Engaging rural surgeons to enhance opioid stewardship

PROJECT SUMMARY/ABSTRACT
Over 46,000 people died from opioid overdose in 2018 and an additional 11.4 million abused prescription
opioids. This led to the declaration of a national public health emergency to address the opioid crisis. Excess
opioid prescribing by healthcare providers, including surgeons, has played a major role in the current epidemic.
Interventions targeting opioid prescribing in surgical populations have had only modest results, with none of
these specifically designed for rural surgical patients. Rural health disparities compound the complexity of the
opioid epidemic for rural surgical patients, necessitating the development of novel interventions in this
population. This project will characterize unique factors contributing to excess opioid prescribing in rural
surgical patients and adapt a multifaceted intervention to decrease excess prescribing.
The project proposes the following aims: 1) Identify patient, surgeon and system factors associated with opioid
prescribing following surgery in rural settings, 2) Characterize surgeon and patient perceptions of factors
associated with perioperative opioid prescribing among rural surgeons, and 3) Adapt and pilot-test a behavioral
intervention to improve opioid stewardship in rural surgeons. Through mentored research and career
development activities, Dr. Borza will prepare for a career as an independent health services researcher
focused on improving quality of care in rural surgery through the development, evaluation and dissemination of
tailored interventions and research informing surgical quality, practice patterns and policy evaluations. He will
acquire expertise in 1) performance measurement in rural surgery, 2) qualitative design and analysis, 3)
intervention design and development, and 4) responsible conduct of research.
As a surgeon with a Master’s degree in Healthcare Research, Dr. Borza is uniquely qualified to conduct this
work. This proposal addresses educational and career development gaps critical to securing independent
funding through a multidisciplinary mentored program with experts in performance measurement, rural health,
substance abuse, qualitative research, intervention design and development and quality improvement through
surgical collaboratives. He is supported by the robust research infrastructure at the University of Wisconsin,
where the Department of Urology ranks twelfth in National Institutes of Health funding, the Department of
Surgery Wisconsin Surgical Outcomes Research Program promotes the collaboration and success of health
services researchers and the Surgical Collaborative of Wisconsin offers a well-established, engaged network
of surgeons. In addressing excess opioid prescribing by rural surgeons, this award meets an urgent public
health need in an underserved population while affording the education and mentored research experience
critical for Dr. Borza’s development into a national leader on rural surgical quality and independent health
services researcher.

Grant Number: 5K08HS028474-04
NIH Institute/Center: AHRQ
Principal Investigator: Tudor Borza