1. 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

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

9. 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.

10. 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.

11. 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

13. Clinic Self-Assessment Tool

14. Self-Assessment Results

15. 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