Postoperative Nudges to Reduce Opioid Prescribing

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.

Conditions

• Opioid Prescribing

Interventions

BEHAVIORAL

Guideline-Based (Injunctive Norm) Nudges

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed. Dear Dr. \[Name\], In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amounts recommended by safety guidelines for these procedures. For patient safety, Sutter Health recommends prescribing within the ranges below for these procedures. Doing so will also meet best-practice safety guidelines for post-operative opioid prescribing. We will continue to send you opioid prescribing safety reports. Sincerely, \[Signature\] \[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\]

BEHAVIORAL

Peer-Based (Social Norm) Nudges

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed. Dear Dr. \[Name\], In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amount prescribed by YY% of your peers for these procedures. YY% of \[specialty\] surgeons at Sutter Health prescribe within the ranges below for these procedures. We will continue to send you opioid prescribing safety reports. Sincerely, \[Signature\] \[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\] The ranges of 5mg oxycodone tablets displayed will be the same as the ranges stipulated by the prescribing guidelines, but this nudge will not mention guidelines.

Sponsors & Collaborators

• Sutter Health

  collaborator OTHER

• University of California, Los Angeles

  collaborator OTHER

• University of Southern California

  collaborator OTHER

• University of Michigan

  collaborator OTHER

• RAND

  lead OTHER

Principal Investigators

• Katherine E Watkins, MD, MSHS · RAND

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-10-19

Primary Completion

2022-10-18

Completion

2023-10-18

Countries

• United States

Study Locations