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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/9b0ee8e09de4db7331739bd2d82e0494.pdf?Expires=1712793600&Signature=s8G-9mUmEdRU4BdGR-F%7EDQMJsRXNEky%7E1Yhazn5vVix%7ENNIgN7Xv66K9854BOo5W-cM6-7ypt7rWJXQwVC0APMNDN0OrPz9tW0kjNbVB4jdXsEY32DoKj2p0UtCEsALi33NlMQS%7EmKVHI2wTRdlOV4ec66kQjoKX6YV%7ELRdl76giktyc4BQHY-rllTfpX2nAE2w5TiSAYucRglfxlQTyPrbAdOefV1k38H9Ai80cmStt83PgguS45yOh1x4o6Z%7EXgPF71CearE-%7E0aaOU7FQ8PpFRKsBd%7EvULVTfygbHcs9DZQ57y8znwGgzhoJuRU%7EQ6NOELulTk3BCAZCGlbzfQA__&Key-Pair-Id=K6UGZS9ZTDSZM
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Improving safety and management when prescribing chronic opioids:
Applying what we have learned in population management.
Scot B. Sternberg, MS; Vasudev Mandyam, MD; Gail Piatkowski, Marc Cohen, MD; and Julia Lindenberg, MD
Beth Israel Deaconess Medical Center
Problem and Context:
Paradigm:
As pain became a fifth vital sign, opioids became more frequently prescribed for
chronic pain in primary care.
Facing an increasing prevalence of opioid use disorders nation-wide, and an
epidemic of overdoses, the efficacy and safety in this practice has raised
questions and concerns
Healthcare Associates (HCA), a large adult academic primary care practice, has an
opioid committee to advise the practice on safe prescribing.
While the practice, a level III Patient Centered Medical Home, had developed a
variety of registries and tools to facilitate population management improving
preventive screening and management of several chronic illnesses, there were
no effective mechanisms available:
o To identify all patients receiving chronic opioids;
o To assess guideline adherence and management of risk
o To intervene at the population level.
Objectives:
Develop registry which accurately identifies patients prescribed chronic opioids
and measures adherence to treatment standards and risk factors.
Implement strategies to improve performance
Increase guideline adherence and improve safety.
*This work was supported, in part, by the Linde Fellowship in Primary Care Leadership.
For more information, contact:
For more information, Contact Julia Lindenberg, MD: jlindenb@bidmc.harvard.edu and Scot B. Sternberg, MS: sbsternb@bidmc.harvard.edu
�Improving safety and management when prescribing chronic opioids:
Applying what we haveIsrael Deaconessin population management.
Beth learned Medical Center
Registry Development:
Strategies For Change/Interventions:
Developed algorithm to capture patients prescribed chronic opioids (defined as
90 days or greater).
Identify guideline adherence and gaps including annual opioid treatment
agreements; urine toxicology screens; regular visits with primary PCP or primary
nurse (NP); and prescription monitoring program checks.
Annual Opioid
Agreement
Urine Toxicology
Screening
Prescription
Monitoring Checks
Regular PCP/NP
Visits
Identify areas of risk including (Volkow, March 2016, NEJM)
o Co-morbid behavioral health diagnoses: opioid use disorder; other substance
use/addictive behavior; mood disorders or Post Traumatic Stress Disorder
o Medication risks : Methadone; Benzodiazepine
o Co-morbid medical diagnoses: Chronic Kidney Disease (CKD) stages 4, 5 or
ESRD; Liver Disease; Obstructive Sleep Apnea (OSA)
Opioid Use
Disorder
Other
Substance Use
Chronic Kidney Disease
PTSD
Depression
Liver Disease
Benzodiazepine
Methadone
Obstructive Sleep
Apnea
Morphine Equivalency (MME) - pending programming (phase II)
Upon programming, panels of 10 providers were reviewed for validation and
minor specification refinements were made to ensure capture and validity
Reviewed practice-wide and suite-based data as well as individual provider
panels in suite meetings
Provided additional educational resources including case vignettes and videos.
o Scope of Pain has link to videos as well as other resources
https://www.scopeofpain.com/tools-resources/
o MyTopCare has many resources, including some good tips and guidelines
around urine tox screens and interpreting results
http://mytopcare.org/prescribers/about-urine-drug-tests/
Identified opportunities for improvement and built consensus for goals and
initial targets.
Increase to 80% patients prescribed chronic opioids with up-to-date annual
opioid treatment agreements.
o MD panel data made available
o Opioid agreement data added to pre-visit Q-card with prompts
o Self-Assessment tool as prompt given by MA or directly by provider
Increase to 80% of patients prescribed chronic opioids with agreement for
urine toxicology screens.
Considerpanel datachange to assess whether pneumatic tube system is contributing factor
o MD pilot tests of available
Provide education to phlebotomists about best practices with regard to specimen collection
o Urine Tox Screen data added to Q-card with prompts
Conduct further data analysis to better understand this problem’s context, both within HCA and
Initial roll out to one suite and then expand practice-wide
across the institution
Measure and monitor rates monthly, integrate feedback from providers, staff
and patients, and define next steps
For more information, contact:
�Improving safety and management when prescribing chronic opioids:
Applying what we have learned in population management.
For more information, contact:
�Improving safety and management when prescribing chronic opioids:
Applying what we have learned in population management.
Results To Date:
Next Steps:
Lessons Learned :
In addition to education, a registry for patients on chronic opioids can identify
patients whom providers may not realize meet criteria or are overdue for
monitoring follow-up
Population health strategies can be applied to safe opioid prescribing.
Further work is needed to use the registry and to enhance strategies and
tools that can improve adherence, closing care gaps and manage risks safely.
Develop resources to provide reviews of complex patient care issues and
provide recommendations and assistance for patients at risk and who may
need tapering or alternative treatments
For more information, contact:
For more information, Contact Julia Lindenberg, MD: jlindenb@bidmc.harvard.edu and Scot B. Sternberg, MS: sbsternb@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Julia Lindenberg (<a href="mailto:jlindenb@bidmc.harvard.edu">jlindenb@bidmc.harvard.edu</a>)<br />Scot Sternberg (<a href="mailto:sbsternb@bidmc.harvard.edu">sbsternb@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Project Team
Scot B. Sternberg
Vasudev Mandyam
Gail Piatkowski
Marc Cohen
Julia Lindenberg
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Improving Management and Safety When Prescribing Chronic Opioids: Applying What We've Learned from Population Management
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety