{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T07:34:00Z","timestamp":1780385640336,"version":"3.54.1"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Despite guidelines recommending avoidance of benzodiazepine administration to older patients, many of them now receive benzodiazepines as a part of anesthesia care. The effectiveness of clinician- and patient-facing interventions to discourage such use remains insufficiently characterized.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the effect of clinician peer comparison, patient informational mail, or a combination of these interventions compared with usual care on the rate of perioperative benzodiazepine administration to older patients.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This 2\u2009\u00d7\u20092 factorial, stepped-wedge, cluster randomized clinical trial of a corporate quality improvement initiative was conducted between August 8, 2022, and May 28, 2023, across 415 hospitals, surgery centers, and physician offices in 8 US states served by anesthesia clinicians from a national anesthesia practice. Participants were adults aged 65 years or older who underwent an elective surgical or endoscopic procedure with general anesthesia. Data analyses followed the intention-to-treat principle.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Patients were randomly assigned to 1 of 4 groups\u2014clinician peer comparison (wherein clinicians received feedback regarding their performance compared with other clinicians in the practice), patient informational mail (wherein patients received an informational letter encouraging them to have a discussion regarding medication selection with their clinician on the day of surgery), both interventions, or usual care (no intervention).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Rate of benzodiazepine administration during anesthesia care and patient satisfaction with anesthesia care (measured by the Anesthesia Patient Satisfaction Questionnaire, version 2).<\/jats:p><\/jats:sec>Results<\/jats:title>Among the 509\u202f269 enrolled participants (255 871 females [50.2%]; mean [SD] age, 74 [7] years), 81\u202f363 (16.0%) were assigned to clinician peer comparison, 98\u202f520 (19.3%) to patient informational mail, 169\u202f712 (33.3%) to both interventions, and 159\u202f674 (31.4%) to usual care. Among patients who received benzodiazepine during anesthesia care, 24.5% were in the usual care group compared with 19.7% in the clinician peer comparison group, 20.0% in the patient informational mail group, and 19.7% in the combination group. After adjustment for time, none of the study interventions were associated with lower odds of benzodiazepine administration compared with usual care (odds ratio [OR], 1.02 [95% CI, 0.98-1.07]; P<\/jats:italic>\u2009=\u2009.35 for clinician peer comparison; OR, 1.01 [95% CI, 0.96-1.05]; P<\/jats:italic>\u2009=\u2009.81 for patient informational mail; and OR, 1.11 [95% CI, 1.05-1.16]; P<\/jats:italic>\u2009&amp;lt;\u2009.001 for combined interventions). Satisfaction scores were high in all groups and did not vary by treatment assignment.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This randomized clinical trial found that clinician peer comparison, patient informational mail, or a combination of both interventions did not reduce benzodiazepine administration to older patients compared with usual care; patient satisfaction remained high throughout the study. Overall, the findings suggest a need to explore other patient-targeted interventions to improve anesthesia care.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>Clinicaltrials.gov Identifier: NCT05436392<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.42207","type":"journal-article","created":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T15:33:01Z","timestamp":1730388781000},"page":"e2442207","source":"Crossref","is-referenced-by-count":3,"title":["Strategies to Limit Benzodiazepine Use in Anesthesia for Older Adults"],"prefix":"10.1001","volume":"7","author":[{"given":"Mark D.","family":"Neuman","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia"},{"name":"Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, 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