University of California San Francisco

Leveraging learning health systems to improve prescribing behavior

Another main component of Dr. Bongiovanni’s research involves leveraging learning health systems by using implementation science to improve uptake of clinician behavior, especially to improve the use of multimodal pain medication for surgical patients.  Much of her work addresses outcomes in surgical patients, particularly pain control and multimodal analgesia to decrease opioid prescribing and promote better pain control, especially in older adults. Through her clinical work, Dr. Bongiovanni recognized opportunities to improve our approach to analgesia in surgical patients. During clinical fellowship, she initiated two patient-centered quality improvement programs at San Francisco General Hospital (SFGH). First, she led a team of multi-disciplinary providers introducing non-opioid forms of pain and symptom management for surgical patients in the intensive care unit. This work was supported by two grants through the Patient Care Fund. Second, through a Graduate Medical Education incentive program, Dr. Bongiovanni initiated a quality improvement project to increase multimodal analgesia and decrease opioid prescribing at discharge for surgical patients at SFGH. Both programs were successful, with an increase of acetaminophen prescribed on discharge from 48 to 100%, an increase in prescribing of ibuprofen from 0 to 81%, and one-third decrease in opioid prescribing. The project was so impactful in changing resident behavior and improving care that it has been expanded to include more procedures and other surgical services. These initiatives included translating patient discharge instructions into multiple languages, to equitably reach non-English-speaking patients, and making discharge instructions available both electronically and as a hand-out in the Post-Anesthesia Recovery Area. Finally, Dr. Bongiovanni developed and led a large randomized controlled trial to improve uptake of multimodal pain medication hospital wide.

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