Summer 2016

In this Issue: Improving the Safety of Prescription Opioid Use among Veterans » Table of Contents

Identifying Veterans at High Risk of Opioid Overdose

Feature Article

As of 2013, almost one in four Veterans receiving VA prescriptions also received an opioid medication. As is evident from national trends, patients receiving these medications are at higher risk of overdose, death, and other adverse outcomes (Bohnert et al, 2011; Compton et al, 2016). To mitigate these risks, VA's Office of Mental Health Operations (OMHO), in collaboration with the National Pain Management Program, developed a predictive model to estimate the risk of opioid-related adverse outcomes. The Stratification Tool for Opioid Risk Management (STORM) uses a real-time data dashboard to present individual patients' level of risk, as well as patient-specific clinical risk factors. Thus, STORM offers a practical solution to ensure that risk-mitigation strategies are delivered to the patients most likely to experience adverse outcomes. In addition to assessing the risk of opioid-related adverse outcomes, STORM displays and tracks the use of recommended risk-mitigation strategies, including:

• Provision of naloxone kits,
• Reduced opioid dosage, and
• Use of non-opioid pain management approaches such as physical therapy and acupuncture, among others.

STORM has been pilot-tested with more than 1,000 users who have viewed the dashboard more than 12,000 times. Validation and usability reviews indicate that the STORM dashboard is an acceptable and efficient method of reviewing patient-specific risk information. Therefore, STORM will be rolled out to VA facilities to identify Veterans at very high and high risk for an opioid overdose or suicide-related event.

Evaluating VA Policy for STORM Implementation

In evaluating the implementation of VA policy pertaining to the use of STORM, QUERI's Partnered Evidence-based Policy Resource Center (PEPReC) will be joined by a team from the Center for Health Equity Research and Promotion (CHERP) at the VA Pittsburgh Healthcare System. Using VA administrative data, PEPReC investigators will focus on assessing STORM's impact on adverse outcomes and costs, while CHERP partners will determine the mediating effects of processes of care – and how specific implementation strategies moderate STORM's impact during rollout. This work will inform ongoing implementation and sustainability of STORM through additional support from HSR&D's Office of Management and Budget funded Learning Healthcare System initiative. This initiative promotes randomized program evaluations like this one, which will compare different policies related to STORM dashboard dissemination to determine the best approaches for sustainability of this high-priority initiative.

PEPReC will evaluate primary outcomes, including rates of suicide-related events, overdoses, accidents, and VA healthcare costs. Additionally, the use of risk-mitigation strategies recommended by STORM and the use of STORM will be examined. The effects of selected implementation strategies will be assessed by CHERP.

For more information about this project, please contact Austin Frakt, PhD, at Austin.Frakt@va.gov or CHERP investigators Walid Gellad, MD, MPH, at Walid.Gellad@va.gov) and Leslie Hausmann, PhD, at Leslie.Hausmann@va.gov .