Drivers of variation in postpartum opioid prescribing across hospitals participating in a statewide maternity care quality collaborative.

Autor: Peahl AF; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA., Low LK; School of Nursing, University of Michigan, Ann Arbor, Michigan, USA., Langen ES; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA., Moniz MH; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA., Aaron B; Medical School, University of Michigan, Ann Arbor, Michigan, USA., Hu HM; Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA., Waljee J; Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA., Townsel C; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
Jazyk: angličtina
Zdroj: Birth (Berkeley, Calif.) [Birth] 2024 Sep; Vol. 51 (3), pp. 541-558. Date of Electronic Publication: 2023 Dec 30.
DOI: 10.1111/birt.12809
Abstrakt: Background: We describe variation in postpartum opioid prescribing across a statewide quality collaborative and assess the proportion due to practitioner and hospital characteristics.
Methods: We assessed postpartum prescribing data from nulliparous, term, singleton, vertex births between January 2020 and June 2021 included in the clinical registry of a statewide obstetric quality collaborative funded by Blue Cross Blue Shield of Michigan. Data were summarized using descriptive statistics. Mixed effect logistic regression and linear models adjusted for patient characteristics and assessed practitioner- and hospital-level predictors of receiving a postpartum opioid prescription and prescription size. Relative contributions of practitioner and hospital characteristics were assessed using the intraclass correlation coefficient.
Results: Of 40,589 patients birthing at 68 hospitals, 3.0% (872/29,412) received an opioid prescription after vaginal birth and 87.8% (9812/11,177) received one after cesarean birth, with high variation across hospitals. In adjusted models, the strongest patient-level predictors of receiving a prescription were cesarean birth (aOR 899.1, 95% CI 752.8-1066.7) and third-/fourth-degree perineal laceration (aOR 25.7, 95% CI 17.4-37.9). Receiving care from a certified nurse-midwife (aOR 0.63, 95% CI 0.48-0.82) or family medicine physician (aOR 0.60, 95%CI 0.39-0.91) was associated with lower prescribing rates. Hospital-level predictors included receiving care at hospitals with <500 annual births (aOR 4.07, 95% CI 1.61-15.0). A positive safety culture was associated with lower prescribing rates (aOR 0.37, 95% CI 0.15-0.88). Much of the variation in postpartum prescribing was attributable to practitioners and hospitals (prescription receipt: practitioners 25.1%, hospitals 12.1%; prescription size: practitioners 5.4%, hospitals: 52.2%).
Discussion: Variation in postpartum opioid prescribing after birth is high and driven largely by practitioner- and hospital-level factors. Opioid stewardship efforts targeted at both the practitioner and hospital level may be effective for reducing opioid prescribing harms.
(© 2023 The Authors. Birth published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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