Design and Implementation of an Opioid Scorecard for Hospital System-Wide Peer Comparison of Opioid Prescribing Habits: Observational Study

Background: Reductions in opioid prescribing by health care providers can lead to a decreased risk of opioid dependencein patients. Peer comparison has been demonstrated to impact providers' prescribing habits, though its effect on opioidprescribing has predominantly been studied in the emergency department setting. Objective: The purpose of this study is to describe the development of an enterprise-wide opioid scorecard, the architecture ofits implementation, and plans for future research on its effects. Methods: Using data generated by the author's enterprise vendor-based electronic health record, the enterprise analyticssoftware, and expertise from a dedicated group of informaticists, physicians, and analysts, the authors developed an opioidscorecard that was released on a quarterly basis via email to all opioid prescribers at our institution. These scorecards compareproviders' opioid prescribing habits on the basis of established metrics to those of their peers within their specialty throughoutthe enterprise. Results: At the time of this study's completion, 2034 providers have received at least 1 scorecard over a 5-quarter periodending in September 2021. Poisson regression demonstrated a 1.6% quarterly reduction in opioid prescribing, and chi-squareanalysis demonstrated pre-post reductions in the proportion of prescriptions longer than 5 days' duration and a morphineequivalent daily dose of >50. Conclusions: To our knowledge, this is the first peer comparison effort with high-quality evidence-based metrics of this scalepublished in the literature. By sharing this process for designing the metrics and the process of distribution, the authors hopeto influence other health systems to attempt to curb the opioid pandemic through peer comparison. Future research examiningthe effects of this intervention could demonstrate significant reductions in opioid prescribing, thus potentially reducing theprogression of individual patients to opioid use disorder and the associated increased risk of morbidity and mortality.