In line with the National Institute on Drug Abuse mission to advance science on drug use and addiction, the goal of this research is to encourage appropriate opioid prescribing for chronic pain, using behavioral economics and electronic health records (EHRs). First, a chronic pain dashboard will be implemented in an EHR. The dashboard will help primary care providers (PCPs) easily and conveniently review the information they need to prescribe opioids as recommended by the Centers for Disease Control and Prevention?s (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. Second, the pain dashboard will be pilot tested. Last, a pragmatic trial will be conducted to assess the effect of the pain dashboard on PCPs? review of guideline- recommended risk, benefit, and goal information and on guideline-recommended medication ordering behavior. The hypothesis is that the pain dashboard will nudge PCPs toward (i) more complete assessment of risk, benefits, and goals and (ii) guideline-concordant medication prescribing behavior.
The specific aims are:
Specific Aim 1 : Implement and establish feasibility of a chronic pain dashboard in an enterprise EHR in a large urban safety-net health system.
Aim 1 a: Implement a chronic pain dashboard in an enterprise EHR. Building on an ongoing collaboration with Eskenazi Health system, the chronic pain dashboard will be implemented in the Epic EHR system.
Aim 1 b: Pilot test the dashboard?s proposed mechanism of action and verify feasibility of a pragmatic trial. A series of simulated clinical visits will be conducted with 15-25 PCPs to test the expected effect of the dashboard on ease and convenience of accessing risk, benefit, and goal information, and on guideline- concordant prescribing. Proposed outcome measures, sample size estimates, and recruitment goals will be validated for a subsequent pragmatic trial.
Specific Aim 2 : Across two health systems, implement the chronic pain dashboard in primary care clinics and evaluate its effect on PCPs? review of guideline-recommended risk, benefit, and goal information (primary outcome) and guideline-concordant medication prescribing behavior (secondary outcomes). A two-arm pragmatic cluster randomized controlled trial with 80 PCPs will be conducted across two health systems. This innovative project will be the first to implement and test an EHR decision support tool that uses behavioral economics to increase adoption of chronic pain guideline recommendations. This study will create new technology that healthcare organizations and clinicians can use to increase safe and effective care for the millions of Americans who suffer from chronic pain.
This research will improve understanding of how information technology can help primary care clinicians provide the best possible care for patients with chronic pain. By developing and testing new clinical information technology tools, this research will help ensure safe and high quality care for the millions of Americans who suffer from chronic pain.