Postoperative Nudges to Reduce Opioid Prescribing

NCT05070338 | Completed Results DMC

• 1 other identifier: R01DA046226
• Study Type: interventional
• Target: 640
• Locations: 1 country
• Sites: 1

Brief Summary

This study tests the effectiveness of two email-based behavioral nudges, one based on peer behavior and one based on best practice guidelines, in reducing excessive opioid prescriptions after surgery. It will be conducted in three surgical specialties (general surgery, orthopedic surgery, and obstetric/gynecological surgery) at 19 hospitals within one healthcare system. These specialties will each be randomized to a control group or one of two nudge groups. Each month for one year, surgeons in the nudge groups will receive emails comparing their opioid prescribing either to their peers' prescribing or to prescribing guidelines. Both types of email-based nudges are expected to reduce opioid prescribing after surgery.

Conditions

Opioid Prescribing

Keywords

Opioid Epidemic; Inappropriate Prescribing; Opioid-Related Disorders; Practice Guideline; Peer Influence; Nudges

Outcome Measures

Primary Outcomes (1)

• Proportion of Discharges With Opioid Prescriptions Above Prescribing Guidelines

  Prescriptions will be compared to prescribing guidelines via morphine milligram equivalents (MMEs) and coded as within or above guidelines. If no opioid is prescribed at discharge, this will be coded as within guidelines.

  12 months

Secondary Outcomes (7)

• Morphine Milligram Equivalents (MMEs) Prescribed at Discharge

  12 months

• Days' Supply of Opioids Prescribed at Discharge

  12 months

• Proportion of Discharges Where Any Opioid Was Prescribed

  12 months

• Proportion of Patients on Opioids for Greater Than 3 Months Post-discharge

  3-6 months post-discharge

• Number of 30-day All-cause Emergency Department Visits

  0-30 days post-discharge

Study Arms (3)

Guideline-Based Nudges

EXPERIMENTAL

Behavioral: Guideline-Based (Injunctive Norm) Nudges

Peer-Based Nudges

EXPERIMENTAL

Behavioral: Peer-Based (Social Norm) Nudges

Control

NO INTERVENTION

Interventions

Guideline-Based (Injunctive Norm) Nudges BEHAVIORAL

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed. Dear Dr. \[Name\], In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amounts recommended by safety guidelines for these procedures. For patient safety, Sutter Health recommends prescribing within the ranges below for these procedures. Doing so will also meet best-practice safety guidelines for post-operative opioid prescribing. We will continue to send you opioid prescribing safety reports. Sincerely, \[Signature\] \[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\]

Guideline-Based Nudges

Peer-Based (Social Norm) Nudges BEHAVIORAL

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed. Dear Dr. \[Name\], In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amount prescribed by YY% of your peers for these procedures. YY% of \[specialty\] surgeons at Sutter Health prescribe within the ranges below for these procedures. We will continue to send you opioid prescribing safety reports. Sincerely, \[Signature\] \[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\] The ranges of 5mg oxycodone tablets displayed will be the same as the ranges stipulated by the prescribing guidelines, but this nudge will not mention guidelines.

Peer-Based Nudges

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

The nudges that a surgeon in either intervention arm will receive are based on that surgeon's eligible discharge opioid prescriptions in the previous month. Eligible prescriptions meet all of the following criteria: * the patient is at least 18 years old at the date of surgery * the patient is discharged to their home * the surgical procedure has an applicable post-operative opioid prescribing guideline * the surgical procedure is the only surgical procedure performed during the patient's hospital stay * the prescription is for an opioid taken orally (tablets, capsules, or liquid solution) To avoid contamination between the intervention arms, surgeons who operate across multiple surgical specialties (defined as surgeons who performed less than 90% of their total procedures in one specialty between June 2020 and May 2021) will not be eligible.

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• RAND: lead
• Sutter Health: collaborator
• University of California, Los Angeles: collaborator
• University of Southern California: collaborator
• University of Michigan: collaborator

Study Sites (1)

Sutter Health

Sacramento, California, 95833, United States

Location

Related Publications (4)

• Martinez MC, Bouskill K, Yan XS, Kirkegaard A, Doctor JN, Watkins KE. A qualitative analysis on the implementation of a nudge intervention to reduce post-surgical opioid prescribing. BMC Health Serv Res. 2025 Apr 8;25(1):512. doi: 10.1186/s12913-025-12651-7.

  PMID: 40200214 DERIVED

• Martinez M, Kirkegaard A, Bouskill K, Yan XS, Wagner Z, Watkins KE. Surgeons' views of peer comparison and guideline-based feedback on postsurgery opioid prescriptions: a qualitative investigation. BMJ Open Qual. 2024 Apr 5;13(2):e002750. doi: 10.1136/bmjoq-2024-002750.

  PMID: 38580444 DERIVED

• Wagner Z, Kirkegaard A, Mariano LT, Doctor JN, Yan X, Persell SD, Goldstein NJ, Fox CR, Brummett CM, Romanelli RJ, Bouskill K, Martinez M, Zanocco K, Meeker D, Mudiganti S, Waljee J, Watkins KE. Peer Comparison or Guideline-Based Feedback and Postsurgery Opioid Prescriptions: A Randomized Clinical Trial. JAMA Health Forum. 2024 Mar 1;5(3):e240077. doi: 10.1001/jamahealthforum.2024.0077.

  PMID: 38488780 DERIVED

• Kirkegaard A, Wagner Z, Mariano LT, Martinez MC, Yan XS, Romanelli RJ, Watkins KE. Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial. BMJ Open. 2022 Sep 19;12(9):e061980. doi: 10.1136/bmjopen-2022-061980.

  PMID: 36123066 DERIVED

MeSH Terms

Conditions

Opioid-Related Disorders

Condition Hierarchy (Ancestors)

Narcotic-Related Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders

Results Point of Contact

• Title: Katherine E. Watkins
• Organization: RAND Corporation

kwatkins@rand.org

310-393-0411

Study Officials

• Katherine E Watkins, MD, MSHS

  RAND

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 21, 2021
• First Posted: October 7, 2021
• Study Start: October 19, 2021
• Primary Completion: October 18, 2022
• Study Completion: October 18, 2023
• Last Updated: April 8, 2025
• Results First Posted: April 8, 2025

Record last verified: 2025-03

Data Sharing

• IPD Sharing: Will share

Locations

US (1)