Oregon s comprehensive approach to clinical change
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1 Oregon s comprehensive approach to clinical change Oregon Conference on Opioids, Pain and Addiction Treatment Eugene, OR May 17, 2018
2 Learning Objectives Participants will learn: 1. Oregon's successes, challenges, and early results with a comprehensive approach to implementing the CDC Guideline for Prescribing Opioids for Chronic Pain 2. How the Pain Management Improvement Team is using The Six Building Blocks of Opioid Prescribing to improve pain treatment and opioid prescribing in Oregon 3. Available implementation tools such quality improvement metrics, sample policies, screening tools, and treatment agreements, Electronic Health Record guidance, provider trainings, and other resources No conflicts to disclose
3 Topics covered Data snapshot The Oregon Opioid Initiative PDO project map Technical Assistance Team: PMIT Oregon implementation toolbox 6 Building Blocks self-assessment Early results Next steps
4 4 Drug Overdose Deaths US
5 Oregon Opioid Overdose Deaths Declined 30% from Pharmaceutical Opioids Rate per 100,000 population Heroin Methamphetamine and stimulants
6 Oregon patients on high-dose opioids (>90MED) declined 48% (Q1) MED individuals per 1,000 residents
7 7 Oregon Opioid Initiative: Strategies
8 Prescription Drug Overdose Prevention project 2018 PMIT Site PDO Coordinator The Pain Management Improvement Team (PMIT) uses academic detailing and practice facilitation methods to provide training and mentoring on best clinical practices for pain management and safe opioid prescribing Variety of settings in high-burden regions ücoordinated Care Organization ülarge health system/health plan üfederally Qualified Health Centers üor Medical Board referrals
9 Meet the Southern OR PMIT Pain Management Improvement Team Jim Shames, MD Oregon Pain Guidance State leader Laura Heesacker, MSW, LCSW Oregon Pain Guidance Behavioral health, chronic pain management John Kolsbun, MD Medical Director, AllCare Health CCO Nadejda Razi-Robertson, LCSW, PhD Behavioral health, practice facilitator Simon Parker-Shames, MPH Health Informaticist
10 Oregon Implementation Toolbox Academic Detailing Tailored education Peer-to-peer trainings and support: Difficult conversations, tapering, medicationassisted treatment, integrating behavioral health, managing complex cases Pain consultation service: teleconferences, inperson case reviews Practice facilitation QI and systems work 6 Building Blocks selfassessment QI metrics EHR integration guide MED calculator PDMP reporting for Medical Directors and providers Other resources Oregon Pain Guidance Spotlight on Practice tele-conference educational nights OHSU ECHO: Addictions Medicine and Persistent Pain University of WA Tele- Pain TM Program Regional and state opioid/pain conferences
11 Six Building Blocks Self-assessment Developed by Dr Michael Parchman and team, MacColl Center for Health Care Innovation: improvingopioidcare.org A way to identify organizational strengths, weaknesses, and gaps in how pain is treated and how safely opioids are used as compared to the CDC Guideline for Prescribing Opioids for Chronic Pain Modified for Oregon PDO Project with focus on pain management: ance.org/6-building-blocksoverview/
12 Implementation stages Stage 1 Stage 2 Stage 3 Site leadership agrees to MOU, IDs champion 6 Building Blocks (6BB) web survey Portland State Univ. compiles baseline report Site kickoff meeting to discuss 6BB report and identify implementation team PMIT helps site develops metricsbased work plan PMIT provides training, monitoring, and technical assistance Champion sends 6BB follow-up survey to all staff PSU compiles final report Project close-out meeting to discuss results and develop sustainability plan Months 1-2 Months 2-7 Months 7-8
13 Providence Medford 6BB results 1 year Rate of change ñ60.7% ñ108.3% ñ200.0% ñ133.3% ñ200.0% ñ200.0% ñ143.4%
14 Next steps Recruit new sites for Launch Mid-Willamette Valley PMIT (Salem Health) Take lessons learned and scale up project design
15 Questions? Contact:
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