Abstract
Introduction
Our aim was to evaluate variation in opioid prescribing rates and prescription size
following childbirth across providers and hospitals.
Methods
This retrospective cohort study analyzed claims data from a single-payer Preferred
Provider Organization from June 2014 to May 2019 in 84 hospitals in a statewide quality
collaborative. All patients aged 12–55 years, undergoing childbirth, with continuous
enrollment in pregnancy were included. The primary outcome was the predicted rate
of postpartum opioid fills from 7 days before birth to 3 days after discharge. Secondary
outcomes included postpartum opioid prescription size in oral morphine equivalents,
a standardized measure that includes the number of pills prescribed times the strength
of the medication. Multilevel regression models accounted for clustering. We calculated
attributable variation in opioid fills using the intraclass correlation coefficient.
Results
Of 41,427 births, 15,459 patients (37.2%) filled a postpartum opioid prescription
(vaginal, 4,624/27,536 [16.8%]; cesarean, 10,835/13,891 [78.0%]). The median postpartum
prescription size was 150 oral morphine equivalents (interquartile range [IQR], 30)
(vaginal, 135; [IQR, 45]; cesarean, 150 [IQR, 75]). In adjusted models, the rates
of opioid prescribing after vaginal birth differed from cesarean birth (vaginal median,
12.1% [range, 1.1%–60.0%]; cesarean median, 80.4% [range, 43.6%–90.2%]). More variation
in postpartum opioid fills was attributable to providers and hospitals for vaginal
(provider, 29%; hospital, 24%) than cesarean birth (provider, 8%; hospital, 6%). Variation
in prescription size was driven by providers for vaginal birth (provider, 27%; hospital,
6%) and providers and hospitals for cesarean birth (provider, 29%; hospital, 21%).
Conclusions
Across a statewide quality collaborative, variation in postpartum opioid prescribing
is attributable to providers and hospitals. Future efforts at the provider and hospital
levels are needed to implement best practices for postpartum opioid prescribing.
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Biography
Alex F. Peahl, MD, MSc, is Assistant Professor, University of Michigan Department of Obstetrics and Gynecology and the Chair of the American College of Obstetricians and Gynecologists' Prenatal Care Initiative. Her research focuses on improving the effectiveness, efficiency, and equity of reproductive health care.
Biography
Daniel M. Morgan, MD, is Professor, University of Michigan Department of Obstetrics and Gynecology. His research focuses on clinical outcomes of treatment for pelvic floor disorders, health care services research, and quality improvement efforts.
Biography
Elizabeth S. Langen, MD, is Associate Professor, University of Michigan Department of Obstetrics and Gynecology and Co-Director of the Obstetrics Initiative. Her research interests include labor abnormalities in term and preterm birth, as well as maternal cardiac disease in pregnancy.
Biography
Lisa Kane Low, PhD, CNM, is Professor, University of Michigan Department of Obstetrics and Gynecology and School of Nursing, and Co-Director of the Obstetrics Initiative. Her research focuses on evidence-based childbirth practices that promote optimal outcomes for childbearing women and their families.
Biography
Chad M. Brummett, MD, is Professor, University of Michigan Department of Anesthesiology and Co-Director of the Michigan Opioid Prescribing Engagement Network. His research interests include predictors of acute and chronic post-surgical pain and failure to derive benefit from surgical interventions.
Biography
Yen-Ling Lai, MS, is Clinical Information Analyst, Michigan Opioid Prescribing Engagement Network, Department of Surgery at the University of Michigan.
Biography
Hsou-Mei Hu, PhD, is Clinical Information Analyst, Michigan Opioid Prescribing Engagement Network, Department of Surgery at the University of Michigan.
Biography
Melissa Bauer, DO, is Associate Professor, Duke University Department of Anesthesiology. Her research interests are focused on early identification and improving treatment for maternal infection and sepsis, and she is passionate about providing patient-centered care to meet each patient's needs.
Biography
Jennifer Waljee, MD, MPH, is Associate Professor, University of Michigan Department of Surgery; Co-Director, Michigan Opioid Prescribing Engagement Network; and Director, Center for Healthcare Outcomes & Policy. Her research interests include the development and implementation of patient-reported outcomes as quality measures.
Article info
Publication history
Published online: September 20, 2022
Accepted:
August 18,
2022
Received in revised form:
August 16,
2022
Received:
December 8,
2021
Footnotes
Funding Statement: Drs. Brummett and Waljee received funding for research from the National Institute on Drug Abuse (R01 DA042859). This work is supported by a grant from the Michigan Department of Health and Human Services, Blue Cross Blue Shield of Michigan, and the Substance Abuse and Mental Health Services Administration. The funders played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Data Access and Responsibility: Dr. Peahl had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Conflicts of Interest: Dr. Brummett is a consultant for Alosa Health and Heron Therapeutics. He also provides expert testimony. Dr. Peahl is a consultant for MAVEN. The remaining authors report no conflicts of interest.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
