Capturing Patient-Reported Data About Opioid Use
Project status
Collaborators
Daniel Lee, MD, MS
Zarina Ali, MD, MS
Brian Sennett, MD
Rachel Kleinman, MHSA
Hannah Lacko, MA
Annamarie Horan, PhD, MPA
Mary Coolet, PhD
Eric Hume, MD
Samir Mehta, MD
Innovation leads
Funding
Food and Drug Administration
Opportunity
Excess opioid prescribing can contribute to opioid misuse, such as when unused pills are diverted to people for whom they were not intended.
Interventions to tailor or "right-size" opioid prescriptions to better match patient needs must be identified and implemented to address this issue. A better understanding of the number of opioid pills patients use after surgery is needed to enable such interventions.
Intervention
We built and deployed an automated text messaging program to capture patient-reported data about pain intensity and opioid use. Participating patients provided e-consent immediately following surgery and then self-reported data over three to four weeks using Way to Health.
Impact
During the initial pilot, more than 1,100 patients undergoing orthopaedic or urology surgical procedures consented to use the system. In these populations, we found that roughly 61 percent of prescribed opioid tablets went unused – signaling an opportunity for guidelines to be revised to reduce overprescribing.
Over the past five years, the data collected through our program has been leveraged to develop patient-informed and procedure-specific opioid prescribing guidelines for the top 30 high-volume surgeries at Penn Medicine. The new guidelines are designed to enable patients to manage post-operative pain effectively while reducing the volume of leftover pills.
With new guidelines established, we launched a study to evaluate the effectiveness of peer comparisons to increase clinician adherence to procedure-specific opioid prescribing guidelines. Clinicians enrolled in the study received monthly report cards showing the average number of opioid pills they prescribed after a given procedure compared to other clinicians in the health system and health system guidelines.
In parallel, we have been investigating how patient characteristics are correlated with with opioid usage – information that could be used to further tailor prescriptions. From more than 3,600 patients who underwent one of the 30 most common surgeries, we learned that patients who were younger, had never used opioids before, and reported lower pain scores used fewer tablets.