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Utilization of a National Registry to influence opioid prescribing behavior after hernia repair

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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.

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Acknowledgements

Abdominal Core Health Quality Collaborative Opioid Task Force: Rana Higgins MD, Clayton Petro MD, Arielle Perez MD, Benjamin Poulose MD, Michael Rosen MD, Lauren Ott PA-C, Todd Harris MD, Amitabh Goel MD, Ruth Potee MD, Chad Brummett MD, Gordon Hafner MD, Anthony Iacco MD.

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Correspondence to J. A. Warren.

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Conflict of interest

Dr. Warren reports honorarium from Intuitive for speaking unrelated to this study. Dr. Reinhorn reports consulting fees from Heron Therapeutics unrelated to this study. Drs Warren and Reinhorn serve on the board of the ACHQC and Dr. Warren. Dr. Dews has no disclosures.

Ethical approval

This work complies with all ethical standards of research and is a registry-based study.

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This article did not involve human or animal subjects.

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The members of “Abdominal Core Health Quality Collaborative Opioid Task Force” are presented in Acknowledgements section.

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Reinhorn, M., Dews, T., Warren, J.A. et al. Utilization of a National Registry to influence opioid prescribing behavior after hernia repair. Hernia 26, 847–853 (2022). https://doi.org/10.1007/s10029-021-02495-5

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  • DOI: https://doi.org/10.1007/s10029-021-02495-5

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