Special Projects Fund

Grantee Name

Cornell University, Joan & Sanford I. Weill Medical College

Funding Area

Special Projects Fund

Publication Date

October 2021

Grant Amount

$186,799

Grant Date:

October 2017- September 2019

The opioid epidemic has been called the worst drug crisis in American history; death rates rival those of AIDS during the 1990s, and overdoses from heroin and other opioids kill more than 27,000 people a year.

Physicians themselves are inadvertently contributing to the problem by prescribing doses and durations that are more than the minimum required to control pain and that are more likely to lead to long-term dependency. However, changing prescribing practices is a slow process, with training and detailing typically producing only modest changes.

In 2017, NYSHealth awarded Weill Cornell Medicine a grant to encourage physicians at hospitals and federally qualified health centers (FQHCs) to prescribe opioids at levels consistent with Centers for Disease Control and Prevention (CDC) guidelines.

Outcomes and Lessons Learned

  • Adapted an existing electronic health record (EHR) prescribing interface, originally designed to nudge prescribers to choose generic drugs over brand-name ones, to encourage prescribers to choose opioids at levels consistent with CDC guidelines.
  • Modified the EHR so it defaulted opioids to CDC-recommended short-duration and low-dose formulations, but allowed defaults to be overridden by providers to ensure that clinical judgment was not constrained.
  • Implemented and tested the adapted EHR in a private ambulatory setting for prescribers in all specialties at Weill Cornell.
  • Increased prescription adherence to CDC guidelines among Weill Cornell prescribers from 12% to 31%.
  • Evaluated the intervention quantitatively using a quasi-experimental design and de-identified EHR data from six months before and after implementation.
  • Developed the following materials and information for providers:
    • A free, shareable implementation toolkit, which includes a curated list of eligible opioids;
    • A process to bring the opioid prescription into compliance with CDC recommendations;
    • Potential schedule and procedures for prescriber notification and adverse event reporting; and
    • Guidelines for estimated time and expertise required to implement the intervention as well as lessons learned from this project.
  • Replicated the intervention using the implementation toolkit at the Institute for Family Health (IFH), an FQHC with 19 sites in New York City. IFH began the intervention with a high adherence rate—44% of prescriptions were already consistent with the CDC guidelines—which remained consistent throughout the intervention and did not increase significantly.
  • Held an in-person event with Jessica S. Ancker, M.P.H., Ph.D., Associate Professor of Healthcare Policy and Research at Weill Cornell Medicine, to discuss lessons learned from this project.
  • Published a peer-reviewed article in the Journal of General Internal Medicine, “Effect of an Electronic Health Record ‘Nudge’ on Opioid Prescribing and Electronic Health Record Keystrokes in Ambulatory Care,” detailing key results of the intervention.

This project found that the nudge intervention was effective in settings like Weill Cornell, where the initial adherence to CDC guidelines was low, but did not have as much impact in settings with higher adherence rates, like IFH. Implementing the intervention at these two health systems helped Weill Cornell understand where best to target the program in the future.

Weill Cornell has continued to share this intervention program and toolkit with other health systems through articles and presentations, but since the close of this grant, many hospital systems have redirected their focus to treatment of COVID-19 patients. Weill Cornell will continue this work when the timing is appropriate.

Co-Funding and Additional Funds Leveraged: None