n = 65 for VHR; n = 53 for IHR), and analysis of the impact of this process is ongoing. CONCLUSION: Quality improvement requires physician engagement, which can be facilitated by meaningful and actionable data. The specificity of the ACHQC and the ability to provide surgeons with individualized data is a model method to incite change in physician behavior and improve patient outcomes.
Authors: Aldo Fafaj; Samuel J Zolin; Nikki Rossetti; Jonah D Thomas; Charlotte M Horne; Clayton C Petro; David M Krpata; Ajita S Prabhu; Steven Rosenblatt; Michael J Rosen Journal: Surgery Date: 2020-06-02 Impact factor: 3.982
Authors: Alexander Hallway; Joceline Vu; Jay Lee; William Palazzolo; Jennifer Waljee; Chad Brummett; Michael Englesbe; Ryan Howard Journal: J Am Coll Surg Date: 2019-05-30 Impact factor: 6.113
Authors: Jeremy A Warren; Caroline Stoddard; Ahan L Hunter; Anthony J Horton; Carlyn Atwood; Joseph A Ewing; Steven Pusker; Vito A Cancellaro; Kevin B Walker; William S Cobb; Alfredo M Carbonell; Robert R Morgan Journal: J Gastrointest Surg Date: 2017-08-14 Impact factor: 3.452
Authors: Sook C Hoang; Sudheer R Vemuru; Taryn E Hassinger; Charles M Friel; Traci L Hedrick Journal: Dis Colon Rectum Date: 2020-03 Impact factor: 4.585
Authors: Paul Potnuru; Roman Dudaryk; Ralf E Gebhard; Christian Diez; Omaida C Velazquez; Keith A Candiotti; Richard H Epstein Journal: Surgery Date: 2019-06-10 Impact factor: 3.982
Authors: Alexander S Chiu; Raymond A Jean; Jessica R Hoag; Mollie Freedman-Weiss; James M Healy; Kevin Y Pei Journal: JAMA Surg Date: 2018-11-01 Impact factor: 14.766
Authors: Diana E Peterman; Bryan P Knoedler; Joseph A Ewing; Alfredo M Carbonell; William S Cobb; Jeremy A Warren Journal: Am Surg Date: 2020-08-24 Impact factor: 0.688
Authors: Maureen V Hill; Ryland S Stucke; Sarah E Billmeier; Julia L Kelly; Richard J Barth Journal: J Am Coll Surg Date: 2017-11-30 Impact factor: 6.113