Opioid Management in Primary Care Michael Parchman, MD, MPH 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

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

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

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

Research published in Journal of American Board of Family Medicine February 2017

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 Self-Assessment Tool

Six BB Self-Assessment Results: Opportunities to Improve Non-existent or incomplete policies & workflows about: COT refills Co-prescribing of sedatives Checking state controlled substance registry Population Health Not tracking or monitoring all patients on COT pro-actively (registry or other) Planned Visits No care plans documented for COT & chronic pain management

What have we learned? Clinicians in clinics with higher BB scores are More confident in use of opioids for chronic pain More comfortable prescribing opioids for chronic pain Phases of clinic re-design work: Phase 1: revise policies and patient agreements Phase 2: redesign workflows and discuss data for population management Phase 3: implement tracking of patients, patient outreach/education and measures of success

www.improvingopioidcare.org