Long-Term Sustainability of QI Interventions: Outcomes in Opioid Prescribing for Postoperative Care

The opioid epidemic remains a critical public health challenge. This study aimed to assess the sustainability of improved opioid prescribing practices following the implementation of an intervention in the postoperative clinical setting.

Conducted as a quality improvement (QI) initiative at an academic medical center, this pre-post interventional study spanned four phases: preimplementation (October 2019-June 2020), implementation (July-December 2020), and postimplementation (January-December 2021), followed by the sustainability phase (January 2022-November 2023). The authors examined opioid-naïve patients ≥ 18 years undergoing procedures under specified Current Procedural Terminology (CPT) codes. Interventions included education and monthly feedback reports based on Opioid Prescribing Engagement Network (OPEN) guidelines. Descriptive statistics were used to summarize data; chi-square test was used to compare categorical variables.

The postimplementation cohort consisted of 2,513 patients vs. 2,290 in the preimplementation group, with statistically similar baseline characteristics. We observed a compliance increase to 68.9% vs. 45.1% (p < 0.001). The sustainability cohort included 4,976 patients and had a further increase to 80.1% compliance compared to the postimplementation cohort (p < 0.001). Residents (nonresident prescribers include advanced practice providers and attending surgeons) were more likely to be prescribing providers in postimplementation vs. sustainability cohort, 39.6% vs. 22.2% (p < 0.001). Subanalysis was conducted across 12 consecutive months comparing the period with a consistent distribution of performance reports with the period when no performance reminders were sent for the previous month (November 2022-May 2023 vs. June-November 2023). The compliance rates for these two subperiods did not differ (82.04% vs. 81.98%, respectively, p = 0.97).

This study's data demonstrate that a well-structured QI initiative can lead to sustained improvements in opioid prescribing practices and "enculturation" to maintain long-term change within an institution.