Opioid prescribing after Joint Commission hospital accreditation inspections: quasi-experimental analysis
David C Cron, Christopher M Worsham, Charles F Bray, Anupam B JenaAbstract
Objective
To assess the association between hospital accreditation inspections, which have historically included systematic evaluations of inpatient pain management practices, and opioid prescribing at hospital discharge.
Design
Quasi-experimental analysis.
Setting
US hospitals, stratified by hospital teaching status.
Participants
233 744 hospital admissions for Medicare beneficiaries with no Part D claim for opioids in the 90 days before hospital admission who were admitted near the dates of Joint Commission hospital accreditation visits.
Main outcome measure
The primary outcome was opioid prescribing to Medicare beneficiaries with no opioid claim in the 90 days before hospital admission during accreditation visits, leveraging the clinically arbitrary timing of these inspections for quasi-experimental analysis. Weekly per beneficiary rates of opioid prescription at discharge were compared with rates in the ±3 weeks surrounding the inspection to assess whether opioid prescribing at discharge increased during inspection weeks, when inpatient pain management practices are scrutinised.
Results
Overall, 21 156 hospital admissions at 90 teaching hospitals and 212 588 at 2400 non-teaching hospitals during 2008-18 were analysed. Patient characteristics were similar between inspection and surrounding non-inspection weeks for both hospital types. The adjusted odds of post-discharge opioid prescription was, however, 19% higher during inspection versus non-inspection weeks at teaching hospitals (1.19, 95% confidence interval (CI) 1.05 to 1.34, P=0.007). Non-teaching hospitals showed no statistically significant change in opioid prescribing during inspection versus non-inspection weeks (adjusted odds ratio 1.02, 95% CI 0.98 to 1.07, P=0.36).
Conclusion
Opioid prescribing at hospital discharge was higher among Medicare beneficiaries admitted to teaching hospitals during weeks of unannounced Joint Commission inspections compared with surrounding non-inspection weeks, raising the possibility that heightened focus on pain management may influence clinicians’ decisions to prescribe opioids.