Scott G. Weiner, MD, MPH, Christin N. Price, MD, Alev J

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A Health System–Wide Initiative to Decrease Opioid-Related Morbidity and Mortality Scott G. Weiner, MD, MPH, Christin N. Price, MD, Alev J. Atalay, MD, Elizabeth M. Harry, MD, Erika A. Pabo, MD, MBA, Rajesh Patel, MD, MPH, Joji Suzuki, MD, Shelly Anderson, MPM, Stanley W. Ashley, MD, Allen Kachalia, MD, JD Joint Commission Journal on Quality and Patient Safety Volume 45, Issue 1, Pages 3-13 (January 2019) DOI: 10.1016/j.jcjq.2018.07.003 Copyright © 2018 The Joint Commission Terms and Conditions

Figure 1 There was a downward trend in both the numbers of Schedule II opioid analgesic prescriptions written and the opioid content of each prescription. Over this time period, the health system decreased the monthly prescriptions from around 9,000 to 6,500. The opioid content, standardized in MME, also dropped slightly. * P < 0.001 for the linear trend line fit for both measures. Joint Commission Journal on Quality and Patient Safety 2019 45, 3-13DOI: (10.1016/j.jcjq.2018.07.003) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 2 Two findings are demonstrated: The number of unique patients receiving a Schedule II opioid prescription in the health system has dropped from around 7,000 patients per month to 5,000 patients per month; and there was a decrease in the number of higher opioid-containing prescriptions—those with ≥ 90 MME total in the prescription. The value of 90 MME is equivalent to twelve 5 mg oxycodone pills and was chosen as a cutoff for high vs. low opioid content prescriptions. * P < 0.001 for the linear trend line fit for both measures. Joint Commission Journal on Quality and Patient Safety 2019 45, 3-13DOI: (10.1016/j.jcjq.2018.07.003) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 3 This figure indicates progress on treatment of opioid use disorder. The combination buprenorphine/naloxone film preparation is used exclusively for treatment of opioid use disorder and was chosen as a marker. The monthly number of prescriptions written increased from around 100 to 275 over this time period. The number of providers writing these prescriptions also increased, indicating expanded access to opioid use disorder treatment. * P < 0.001 for the linear trend line fit for both measures. Joint Commission Journal on Quality and Patient Safety 2019 45, 3-13DOI: (10.1016/j.jcjq.2018.07.003) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 4 This figure demonstrates the monthly number of opioid overdose encounters in the health system. Although the trend is slightly downward, it does not reach statistical significance. There is also considerable variation month to month. * P = 0.29 for the linear trend line fit. Joint Commission Journal on Quality and Patient Safety 2019 45, 3-13DOI: (10.1016/j.jcjq.2018.07.003) Copyright © 2018 The Joint Commission Terms and Conditions