Developing evidence-based, guideline-concordant updated patient safety PDMP alerts

The University of California, Davis seeks 2023 Harold Rogers PDMP Solicitation Category 2 funding to help PDMPs develop updated, evidence-based, guideline-concordant patient safety alerts. The purpose of this project is to strengthen PDMPs’ capacity to generate and implement new patient safety alerts that are based on current prescribing patterns and clinical guidelines. Many PDMPs are using patient safety alerts developed in the 2000s and early 2010s, even though controlled substance prescribing practices have changed drastically in the past decade, including a substantial drop in opioid prescribing rates. Additionally, the CDC’s updated 2022 opioid prescribing guidelines no longer endorse specific opioid dose thresholds and caution clinicians that rapid opioid dose reduction can increase patients’ overdose risk. PDMP administrators need information that will allow them to implement evidence-based patient safety alerts that reflect current prescribing patterns and the CDC’s updated clinical guidelines. Objective 1 of this project is to generate evidence for updating PDMP safety alerts by linking statewide California PDMP and death certificate records from 2020-2022 and analyzing these linked data to identify outlier prescribing patterns and prescribing patterns associated with fatal overdose risk. Objective 2 will involve establishing a framework that PDMP administrators can use to generate updated patient safety alerts for implementation. To accomplish Objective 2, the impact of updating PDMP alerts on user burden (“alert fatigue”) will be estimated by comparing the numbers of alerts expected to be generated across a range of potential updated alert types and thresholds versus the number of alerts generated by California’s current PDMP alert system. Findings from these analyses and from Objective 1 will then be shared with multiple stakeholders, including California’s PDMP administrator, the California Department of Public Health, and PDMP users, and their input on the optimal content and thresholds to utilize for generating updated alerts will be elicited. The service area for this project is all of California. Expected outcomes include data reports and analyses for each Objective and a framework for updating PDMP alerts. Project findings, analytic methods, statistical code, and the stakeholder engagement approach will be shared with PDMP administrators in California and other states. PDMP administrators are expected to benefit from this project, which will strengthen their capacity to generate and test updated, evidence-based patient safety alerts that ultimately benefit patients and prescribers by promoting safer, evidence-based controlled substance prescribing.