Standardized Order Sets Do Not Eliminate Racial or Ethnic Inequities in Postpartum Pain Management.

Area of Science:

• Obstetrics and Gynecology
• Health Services Research
• Pain Management

Background:

• Racial and ethnic inequities persist in post-cesarean pain management.
• Standardized order sets are a potential strategy to mitigate these disparities.

Purpose of the Study:

• To evaluate the impact of a standardized pain management order set on racial and ethnic inequities in post-cesarean pain care.
• To quantify changes in pain evaluation and management processes and outcomes stratified by race and ethnicity.

Main Methods:

• Retrospective cohort study comparing pre- and post-implementation periods of a standardized post-cesarean order set.
• Analysis of electronic medical records for pain scores, pain assessments, and analgesic doses (opioids, NSAIDs, acetaminophen).
• Propensity score adjustment and difference-in-difference analysis to assess changes in pain management outcomes by race/ethnicity.

Main Results:

• Severe pain remained more prevalent among non-Hispanic Black patients post-implementation.
• While overall opioid use decreased and nonopioid analgesic use increased, racial and ethnic inequities in assessments and treatment largely persisted.
• A modest increase in NSAID doses was observed for Hispanic patients 24-48 hours postpartum.

Conclusions:

• The standardized pain management order set reduced overall postpartum opioid use but did not resolve racial and ethnic disparities in pain evaluation and management.
• Future interventions should focus on racial equity-centered education and strategies to eliminate these disparities in pain management.