Study Shows Predictive Tool is Associated with 22% Lower Odds of All-Cause Mortality among High-Risk Veterans Taking Opioids
Risk of overdose, suicide and other adverse outcomes are elevated among sub-populations prescribed opioid analgesics. In 2018, VA mandated a case review intervention that targeted patients who had been prescribed opioid analgesics and who were at high risk of adverse outcomes. The Stratification Tool for Opioid Risk Mitigation (STORM), a provider-facing dashboard that uses predictive analytics to stratify patients prescribed opioids based on their risk for overdose/suicide, was developed to identify these patients and assist providers in determining whether a patient needed a revised treatment plan or augmented care. Investigators conducted a stepped-wedge cluster randomized controlled trial to evaluate the impact of the case review mandate on serious adverse events (SAEs) and all-cause mortality among Veterans designated as high-risk between 2018-2020. There were 44,042 patients – from all 140 VA medical centers – who were actively prescribed opioid analgesics and who had high STORM risk scores for an overdose or suicide-related event. From this larger cohort, two patient groups were created: 1) a treatment cohort who received “very high” risk categorization on the dashboard (n=11,845), and 2) a control cohort (32,197) who did not. In addition to mortality, investigators examined the incidence of nine different SAEs (i.e., car accidents, opioid overdose, accidental falls) that may be impacted by opioid use within 127 days of “very high” risk designation.
- Identifying high-risk patients and mandating they receive an interdisciplinary case review was associated with 22% lower odds of all-cause mortality relative to control patients. This kind of impact is on par with interventions such as common medications for heart disease.
- Mandated review patients were five times more likely to receive a case review than non-mandated patients with similar risk – and they received more risk mitigation strategies.
- Results suggest that providers can leverage predictive analytic-targeted population health approaches and interdisciplinary collaboration to improve patient outcomes.
- SAEs were only captured if documented in the VA medical record.
- There was a relatively short time for outcome assessment. For example, a patient’s engagement in recovery or rehabilitative activities may produce delayed benefits that may not have been apparent within the time frame allocated for the study.
This study was funded by HSR&D (SDR 19-326). Drs. Strombotne, Minegishi, Garrido, Pizer, and Frakt, and Mr. Legler are part of HSR&D/QUERI’s Partnered Evidence-based Policy Resource Center (PEPReC). Drs. Trafton, Oliva, and Lewis are with HSR&D’s Center for Innovation to Implementation.
Strombotne K, Legler A, Minegishi T, Trafton J, Oliva E, Lewis E, Sohoni P, Garrido M, Pizer S, and Frakt A. Effect of a Predictive Analytics-Targeted Program in Patients on Opioids: A Stepped-Wedge Cluster Randomized Controlled Trial. Journal of General Internal Medicine. May 2, 2022; online ahead of print.