Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study
BackgroundOur objective is to determine the effect of a new national clinical practice guideline (CPG) for pain management after childbirth, as implemented with less vs. more intensive implementation support, on postpartum opioid prescribing.MethodsA quasi-experimental analysis will measure the impa...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-03-01
|
| Series: | Frontiers in Global Women's Health |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fgwh.2025.1504511/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850037119143116800 |
|---|---|
| author | Michelle H. Moniz Michelle H. Moniz Michelle H. Moniz Amy M. Kilbourne Amy M. Kilbourne Alex F. Peahl Alex F. Peahl Alex F. Peahl Jennifer F. Waljee Jennifer F. Waljee Jennifer F. Waljee Shelytia Cocroft Carey Simpson Carey Simpson Lisa Kane Low Lisa Kane Low Lisa Kane Low Mark C. Bicket Mark C. Bicket Mark C. Bicket Michael J. Englesbe Michael J. Englesbe Michael J. Englesbe Molly J. Stout Molly J. Stout Vidhya Gunaseelan Vidhya Gunaseelan Althea Bourdeau Althea Bourdeau May Hu Carrie Miller Carrie Miller Shawna N. Smith Shawna N. Smith Shawna N. Smith |
| author_facet | Michelle H. Moniz Michelle H. Moniz Michelle H. Moniz Amy M. Kilbourne Amy M. Kilbourne Alex F. Peahl Alex F. Peahl Alex F. Peahl Jennifer F. Waljee Jennifer F. Waljee Jennifer F. Waljee Shelytia Cocroft Carey Simpson Carey Simpson Lisa Kane Low Lisa Kane Low Lisa Kane Low Mark C. Bicket Mark C. Bicket Mark C. Bicket Michael J. Englesbe Michael J. Englesbe Michael J. Englesbe Molly J. Stout Molly J. Stout Vidhya Gunaseelan Vidhya Gunaseelan Althea Bourdeau Althea Bourdeau May Hu Carrie Miller Carrie Miller Shawna N. Smith Shawna N. Smith Shawna N. Smith |
| author_sort | Michelle H. Moniz |
| collection | DOAJ |
| description | BackgroundOur objective is to determine the effect of a new national clinical practice guideline (CPG) for pain management after childbirth, as implemented with less vs. more intensive implementation support, on postpartum opioid prescribing.MethodsA quasi-experimental analysis will measure the impact of post-childbirth pain management guidelines on opioid prescribing in a statewide hospital collaborative, overall and among key patient subgroups at risk for inequitable care and outcomes. We will also use a randomized, non-responder design and mixed-methods approaches to evaluate the effects of Replicating Effective Programs (REP), a theory-driven, scalable implementation intervention, and Enhanced REP (E-REP; i.e., REP augmented with facilitation, which is individualized consultation with site champions to overcome local barriers) on the uptake of the CPG. The study will include hospitals within the Obstetrics Initiative (OBI), a perinatal collaborative quality initiative funded by Blue Cross Blue Shield of Michigan that includes 68 member hospitals serving more than 120,000 postpartum people, over approximately 15 months. Hospitals not initially responding to REP—defined by performance <15th percentile of all OBI hospitals for (a) inpatient order for opioid-sparing postpartum pain management (e.g., scheduled acetaminophen and non-steroidal anti-inflammatory drugs when not contraindicated), or (b) amount of opioid prescribed at discharge—will be allocated via block randomization to continue REP or to E-REP. Using interrupted time series analyses, the primary analysis will evaluate the rate of postpartum opioid-sparing prescribing metrics at the time of discharge (primary outcome) and opioid prescription refills and high-risk prescribing (secondary outcomes) before and after CPG implementation with REP. We will evaluate inequities in outcomes by patient, procedure, prescriber, and hospital factors. Exploratory analyses will examine temporal trends in patient-reported outcomes and the effects of continued REP vs. E-REP among slower-responder sites. We will evaluate implementation outcomes (e.g., acceptability, feasibility, costs, needed REP and E-REP adaptations) using clinician and patient surveys and qualitative methods (ClinicalTrials.gov identifier: NCT06285123).DiscussionFindings will inform refinements to the REP and E-REP interventions and add to the literature on the effectiveness of facilitation to promote uptake of evidence-based clinical practices in maternity care. |
| format | Article |
| id | doaj-art-53ccfc2ed9154519b67f2f7fd5130fbd |
| institution | DOAJ |
| issn | 2673-5059 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Global Women's Health |
| spelling | doaj-art-53ccfc2ed9154519b67f2f7fd5130fbd2025-08-20T02:56:58ZengFrontiers Media S.A.Frontiers in Global Women's Health2673-50592025-03-01610.3389/fgwh.2025.15045111504511Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation studyMichelle H. Moniz0Michelle H. Moniz1Michelle H. Moniz2Amy M. Kilbourne3Amy M. Kilbourne4Alex F. Peahl5Alex F. Peahl6Alex F. Peahl7Jennifer F. Waljee8Jennifer F. Waljee9Jennifer F. Waljee10Shelytia Cocroft11Carey Simpson12Carey Simpson13Lisa Kane Low14Lisa Kane Low15Lisa Kane Low16Mark C. Bicket17Mark C. Bicket18Mark C. Bicket19Michael J. Englesbe20Michael J. Englesbe21Michael J. Englesbe22Molly J. Stout23Molly J. Stout24Vidhya Gunaseelan25Vidhya Gunaseelan26Althea Bourdeau27Althea Bourdeau28May Hu29Carrie Miller30Carrie Miller31Shawna N. Smith32Shawna N. Smith33Shawna N. Smith34Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United StatesInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United StatesObstetrics Initiative, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United StatesOffice of Research and Development, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, United StatesDepartment of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United StatesDepartment of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United StatesInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United StatesObstetrics Initiative, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United StatesInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United StatesDepartment of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesOpioid Prescribing Engagement Network, Ann Arbor, MI, United StatesCenter for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United StatesObstetrics Initiative, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United StatesDepartment of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United StatesDepartment of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United StatesObstetrics Initiative, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United StatesSchool of Nursing, University of Michigan, Ann Arbor, MI, United StatesInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United StatesOpioid Prescribing Engagement Network, Ann Arbor, MI, United States0Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United StatesInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United StatesDepartment of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesCenter for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United StatesDepartment of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United StatesObstetrics Initiative, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United StatesOpioid Prescribing