Design and Implementation of an Opioid Scorecard for Hospital System–Wide Peer Comparison of Opioid Prescribing Habits: Observational Study

TL;DR

This study created a system to compare opioid prescribing habits across a hospital system to encourage safer prescribing and reduce opioid dependence risks.

Contribution

The first large-scale, evidence-based opioid prescribing peer comparison system implemented enterprise-wide.

Findings

Quarterly opioid scorecards were sent to 2034 providers over five quarters.

Poisson regression showed a 1.6% quarterly reduction in opioid prescribing.

Chi-square analysis showed reductions in long-duration prescriptions and high morphine equivalent doses.

Abstract

Reductions in opioid prescribing by health care providers can lead to a decreased risk of opioid dependence in patients. Peer comparison has been demonstrated to impact providers’ prescribing habits, though its effect on opioid prescribing has predominantly been studied in the emergency department setting.

The purpose of this study is to describe the development of an enterprise-wide opioid scorecard, the architecture of its implementation, and plans for future research on its effects.

Using data generated by the author’s enterprise vendor–based electronic health record, the enterprise analytics software, and expertise from a dedicated group of informaticists, physicians, and analysts, the authors developed an opioid scorecard that was released on a quarterly basis via email to all opioid prescribers at our institution. These scorecards compare providers’ opioid prescribing habits on the basis of established metrics to those of their peers within their specialty throughout the enterprise.

At the time of this study’s completion, 2034 providers have received at least 1 scorecard over a 5-quarter period ending in September 2021. Poisson regression demonstrated a 1.6% quarterly reduction in opioid prescribing, and chi-square analysis demonstrated pre-post reductions in the proportion of prescriptions longer than 5 days’ duration and a morphine equivalent daily dose of >50.

To our knowledge, this is the first peer comparison effort with high-quality evidence-based metrics of this scale published in the literature. By sharing this process for designing the metrics and the process of distribution, the authors hope to influence other health systems to attempt to curb the opioid pandemic through peer comparison. Future research examining the effects of this intervention could demonstrate significant reductions in opioid prescribing, thus potentially reducing the progression of individual patients to opioid use disorder and the associated increased risk of morbidity and mortality.

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