The Partnership for Innovation:
2009 Grant Projects
Risk Reduction in Prescribing Long-Term Opioids for Chronic Non-Malignant Pain
Project Lead: Randi Beck, MD, Physical Medicine
Challenge: Opioid use, particularly among patients on high-dose regimens, has been associated with increases in abuse of prescription opioids, diversion of prescribed opioids for nonmedical use, fatal and nonfatal overdoses, acetaminophen toxicity due to overuse of combination agents, and increased risk of fractures due to falls in older adults.
In the absence of compelling evidence showing clinically meaningful improvements through the use of opioids in the management of chronic nonmalignant pain (CNMP), it is questionable whether these risks are outweighed by the potential benefits.
Innovation: A Web-based physician education program developed by the Veterans Administration (VA) and modified for Group Health physicians will provide an efficient vehicle for orienting physicians to new system-wide guidelines for opioid prescribing.
Pilot program: The goal of this project is improved management of opioid prescription in CNMP. This includes updated guidelines for opioid prescribing, standardized clinic structure for opioid prescription visit, utilization of updated practice tools (such as pain agreements, educational information for patients, urine drug screens, and function and pain tools). This work will integrate with the Rapid Process Improvement Workshop (RPIW) lead by Patient Safety. The RPIW includes a pilot plan for opioid management in clinics. A Web-based continuing medical education program developed by the VA will be modified to support Group Health physician education.
Potential benefits for patients: The primary objective of the program is to reduce the frequency of long-term opioid use and to increase the regularity of monitoring patients with high-dose regimens. Streamlining opioid prescribing practices through enhanced guidelines and both physician and patient education can reduce the risk of opioid abuse while providing skills and training to physicians to better engage in shared decision-making with patients who need help managing CNMP.
Integrating Behavioral Health Specialty Consultation into the Medical Home
Project Lead: Bradley Steinfeld, PhD, Clinical Psychology
Challenge: Understanding and knowing how to manage complex patients with mental health concerns, and in particular chemical dependency concerns, is a significant issue in primary care. Hospitalizations of patients for detoxification are decreasing since many hospitalizations are medically unnecessary. This trend will increase the demand for support for outpatient treatment, requiring more involvement of the primary care physician.
Innovation: Existing Mind Phone service, consisting of telephonic psychiatric consultations between primary care physicians and Behavioral Health practitioners, will be expanded to encompass chemical dependency issues and substance use concerns.
Pilot program: The pilot will test the effectiveness of real-time availability of phone-based behavioral health specialty consultation (psychiatrist) between the personal physician and the psychiatric consultant to support development of a treatment plan within primary care. The behavioral health specialty consultation would be a single point of contact for both mental health and substance abuse or dependency concerns. Clinical decision support tools will also be developed to help support primary care physician management of these patients. This model aligns with the key principles of the medical home in enhancing the personal physicians' role in coordinating and integrating the health care services for the patient.
Potential benefits for patients: The program could provide better primary care for Group Health members with chemical dependency and behavioral health issues. More accessible and immediate provider-to-provider specialty consultations along with clinical support tools means that primary care physicians are better equipped to assist patients as they struggle with addictive disorders.