Engagement Network, Ann Arbor, MI, United States0Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United StatesDepartment of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United StatesObstetrics Initiative, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States1Department of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesDepartment of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United StatesObstetrics Initiative, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United StatesInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States2Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States3Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United StatesBackgroundOur objective is to determine the effect of a new national clinical practice guideline (CPG) for pain management after childbirth, as implemented with less vs. more intensive implementation support, on postpartum opioid prescribing.MethodsA quasi-experimental analysis will measure the impact of post-childbirth pain management guidelines on opioid prescribing in a statewide hospital collaborative, overall and among key patient subgroups at risk for inequitable care and outcomes. We will also use a randomized, non-responder design and mixed-methods approaches to evaluate the effects of Replicating Effective Programs (REP), a theory-driven, scalable implementation intervention, and Enhanced REP (E-REP; i.e., REP augmented with facilitation, which is individualized consultation with site champions to overcome local barriers) on the uptake of the CPG. The study will include hospitals within the Obstetrics Initiative (OBI), a perinatal collaborative quality initiative funded by Blue Cross Blue Shield of Michigan that includes 68 member hospitals serving more than 120,000 postpartum people, over approximately 15 months. Hospitals not initially responding to REP—defined by performance <15th percentile of all OBI hospitals for (a) inpatient order for opioid-sparing postpartum pain management (e.g., scheduled acetaminophen and non-steroidal anti-inflammatory drugs when not contraindicated), or (b) amount of opioid prescribed at discharge—will be allocated via block randomization to continue REP or to E-REP. Using interrupted time series analyses, the primary analysis will evaluate the rate of postpartum opioid-sparing prescribing metrics at the time of discharge (primary outcome) and opioid prescription refills and high-risk prescribing (secondary outcomes) before and after CPG implementation with REP. We will evaluate inequities in outcomes by patient, procedure, prescriber, and hospital factors. Exploratory analyses will examine temporal trends in patient-reported outcomes and the effects of continued REP vs. E-REP among slower-responder sites. We will evaluate implementation outcomes (e.g., acceptability, feasibility, costs, needed REP and E-REP adaptations) using clinician and patient surveys and qualitative methods (ClinicalTrials.gov identifier: NCT06285123).DiscussionFindings will inform refinements to the REP and E-REP interventions and add to the literature on the effectiveness of facilitation to promote uptake of evidence-based clinical practices in maternity care.https://www.frontiersin.org/articles/10.3389/fgwh.2025.1504511/fullacute painopioidpostpartumimplementationguideline |
| spellingShingle | Michelle H. Moniz Michelle H. Moniz Michelle H. Moniz Amy M. Kilbourne Amy M. Kilbourne Alex F. Peahl Alex F. Peahl Alex F. Peahl Jennifer F. Waljee Jennifer F. Waljee Jennifer F. Waljee Shelytia Cocroft Carey Simpson Carey Simpson Lisa Kane Low Lisa Kane Low Lisa Kane Low Mark C. Bicket Mark C. Bicket Mark C. Bicket Michael J. Englesbe Michael J. Englesbe Michael J. Englesbe Molly J. Stout Molly J. Stout Vidhya Gunaseelan Vidhya Gunaseelan Althea Bourdeau Althea Bourdeau May Hu Carrie Miller Carrie Miller Shawna N. Smith Shawna N. Smith Shawna N. Smith Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study Frontiers in Global Women's Health acute pain opioid postpartum implementation guideline |
| title | Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study |
| title_full | Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study |
| title_fullStr | Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study |
| title_full_unstemmed | Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study |
| title_short | Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study |
| title_sort | can theory driven implementation interventions help clinician champions promote opioid stewardship after childbirth protocol for a pragmatic implementation study |
| topic | acute pain opioid postpartum implementation guideline |
| url | https://www.frontiersin.org/articles/10.3389/fgwh.2025.1504511/full |
| work_keys_str_mv | AT michellehmoniz cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT michellehmoniz cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT michellehmoniz cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT amymkilbourne cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT amymkilbourne cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT alexfpeahl cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT alexfpeahl cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT alexfpeahl cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT jenniferfwaljee cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT jenniferfwaljee cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT jenniferfwaljee cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT shelytiacocroft cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT careysimpson cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT careysimpson cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT lisakanelow cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT lisakanelow cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT lisakanelow cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT markcbicket cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT markcbicket cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT markcbicket cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT michaeljenglesbe cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT michaeljenglesbe cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT michaeljenglesbe cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT mollyjstout cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT mollyjstout cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT vidhyagunaseelan cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT vidhyagunaseelan cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT altheabourdeau cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT altheabourdeau cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT mayhu cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT carriemiller cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT carriemiller cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT shawnansmith cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT shawnansmith cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy AT shawnansmith cantheorydrivenimplementationinterventionshelpclinicianchampionspromoteopioidstewardshipafterchildbirthprotocolforapragmaticimplementationstudy |