Annals of family medicine · 2026
Budget Impact Analysis of the Balanced Opioid Initiative: A Cluster Randomized Trial Aimed at Deprescribing Opioids for Chronic Pain in Primary Care Settings.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Quanbeck Andrew, Li Xiang, Cohen Andrew, Butzine Ella, Brown Randall T
Аннотация
PURPOSE: This study compared the budget impact of 4 deimplementation strategies designed to promote guideline-concordant opioid prescribing.
METHODS: In this cluster randomized trial of 32 primary care clinics, deimplementation strategies targeted the system, clinic, and prescriber levels. All clinics received system-level educational meetings with audit/feedback reports. At month 3, one-half were randomized to add practice facilitation, a clinic-level strategy. At month 9, one-half were again randomized to add prescriber peer consulting, a prescriber-level strategy, resulting in 4 groups: system, system + clinic, system + prescriber, and system + clinic + prescriber. The primary outcome was change in mean morphine milligram equivalent dosage. Secondary outcomes included adherence to opioid risk mitigation metrics (urine drug testing, treatment agreements, pain/function screening, and mental health screening). We calculated the cost of delivering each implementation strategy and budget impacts associated with changes in health care utilization.
RESULTS: Implementation costs per clinic were as follows: $4,416 (system), $5,610 (system + clinic), $7,164 (system + prescriber), and $8,358 (system + clinic + prescriber). With health care utilization changes incorporated, the system strategy's per-clinic costs increased to $10,908, yielding the greatest budget impact, the system + clinic strategy had the least budget impact at $7,266, and the system + prescriber budget impact was $9,625. The budget impact for system + clinic + prescriber was $8,703.
CONCLUSIONS: Higher-intensity deimplementation strategies significantly decreased mean morphine milligram equivalent and increased pain/function screening while decreasing treatment agreements and urine drug screening. The lowest-cost strategy (system) led to more costly downstream health care utilization, resulting in the greatest budget impact. Adding clinic- and prescriber-level strategies might help health systems decrease reliance on opioids for chronic pain, with less budget impact than providing system-level strategies alone.
METHODS: In this cluster randomized trial of 32 primary care clinics, deimplementation strategies targeted the system, clinic, and prescriber levels. All clinics received system-level educational meetings with audit/feedback reports. At month 3, one-half were randomized to add practice facilitation, a clinic-level strategy. At month 9, one-half were again randomized to add prescriber peer consulting, a prescriber-level strategy, resulting in 4 groups: system, system + clinic, system + prescriber, and system + clinic + prescriber. The primary outcome was change in mean morphine milligram equivalent dosage. Secondary outcomes included adherence to opioid risk mitigation metrics (urine drug testing, treatment agreements, pain/function screening, and mental health screening). We calculated the cost of delivering each implementation strategy and budget impacts associated with changes in health care utilization.
RESULTS: Implementation costs per clinic were as follows: $4,416 (system), $5,610 (system + clinic), $7,164 (system + prescriber), and $8,358 (system + clinic + prescriber). With health care utilization changes incorporated, the system strategy's per-clinic costs increased to $10,908, yielding the greatest budget impact, the system + clinic strategy had the least budget impact at $7,266, and the system + prescriber budget impact was $9,625. The budget impact for system + clinic + prescriber was $8,703.
CONCLUSIONS: Higher-intensity deimplementation strategies significantly decreased mean morphine milligram equivalent and increased pain/function screening while decreasing treatment agreements and urine drug screening. The lowest-cost strategy (system) led to more costly downstream health care utilization, resulting in the greatest budget impact. Adding clinic- and prescriber-level strategies might help health systems decrease reliance on opioids for chronic pain, with less budget impact than providing system-level strategies alone.