Jeff Kullgren

Using Default Opioid Prescription Settings to Limit Excessive Opioid Prescribing to Adolescents and Young Adults

Research Project Description
Kao-Ping Chua, Chad Michael Brummett, Amy S B Bohnert, Jeff Kullgren, Lisa Prosser, Sean Esteban McCabe, Anne Sales, Michael D. Fetters, Gary L. Freed

Candidate: Kao-Ping Chua, MD, PhD, is a general pediatrician and health services researcher who aims to design and evaluate interventions to promote appropriate opioid prescribing to children and young adults.

Research Context: Adolescents and young adults collectively have the highest rates of prescription opioid misuse in the U.S., and leftover opioids from prior prescriptions are a key driver of this misuse. Therefore, it is crucial to prevent excessive opioid prescribing in this population. One approach to achieve this goal is to use default dosing settings for opioid prescriptions written in electronic health record (EHR) systems. Although default setting interventions have demonstrated the ability to change opioid prescribing among providers for adults, it is unclear whether these results generalize to providers for adolescents or young adults specifically. Moreover, no such intervention has used patient-reported opioid consumption data to inform the choice of the default settings. This proposal will pilot an EHR-based intervention using default opioid dosing settings for adolescents and young adults undergoing tonsillectomy and/or adenoidectomy (removal of the tonsils and/or adenoids), which are common surgeries in which long courses of opioid therapy are often prescribed.

Specific Aims: 1) To elucidate the range of provider experiences with opioid prescribing to adolescents and young adults undergoing tonsillectomy and/or adenoidectomy, and to use these insights to design and evaluate an EHR intervention using default opioid dosing settings that are based on patient need; 2) To assess providers? experience with and perceptions of the intervention; 3) To identify target procedures and conditions for future interventions to promote appropriate opioid prescribing to adolescents and young adults in Michigan.

Research Plan: Dr. Chua will use qualitative interviews of providers, clinical warehouse data, and patient surveys to design and evaluate an intervention using default opioid dosing settings for adolescents and young adults undergoing tonsillectomy and/or adenoidectomy at the University of Michigan. The default settings will be based on patient-reported opioid consumption data collected before the intervention is implemented, potentially increasing the likelihood that prescribing decisions reflect patient need. Dr. Chua will use claims from adolescents and young adults covered by Blue Cross Blue Shield of Michigan and Michigan Medicaid to identify other common procedures and conditions with high rates and quantities of opioid prescribing; these procedures and conditions may represent targets for future interventions in R01 grants.

Career Development Plan: Dr. Chua will develop expertise in 1) Qualitative and mixed methods research; 2) Implementation research; and 3) Opioid prescribing and substance misuse. His career development will be supported by close mentorship, advanced coursework, and research meetings/seminars.

Environment: The University of Michigan offers the ideal environment for Dr. Chua to pursue this training, with the outstanding guidance of well-established mentors and interdisciplinary institutes dedicated to his success.

National Institute On Drug Abuse

Funding Period: 5/1/2019 to 4/30/2024

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