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| ID | Type | Description | Link |
|---|---|---|---|
| 24-1193 | Other Identifier | COMIRB | |
| R61DA057610 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute on Drug Abuse (NIDA) | NIH |
| National Institutes of Health (NIH) | NIH |
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The 2022 Center for Disease Control and Prevention (CDC) clinical practice guideline for prescribing opioids for pain recommends that when tapering a patient's opioid dose, doses should be decreased at a slow rate to reduce the risk of withdrawal symptoms, overdose, and to promote tolerance of the tapering. This project will evaluate a clinical decision support (CDS) tool in the form of a clinical care pathway that gives providers information, recommendations, and educational material on strategies for opioid tapering. Primary care providers will be randomized at the clinic location to a control arm or intervention arm. The control arm will have the clinical care pathway available, but will not be reminded of the pathway when tapering a patient. The intervention arm will receive a nudge when prescribing a tapering opioid strategy to a patient to use the clinical care pathway. The rate of opioid tapering in line with CDC guidelines will be examined as well as long-term patient outcomes of opioid overdose or poisoning using existing patient health records. The study period will be approximately 18 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual Care | Control group to enable tracking of temporal changes in prescribing. Providers will not see any alert. | ||
| CDS Notification | Providers will see a clinical decision support tool within the electronic health record when treating a patient who may benefit from or is currently tapering opioid medications to encourage the provider to use a clinical care pathway that provides resources and decision support in tapering. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Opioid Tapering Pathway Clinical Decision Support (CDS) | Other | Clinical decision support in the form of an electronic health record (EHR)-integrated, provider facing notification suggesting the provider utilize a clinical care pathway that provides resources and decision support in opioid tapering in line with CDC guidelines. |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of encounters tapering within CDC guidelines | The number of encounters where a provider's actions are in line with CDC tapering guidelines divided by the total number of opioid tapering prescriptions | 18 months |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical decision support (CDS) acceptance rate | The number of times providers accepted the clinical decision support (CDS) tool and utilized the clinical care pathway | 18 months |
| Subsequent opioid overdose/poisoning rates |
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Inclusion Criteria: Primary care patients being tapered from an opioid. Tapering patients:
Exclusion Criteria:
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Residents and visitors to the state of Colorado who seek healthcare within the University of Colorado Health (UCHealth) primary care system receiving long-term opioid treatment.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Heather Tolle, PhD | Contact | 303-724-9924 | heather.tolle@cuanschutz.edu |
| Name | Affiliation | Role |
|---|---|---|
| Jason Hoppe, DO | University of Colorado, Denver | Principal Investigator |
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De-identified data utilized in this project will be housed on the National Addiction and HIV Data Archive Program (NAHDAP) repository after final study results have been published.
Data will be provided to NAHDAP after study results are published in peer-reviewed journals.
Prior to downloading study data, the individual will have to register with the site and agree to a standard data use agreement.
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| ID | Term |
|---|---|
| D019966 | Substance-Related Disorders |
| D040261 | Harm Reduction |
| D009293 | Opioid-Related Disorders |
| D000083682 | Opiate Overdose |
| ID | Term |
|---|---|
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
| D001519 | Behavior |
| D000079524 | Narcotic-Related Disorders |
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The number of patients who had a diagnosis of opioid overdose or poisoning in the six months following an opioid tapering prescription
| 6 months after taper encounter |
| Health care utilization | The number of emergency department and clinic visits | 6 months after taper encounter |
| D062787 |
| Drug Overdose |
| D063487 | Prescription Drug Misuse |
| D000076064 | Drug Misuse |