The Relationship Between Postoperative Prescriber Networks and Opioid Prescribing Discoordination - Following common surgical procedures, nearly all patients in the United States will be prescribed an
opioid. Although these are intended for short-term use, a growing body of literature is demonstrating that a
significant portion of patients will continue to use opioids for greater than three months following their
procedure, increasing the risk for opioid-related harm. To mitigate this risk, the CDC Guidelines for Prescribing
Opioids for Chronic Pain recommend providers only prescribe cumulative doses greater than 90 morphine
milligram equivalents (MME)/day with careful justification and avoiding concurrent opioid and benzodiazepine
prescriptions. However, patients are more likely to exceed the 90 MME/day benchmark through discoordinated
prescribing from multiple prescribers than single high-dose prescriptions. With a high likelihood of receiving an
opioid prescription following a surgical procedure, postoperative opioid prescribing may be unintentionally
contributing to opioid-related harm, especially for vulnerable populations such as those with a serious mental
illness (SMI), a substance use disorder (SUD), or with chronic prescription opioid use.
To date, most research has focused on initial postoperative opioid prescribing, with little attention to the
role of prescribing discoordination (i.e. prescribing in accordance with CDC guideline recommendations)
between outpatient and surgical providers. Prescribers may be able to more effectively coordinate
prescriptions if they are more connected (i.e. have shared clinical attributes such as shared patients, patient
referrals, or practice within the same provider group). For example, a pain management specialist who shares
a practice with a surgeon may be able to more easily view current prescriptions (via direct communication or
the electronic health record) and can plan ongoing therapy accordingly. Social network analysis (SNA) is a
quantitative approach that identifies and measures connections between prescribers. These connections are
quantified and used to calculate network measures that describe each network. Using claims from a single
nation-wide commercial insurer, the goal of this study is to (1) build and characterize patient-prescriber
networks of patients undergoing surgery, and (2) identify network and prescriber characteristics associated
with prescribing discoordination. Policy makers and healthcare providers can use these findings to target policy
recommendations that would enhance prescriber connection, such as changes to reimbursement structures
and enhanced interoperability of electronic health systems.
Activities directed under this fellowship will provide the applicant with methodologic skills in SNA,
clinical skills in the care and management of patients in the acute care settings, and professional development
skills to facilitate new clinical and research partnerships. The applicant has curated a mentorship team with
expertise in these domains to enable her development as an independent nurse scientist.