Melissa B. Weimer DO, MCR, Michele J. Buonora MD, MS, MHS, Alexandra M. Hajduk PhD, MPH, Adam L. Ackerman MD, Krishna R. Daggula MS, William C. Becker MD, Sarwat I. Chaudhry MD, David A. Fiellin MD
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Abstract
Background
The management of analgesia in people hospitalized with chronic pain and elevated risk for opioid-related harm is challenging. While opioid stewardship programs could provide guidance, their feasibility in this population has not been examined.
Objectives
To develop a case identification tool and evaluate the feasibility of an electronic medical record (EMR)-delivered opioid stewardship and pain intervention among hospitalized people with chronic pain and elevated risk for opioid-related harm.
Methods
After developing and evaluating the operating characteristics of a case identification tool to identify people with chronic pain and elevated risk for opioid-related harm, hospitalized adults with chronic pain and elevated risk for opioid-related harm were randomized to an EMR-delivered opioid stewardship and pain intervention versus usual care. Primary outcomes were feasibility-based. Exploratory outcomes were pain-related clinical outcomes.
Results
The case identification tool had a sensitivity of 88.9% and a specificity of 95.7%. The trial recruited 52/97 (54%) of potential participants who completed 52/52 (100%) potential assessments and of whom 45/52 (87%) were retained in the study at 4 weeks, demonstrating feasibility. On average, both treatment arms received 56% of the recommended guideline-concordant care and there was no significant difference in opioid and pain-related care in the two groups.
Conclusion
It is both feasible to develop an EMR-based tool to prospectively identify hospitalized people with chronic pain and elevated risk for opioid-related harm as well as recruit these individuals to an EMR-delivered opioid stewardship and pain intervention. Additional strategies to support the provision of guideline-concordant care may be warranted.
期刊介绍：
JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children.
Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.
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