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Evaluation of a health plan initiative to mitigate chronic opioid therapy risks
Investigator (PI): VonKorff, Michael
Performing Organization (PO): (Current): Kaiser Permanente, Kaiser Permanente Washington Health Research Institute / (206) 287-2900
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2014
Final Year: 2018
Record Source/Award ID: PCORI/IHS-1306-02198
Funding: Total Award Amount: $1,843,875
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Background: Opioid analgesics such as Vicodin and OxyContin are now widely prescribed to manage moderate to severe chronic pain, but the effectiveness and safety of long-term opioid use are unclear. Of the 60 million U.S. adults with moderate to severe chronic pain, 5 to 8 million currently use opioids long-term. Increased opioid prescribing has led to an alarming rise in prescription opioid abuse and overdose among chronic pain patients and in the community-at-large. Patients considering long-term opioid use need reliable information on risks. Clinicians need evidence-based approaches to minimize risks when long-term opioid use is considered. What we plan to study: We will evaluate a health care system initiative to reduce risks of long-term opioid use. The initiative dramatically reduced use of high opioid doses and markedly increased monitoring of patients using opioids long-term. The opioid risk reduction initiative was implemented by some clinics of a large health plan, but not by others serving comparable patients. Our goal is to compare patients from clinics that did and did not use the initiative, to learn how the initiative affected patient health and safety outcomes. How we will conduct the study: We will compare health outcomes and adverse events for patients in clinics that implemented the initiative compared to patients from care settings that did not. We will interview 800 patients using opioids long-term from clinics that implemented the initiative and 800 comparable patients from care settings that did not. We will study patient-reported outcomes including pain and pain-related interference with activities, psychological well-being, and patient perceptions of benefits from and problems with opioids, including validated measures of opioid abuse. We will use electronic data for 28,000 patients using opioids long-term to see if adverse events related to opioid use for chronic pain (overdose, hip or pelvis fractures, and motor vehicle accidents) were lower in clinics that implemented the initiative when compared to care settings that did not. Patient involvement in the research: We are working with patients with diverse perspectives on long-term use of opioids to refine study questions and design, plan data analyses, and report results. These patients were identified through relevant national organizations and from local clinics that implemented the initiative. We are working with these patients to learn from their ideas and perspectives. What we hope to achieve: Our goal is to help clinicians and patients nationwide reduce harms of long-term opioid use by changing how opioids are prescribed and managed, while ensuring safe, compassionate, and effective chronic pain care. Integrating results from this evaluation with other relevant research, we will disseminate a state-of-the-art toolkit and implementation guide to help primary care clinicians regionally and nationally reduce opioid risks for chronic pain patients. More on this project: (1) R.E. Palmer, D.S. Carrell, D. Cronkite et al., The Prevalence of Problem Opioid Use in Patients Receiving Chronic Opioid Therapy: Computer-Assisted Review of Electronic Health Record Clinical Notes. (July 2015) 156(7):1208-14. doi: 10.1097/j.pain.0000000000000145. (2) Von Korff M, Dublin S, Walker RL, Parchman M, Shortreed SM, Hansen RN, Saunders K. The impact of opioid risk reduction initiatives on high-dose opioid prescribing for chronic opioid therapy patients. J Pain. 2016 Jan;17(1):101-10. doi: 10.1016/j.jpain.2015.10.002. PubMed PMID: 26476264.
MeSH Terms:
  • Analgesics, Opioid /*administration & dosage
  • /*adverse effects
  • Chronic Pain /therapy
  • Drug Monitoring
  • Evidence-Based Medicine
  • Humans
  • Medical Records Systems, Computerized
  • Opioid-Related Disorders /prevention & control
  • Outcome Assessment (Health Care)
  • * Pain Management
  • Patient-Centered Care
  • Program Development
  • Risk
  • Substance-Related Disorders
  • United States
Country: United States
State: Washington
Zip Code: 98101
UI: 20143567
CTgovId: NCT02224508
Project Status: Completed
Record History: ('2018: Project extended to 2018.',)