Improving Team-Based Opioid Management in Primary Care Michael Parchman, MD, MPH MacColl Center for Health Care Innovation Kaiser Permanente WA Health Research Institute Southern Oregon Pain Conference, May 2017 Funding Source: the Agency for Healthcare Research & Quality (R18HS023750) Additional support was provided by the National Center For Advancing Translational Sciences of the National Institutes of Health(NIH) under Award Number UL1TR000423

Learning Objective Describe six core concepts (Building Blocks) to support team-based safer prescribing of opioids for chronic pain Assess of the current status of your clinic/setting for team-based safe opioid management Develop an action-plan for practical, feasible next steps you can take when your return home

Agenda Background: what are the Six Building Blocks, how were they developed and what is the evidence? (20 minutes) Exercise: Assessing the Six Building Blocks in your settings (40 minutes) Discussion: reconvene and report-out (15 minutes) Action-Planning and Next Steps (5 minutes)

Team-Based Opioids: The Project Team Michael Parchman, MD, MPH Principal Investigator Director, MacColl Center for Innovation Kaiser Permanente WA Health Research Institute Laura-Mae Baldwin, MD, MPH Co-Investigator Professor, Department of Family Medicine, University of Washington Director, WWAMI region Practice and Research Network Brooke Ike, MPH Project Manager and Practice Facilitator WWAMI region Practice and Research Network Coordinating Center University of Washington Brooke: Do we have any slides like this that include Kari? Can you please add her? Michael had experience with PBRNs, and wanted to test whether this strategy could decrease % COT patients with high MED in rural areas, where primary care providers are faced with managing patients with chronic pain, often with little support. Approached the WPRN as a practice-based research network that he knew included remote rural practices in the Northwestern U.S. Developed a research partnership with the WPRN, including both faculty and staff from the WPRN as collaborative members of the investigative team. This ensured that all aspects of his study had the support of WPRN leadership and staff who knew the practices best. David Tauben, MD Co-Investigator Chief of Pain Medicine University of Washington Kari Stephens, PhD Co-Investigator Informaticist University of Washington

Team-Based Opioid Management in Primary Care A research project aiming to lower the risks of death and drug overdose among patients who are taking opioid medications for chronic non-cancer pain. Systems based approach in clinical organizations, including Creation of an opioid quality improvement team at each site that guides system-based changes Use of an opioid registry to monitor care Implementation of selected best practices to manage patients with chronic non-cancer pain who use chronic opioid medication

Team-Based Opioid Management in Primary Care A collaboration between 20 rural and rural-serving clinics in Eastern Washington and Central Idaho and: Kaiser Permanente WA Health Research Institute University of Washington: WWAMI region Practice and Research Network

Where Did the Six Building Blocks Come From. : LEAP Where Did the Six Building Blocks Come From?: LEAP*: 30 Innovative Primary Care Practices Models for Improving Team-based Care (RWJF) *Learning from Effective Ambulatory Practices

Six Building Blocks (1) Building Block 1: Leadership and consensus Build organization-wide consensus to prioritize safe, more selective, and more cautious opioid prescribing. Building Block 2: Track Patients on COT Implement pro-active population management before, during, and between clinic visits of all COT patients: safe care & measure improvement. Building Block 3: Revise policies and standard work Revise and implement clinic policies and define standard work for health care team members to achieve safer opioid prescribing and COT management in each clinical contact with COT patients.

Six Building Blocks Building Block 4: Prepared, patient-centered visits Prepare and plan for clinic visits of all patients on COT to ensure that care is safe and appropriate. Support patient-centered, empathic communication for COT patient care. Building Block 5: Caring for complex patients Identify and develop resources for patients who become addicted to or who develop complex opioid dependence. Building Block 6: Measuring success Continuously monitor progress and improve with experience.

Clinic Characteristics Baseline (Four of the Six Rural Organizations) Site 1 (3 clinics) Site 2 (5 clinics) Site 4 (2 clinics) Site 6 (3 clinics) PC Provider FTE 10 13.2 5.1 8.3 #COT Patients per Provider Mean Range 28.3 1-113 44.3 1-124 81.7 1-199 34.4 1-123 % MED >= 50 13.9 10.1 24.4 28.2 % MED >= 100 6.8 4.7 10.4 11.9

Clinic Self-Assessment Tool

Self-Assessment Results

Six Building Blocks Self-Assessment Score Confidence in prescribing opioids was associated with: Population tracking and management of all patients on opioids for chronic pain Agreed upon clinic policies for opioid prescribing and clinic workflows Use of quality measures to track success Comfort in using opioids was associated with Agreed upon clinic policies and workflows Resources and support for complex patients

www.improvingopioidcare.org