The Effect of Health Systems' Opioid Quality Improvement (QI) Efforts on Prescribing Practices: Findings from the CDC Opioid QI Collaborative
Authors: Shoemaker‐Hunt Sarah , Childs Ellen , Mikosz Christina , Hersey Catherine , McDonald Douglas , Sargent Wesley 
Published: September 2021

Research Objective

To address the opioid overdose epidemic, the Centers for Disease Control and Prevention (CDC) developed the Guideline for Prescribing Opioids for Chronic Pain. Recognizing that releasing a guideline alone is insufficient for transforming practice, CDC supports initiatives to promote uptake and use, including the CDC Opioid Quality Improvement (QI) Collaborative (“Collaborative”). This presentation describes a mixed‐methods analysis combining systems‐level context, individualized approaches to QI, selected implementation strategies, and preliminary outcomes from the eleven systems in the Collaborative.

Study Design

The Collaborative design is an observational case study of Opioid QI implementation across two cohorts totaling eleven systems. Participating health systems reported QI measure data available in their electronic health records (EHRs) for a self‐determined subset of the sixteen CDC‐developed opioid QI measures. Each system selected a minimum of five QI measures to monitor and report. We calculated odds ratios to determine whether patients were more likely to receive guideline‐concordant care at the end of their system's participation in the Collaborative than at baseline. Qualitative data included interviews conducted with a system representative at the beginning of each cohort, notes from monthly group implementation calls, monthly liaison check‐in calls, and documents provided by systems.

Population Studied

The Collaborative consists of eleven health systems, including over 120 practices representing urban, rural and frontier areas and serving underserved and tribal populations. Systems volunteered to participate, received an honorarium and engaged in the Collaborative for a minimum of 18 months. The baseline measure data reflects approximately 10,000 patients on long‐term opioid therapy (LTOT) across the systems.

Principal Findings

The QI efforts varied based on contextual factors, including: having QI team members in leadership roles, systems' experiences with past QI efforts, availability of IT staff, and external pressure to change practice. QI teams took different approaches to implementing the QI efforts, including selecting “easy wins” first for proof of concept before implementing more difficult QI activities, allowing each clinic to decide how to implement the QI activities at the local level, and heavily involving clinical staff in decisions to change workflow. Most systems used similar implementation strategies to improve practice, including developing a dashboard to audit and provide clinician feedback, providing clinician education, creating standardized treatment agreements in the EHR, using or building clinical decision support tools within the EHR, integrating the prescription drug monitoring program within the EHR, and updating opioid initiatives and workflow. Based on the preliminary outcomes, one system saw significant improvement over seven quarters in two measures of guideline‐concordant care: decreased days' supply for new opioid prescriptions to three days or less (OR = 1.34; CI 1.06–2.89), and increased rates of urine drug testing for patients on LTOT (OR = 1.81; CI 1.12–3.08). We expect to have complete results in February 2021 for five systems.

Conclusions

Initial results suggest the potential for improvement in safer opioid prescribing and management practices after implementing a dedicated QI initiative within participating health systems.

Implications for Policy or Practice

Supporting health systems in their opioid QI initiatives may improve their ability to measure and improve their prescribing practices and advance safer, more effective pain management.

Primary Funding Source

Centers for Disease Control and Prevention.