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Background: Opioids are a mainstay for acute pain management, but their side effects can adversely impact patient recovery. Multimodal analgesia (MMA) is recommended for treatment of postoperative pain and has been incorporated in enhanced recovery after surgery (ERAS) protocols. The objective of this quality improvement study was to implement an MMA care pathway as part of an ERAS program for colorectal surgery and to measure the effect of this intervention on patient outcomes and costs., Methods: This pre-post study included 856 adult inpatients who underwent an elective colorectal surgery at three hospitals within an integrated healthcare system. The impact of ERAS program implementation on opioid prescribing practices, outcomes, and costs was examined after adjusting for clinical and demographic confounders., Results: Improvements were seen in MMA compliance (34.0% vs 65.5%, P  < 0.0001) and ERAS compliance (50.4% vs 57.6%, P  < 0.0001). Reductions in mean days on opioids (4.2 vs 3.2), daily (51.6 vs 33.4 mg) and total (228.8 vs 112.7 mg) morphine milligram equivalents given during hospitalization, and risk-adjusted length of stay (4.3 vs 3.6 days, P  < 0.05) were also observed., Conclusions: Implementing ERAS programs that include MMA care pathways as standard of care may result in more judicious use of opioids and reduce patient recovery time., Competing Interests: Dr. Wan is the Global Head of Evidence Generation and Data Sciences at Mallinckrodt Pharmaceuticals. Ms. Böing previously served as the Senior Manager for Health Economics and Outcomes Research (HEOR) and Real-World Evidence at Mallinckrodt Pharmaceuticals and is currently the Director of Global HEOR for Rare Disease at Ipsen. Dr. Collinsworth is currently a Senior Research Scientist at 3M. The other authors declare no potential conflicts of interest., (Copyright © 2023 Baylor University Medical Center.)

Limited data exist on asthma and chronic obstructive pulmonary disease (COPD) management-major drivers of healthcare resource utilization (HCRU) in the USA. We describe prevalence and exacerbation rates, therapeutic interventions, and HCRU for asthma and/or COPD within a large, integrated healthcare system. Patients with asthma, COPD, and asthma + COPD were identified from retrospective electronic health record data (2016-2018) of >1.7 million patients. Descriptive analysis of disease prevalence and exacerbation frequencies, pharmacotherapies, and HCRU was performed. Time-to-event analysis of time to first exacerbation was performed in patients with asthma and/or COPD. Exacerbation rates, pharmacotherapies, and HCRU were examined by exploratory analysis in an outpatient subset. Overall, 149,086 unique patients (8.6%) had encounters for asthma, COPD, or asthma + COPD. Acute care utilization was high, including emergency department visits (asthma, 52.9%; COPD, 35.1%) and hospitalizations (asthma, 26.7%; COPD, 65.7%). Many patients were prescribed short-acting therapies (asthma, 45.3%; COPD, 40.0%; asthma + COPD, 54.7%). Prescription rates for maintenance therapies were low (17.1%, 20.8%, 31.7%) and annual exacerbation rates were 0.65, 0.80, and 1.33. This analysis showed a substantive prevalence of pulmonary disease, variability between documented prescriptions and pharmacotherapy guidelines, and high HCRU. Appropriate tailoring of pharmacotherapies and management of asthma and COPD over a continuum are opportunities to improve patient care., (Copyright © 2022 Baylor University Medical Center.)

As an initiative of Baylor Health Care System's Best Care Committee, we summarized the association between the Joint Commission's hospital core measures/safety goals and patient outcomes. This summary (which will be formatted as a small, laminated card) can be used by change leaders to communicate the relevance of clinical quality goals. By disseminating this evidence broadly, we aim to further invest clinical staff in delivery of specific care processes, maximize care efforts related to core measures, and extend quality improvement efforts within our organization.