Peer and Patient Feedback to Increase Adherence to Postoperative Opioid Prescribing Guidelines: A Stepped-Wedge Cluster Randomized Clinical Trial
Primary result · Guideline adherenceResult — go to the resultAdjusted intervention effect 5.3% 95% CI 2.0%–8.7%Authors' conclusion
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' ability to manage pain.
Study context
- Population
- Surgical clinicians (≥5 opioid prescriptions/month for eligible procedures) caring for patients undergoing 30 high-volume surgical procedures, 6 surgical departments, Pennsylvania and New Jersey143 surgical clinicians
- Participants
- 20,557 participants
- Comparison
- Intervention vs Baseline
- Baselinen = 10,069reference
- Interventionn = 5,382
- Follow-upn = 5,106
- Primary endpoint
- Proportion of guideline-adherent opioid prescriptions
Methodological detailsstepped-wedge, cluster randomized, 3 steps offset by 2 months, 5-hospital academic health system, Each step: 9-month baseline, 6-month intervention, 6-month follow-up; first step began June 8, 2022; follow-up concluded October 2023
- Stepped-wedge
- Cluster randomized
- 3 steps offset by 2 months
- 5-hospital academic health system
- Each step: 9-month baseline, 6-month intervention, 6-month follow-up; first step began June 8, 2022; follow-up concluded October 2023
Primary result
Guideline adherence
Adjusted intervention effect
5.3%
95% CI 2.0%–8.7%
By group
As reported in the abstract
Secondary outcomes
- Guideline adherence at follow-up
- 74.4%
Guideline adherence at follow-up
- Adherence remained above baseline at follow-up; intervention impact increased over time
Guideline adherence by procedure (subgroup)
- Largest change for knee, hip and shoulder arthroplasty
Safety
Patient-reported pain and ability to manage pain
- Unchanged
Original publication
Peer and Patient Feedback to Increase Adherence to Postoperative Opioid Prescribing Guidelines: A Stepped-Wedge Cluster Randomized Clinical Trial. JAMA Surg. Published 1 August 2025. doi:10.
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