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Data + Structured Quality Improvement: Dynamic Duo for the Front Lines of Opioid Interventions

Data evaluations can be extremely motivating. When the Centers for Disease Control and Prevention began reporting on the opioid epidemic, health care providers and the public were shocked and saddened by the numbers of people across the country who were being harmed by opioid misuse.

The crisis has prompted health care providers to try to change the way we discuss and treat acute and chronic pain. But information in isolation, without additional structure and support, makes change difficult. How can we drive the change needed to make our communities safer, while providing safe and effective care?

Previous public health crises have taught us that improvements in care occur when information is coupled with continuous quality improvement techniques that incorporate retraining and rethinking how we deliver care. Change does not occur in a vacuum. Patients, providers and staff need structured support and resources to alter and improve the way they approach care. For example, outcomes for people with cardiovascular disease have improved significantly because we’ve learned how to apply and harness data and quality improvement processes to identify gaps in care. Providing resources, technical support and continuous feedback on the effectiveness of our interventions does lead to improved outcomes. The Million Hearts® campaign is one example of the power of engaging data and quality techniques to drive improvements in health outcomes across the country.

The good news is that we are now applying this successful model to the opioid crisis — bringing together data and quality improvement techniques to inform and support health care professionals in adopting safer treatment methods for their patients with various painful conditions. Through this approach, providers are identifying potentially risky prescribing practices and gaps in effective nonopioid treatments and substance use disorder services. Comagine Health is partnering with state health departments, health systems and professional organizations to provide support and expertise to professionals who are struggling to address this crisis.

In Utah, we are providing specialized provider education to clinicians in Carbon County, one of the areas most impacted by opioid use disorder and untimely deaths from overdose. We are also using data and education to drive improvements in acute settings by supporting dental providers in the Wasatch Front, Utah’s most populated region. Together with clinicians from Roseman University of Health Sciences, the University of Utah and the Utah Dental Association, we will provide targeted education about safe prescribing, use of Utah’s controlled substance database, naloxone use and simplifying referrals to treatment for substance use disorders.

In Oregon and Washington, we are expanding our work in primary care clinics to provide the Six Building Blocks model of evidence-based, data-driven quality improvement. This model provides tools and resources along with standardized technical assistance to help primary care teams identify and target areas to improve chronic pain care plans, then implement and evaluate those changes. We are also supporting clinicians and their staff with RELIEF+ (Resources Encouraging Lifestyle Interventions and Enhanced pain treatment for 55+). This Comagine Health program uses the Six Building Blocks for quality improvement assessment, along with a focus on the unique needs and risks for older adult patients. The initiative provides data evaluations, technical assistance, and online resources and training for primary care teams. Patients treated in these supported clinics are benefiting from improved processes, including planned, patient-centered visits that provide an integrated, effective approach to chronic pain care.

I encourage you to explore and engage in one of these quality improvement campaigns to drive improvements in your area. Together we can address the opioid epidemic and spread the benefits of improved processes to patients, providers and our communities.

Comments

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Jodi Wimmer (not verified)

Sat, 06/01/2019 - 04:02 am

According to the CDC, Drug overdoses have dramatically increased over the last two decades, with deaths increasing more than four times between 1999 and 2017. In 2017, more than 70,000 people died from drug overdoses, making it a leading cause of injury-related death in the United States. (retrieved from CDC, 2019).  I agree that Primary Care Physicians need more support and training and how to prescribe safely.  These two models of care, Six building Blocks and Relief are great tools to help make sure the patients who are seen with chronic pain do not fall through the cracks and are carefully monitored.  It also gives the provider evidence based material to address concerns with the difficult patient, or pushback from the patient regarding care.  I believe these models will provide better patient outcomes. 

I love that these interventions focus on supporting providers. I think providers are most often well-intentioned, but have a lack of knowledge about prescribing opiates safely for chronic pain patients. With the current opioid epidemic and the addictive potential of opiates, providers may be hesitant to prescribe opiates at all. Rightly so, however,  what is that answer for the chronic pain patients who have been on opiates for years and nothing else seems to help? As a future FNP, I see this being a huge dilemma in practice. Evidenced-based models and guidelines for prescribing opiates for chronic pain patients will greatly support providers and help keep patients safe while managing their pain.

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