Nudging Emergency Care Providers to Reduce Opioid Prescribing Using Peer Norm Comparison Feedback: A Pilot Randomized Trial

Objective To determine the feasibility, acceptability, and potential impact of using audit and feedback (A&F) with or without peer norm comparison on opioid prescribing by emergency medicine providers. Methods A convenience sample of 37 emergency medicine providers were recruited from 16 emergency departments in Western Pennsylvania for a pilot randomized controlled trial. Participants completed a baseline survey, were randomly allocated to A&F (N = 17) or A&F with peer norm comparison (N = 20), and were asked to complete a postintervention survey. We matched each participant 1:1 to a control who was not exposed to either intervention. Results At baseline, 57% of participants perceived that they prescribed opioids at the same frequency as their peers, whereas 32% perceived prescribing less than and 11% perceived prescribing more than their peers. Most participants rated the interventions as helpful, with no differences between conditions. For the A&F with peer norm comparison condition, from pre- to postintervention, there was a relative increase of 20% in the percentage of participants who perceived that they prescribed more opioids than their peers but no change in the A&F condition (P = 0.02). 56.8% of controls, 52.9% of A&F participants, and 75.5% of A&F with peer norm comparison participants reduced their opioid prescribing (P = 0.33). The mean reduction in opioid prescriptions (SD) was 3.3. (9.6) for controls, 3.9 (10.5) for A&F, and 7.3 (7.8) for A&F with peer norm comparison (P = 0.31). Conclusions Audit and feedback interventions with peer norm comparisons are helpful to providers, can alter perceptions about prescribing norms, and are a potentially effective way to alter ED providers’ opioid prescribing behavior.

Meshless and Multi-Resolution Collocation Techniques for Steady State Interface Models

In this paper, two numerical methods are being considered for simulations of 1D elliptic type single and double interface models. The first proposed method is based on Haar wavelet collocation while the second method is based on meshless collocation which is realized on radial basis functions. Numerical experiments are carried out to check performance of both the methods. The accuracy of the methods is assessed in terms of [Formula: see text] error norm. Comparison of numerical results is shown to establish validity and superiority of the methods.

Norm Comparison Estimates for the Composite Operator

This paper obtains the Lipschitz and BMO norm estimates for the composite operator𝕄s∘Papplied to differential forms. Here,𝕄sis the Hardy-Littlewood maximal operator, andPis the potential operator. As applications, we obtain the norm estimates for the Jacobian subdeterminant and the generalized solution of the quasilinear elliptic equation.