A Peer Data Benchmarking Intervention to Reduce Opioid Overprescribing: A Randomized Controlled Trial

Chen Dun, Heidi N. Overton, Christi M. Walsh, Sanuri Hennayake, Peiqi Wang, Christine Fahim, Mark C. Bicket, Martin A. Makary

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Driving physician behavior change has been an elusive goal for quality improvement efforts aimed at reducing low-value care. We proposed the use of “nudge” interventions at the surgeon level in order to reduce post-surgical opioid overprescribing in accordance with consensus guidelines. Methods: We used 2017 Medicare data to identify outlier surgeons. A peer data benchmarking report that showed each surgeon the average number of opioid tablets they prescribed for an open inguinal hernia repair procedure from January 1, 2017 to December 31, 2017. We conducted a 1:1 randomized controlled trial providing outlier surgeons a report of their opioid prescribing patterns for a standard operation compared to the national average and prescribing guidelines. Results: There were 489 surgeons randomized to the intervention, of which 180 (36.8%) had data in the post-intervention period. Data was available for 87 surgeons in the intervention group and 93 surgeons in the control group. 97.7% of surgeons in the intervention group reduced their opioid prescribing pattern compared to 95.7% in the control group. Surgeons who received the data benchmarking report intervention prescribed 14.3% less opioids than surgeons in the control group (10.54 (SD 5.34) vs. 12.30 (SD 6.02), P =.04). The intervention was associated with a 1.83 lower mean number of opioid tablets prescribed per patient in the multivariable linear regression model after controlling for other factors (Intervention group vs. control group 95% CI [−3.61, −.04], P =.04). Discussion: The implementation of a peer data benchmarking intervention can drive physician behavior change towards high-value care.

Original languageEnglish (US)
Pages (from-to)4379-4387
Number of pages9
JournalAmerican Surgeon
Volume89
Issue number11
DOIs
StatePublished - Nov 2023

Keywords

  • general surgery
  • hernia
  • surgical quality

ASJC Scopus subject areas

  • Surgery

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