{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:10:44Z","timestamp":1786975844095,"version":"build-2736575974"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"\n Importance<\/jats:title>\n Prescribing more opioids than patients need following surgery is associated with long-term use, misuse, and diversion. Interventions are needed to increase adherence to procedure-specific guidelines while preserving the ability to manage pain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test whether providing clinicians monthly feedback with peer comparisons and patient-reported outcomes would increase adherence to postoperative opioid prescribing guidelines.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This stepped-wedge cluster randomized clinical trial was conducted at 6 surgical departments or divisions caring for patients undergoing 30 high-volume surgical procedures in a 5-hospital academic health system in Pennsylvania and New Jersey. Surgical clinicians (attending surgeons, advanced practice professionals, and resident physicians) with 5 or more opioid prescriptions per month for eligible procedures during a 3-month period at baseline were eligible for inclusion. Six clinician clusters were randomly assigned to the intervention in 3 steps offset by 2 months. Each step included a 9-month baseline, a 6-month intervention, and a 6-month follow-up. The first step of the intervention began on June 8, 2022. Follow-up concluded in October 2023, and data analysis was performed from November 2023 to April 2024.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Clinicians were emailed a report on their most frequently performed procedures, which contained a figure of the following mean numbers: pills prescribed relative to guidelines, pills peer clinicians prescribed, and pills patients reported using after a procedure; an additional figure displayed patients\u2019 self-reported ability to manage pain. Monthly reports included prescribing trends, peer comparison feedback, and reminders about how many pills patients take and how well patients reported pain management with guideline-adherent prescriptions.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the proportion of guideline-adherent opioid prescriptions; secondary outcomes included patient-reported ability to manage pain (measured on a 0 to 10 scale, with 0 being not at all able), pain score, pills prescribed, pills leftover, and refill rate.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 143 surgical clinicians treating 20\u202f557 patients were included (10\u202f069 at baseline, 5382 during the intervention, and 5106 at follow-up). Mean (SD) patient age was 57.0 (15.7) years, and 10\u202f996 patients (53.5%) were female. The baseline guideline adherence rate was 57.2%. During the intervention, adherence increased to 71.8%, with an adjusted intervention effect of 5.3% (95% CI, 2.0%-8.7%). The impact of the intervention increased over time, and adherence remained above baseline at follow-up (74.4%). The largest change was noted for orthopedic procedures of knee, hip, and shoulder arthroplasty. Patient-reported pain and ability to manage pain were unchanged.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this stepped-wedge cluster randomized clinical trial, a feedback intervention using peer comparisons and patient-reported data increased opioid guideline adherence without compromising patients\u2019 ability to manage pain.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05358522<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2025.1672","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T11:00:49Z","timestamp":1749639649000},"page":"866","source":"Crossref","is-referenced-by-count":7,"title":["Peer and Patient Feedback to Increase Adherence to Postoperative Opioid Prescribing Guidelines"],"prefix":"10.1001","volume":"160","author":[{"given":"Anish K.","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of Pennsylvania, Philadelphia"},{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Ebert","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Nudge Unit, Penn Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiying","family":"Xiong","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Nudge Unit, Penn Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zarina S.","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"Shofer","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yevgeniy","family":"Gitelman","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Department of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Do","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Department of Neurology, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan A.","family":"Spencer","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Nudge Unit, Penn Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Madeline","family":"Grenader","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Nudge Unit, Penn Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael O.","family":"Harhay","sequence":"additional","affiliation":[{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Nudge Unit, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Kit","family":"Delgado","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Pennsylvania, Philadelphia"},{"name":"Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Nudge Unit, Penn Medicine, Philadelphia, Pennsylvania"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"soi250028r1","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1001\/jamasurg.2017.0831","article-title":"Prescription opioid analgesics commonly unused after surgery: a systematic review.","volume":"152","author":"Bicket","year":"2017","journal-title":"JAMA Surg"},{"issue":"3","key":"soi250028r2","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.20.0440","article-title":"An automated text messaging program to inform postoperative opioid 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