Design
BLIND
The study was a prospective, cluster-randomized trial of CDS to de-implement opioid prescribing. Due to the impracticality of randomizing at the patient level, randomization occurred at the provider level, whereby dental providers were randomly assigned on a 1:1:1 basis to one of three study arms: standard practice (SP), clinical decision support (CDS), or clinical decision support augmented with patient educational materials (CDS-E). Randomization was stratified by provider type (dentist vs. oral surgeon) and providers’ volume of opioid prescribing in the baseline period. The study statistician (SA) generated the randomization sequence. Fifty providers were randomized, with 1 subsequently excluded due to a very low volume of extractions during the intervention period. The analysis sample consisted of 49 providers with 12,924 unique patients. Our hypothesis was that the CDS and CDS-E arms would show greater reductions in opioid prescribing compared to standard practice. The outcome of whether or not an opioid was prescribed was assessed at the patient level, and patients were blind to their provider’s study arm. Figure Study flow CDS, clinical decision support; CDS-E, clinical decision support with patient education; SP, standard practice