(380) Provider and hospital-level predictors of variation in postpartum opioid prescribing: a statewide analysis

We assessed postpartum prescribing data from nulliparous, term, singleton, vertex births, collected through chart abstraction from a statewide quality collaborative of 68 maternity hospitals from January 2020 to June 2021. Data were summarized using descriptive statistics. Mixed-effects logistic regression models adjusted for patient characteristics and assessed the provider and hospital level predictors of receiving a postpartum opioid prescription. The relative contribution of provider (e.g., sex, profession) and hospital (e.g., annual delivery volume, culture of safety measured by a Labor Culture Survey theme) characteristics was assessed using the intraclass correlation coefficient.

Results: Of the 40,589 patients included in the analysis, 3.0% (872/29.412) received an opioid after vaginal birth, and 87.8% (9812/11,177) received an opioid after cesarean birth. Variation in rates of postpartum opioid prescribing was high across hospitals (Figure 1). In adjusted models, the strongest predictors of receiving a postpartum opioid were receiving care at a mid-volume hospital with 2401-3600 annual births (aOR 5.88, 95% CI 1.75-19.80) and for-profit hospitals (aOR 5.45, 95% CI 1.44-20.63). Lower rates of prescribing were seen for patients cared for by Family Medicine physicians (aOR 0.62, 95% CI 0.41-0.95), Advanced Practice Providers (aOR 0.63, 95% CI 0.48-0.83), seen at hospitals with a NICU (aOR 0.34, 95% CI 0.21-0.91), and positive culture of safety (aOR 0.37, 95% CI 0.15-0.88) (Table 1). The percentage of variation in postpartum prescribing attributable to providers and hospitals was 6% and 44% respectively.

Conclusion: Variation in postpartum opioid prescribing after birth is high and driven largely by hospital level factors. Opioid stewardship efforts targeted at the hospital level may be effective for reducing harms of opioid prescribing.