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Building Block and Description Key Activities Leadership and consensus Clinical champion and team continually provide visible leadership Demonstrate leadership support and build organization-wide consensus to prioritize more selective and cautious opioid prescribing. Solicit and respond to feedback Build organization-wide consensus Policies, agreements, and workflows Revise and align policy and agreement in accordance to evidence, guidelines, and regulations Revise, align, and implement clinic policies, patient agreements, and workflows for health care team members to improve opioid prescribing and care of patients with chronic pain. Redesign workflows to support policy Tracking and monitoring patient care Develop tracking systems Implementing pro-active population management before, during, and between clinic visits of all patients on long-term opioid therapy. Track patient care in order to pro-actively manage patients Planned, patient-centered visits Train on and implement workflows Prepare and plan for the clinic visits of all patients on long-term opioid therapy. Support patient-centered, empathic communication for care of patients on long-term opioid therapy. Develop patient outreach and education Train on patient-centered empathic communication Caring for complex patients Identify assessment tools Develop policies and resources to ensure that patients who develop opioid use disorder and/or who need mental/behavioral health resources are identified and provided with appropriate care, either in the care setting or by outside referral. Identify and connect to resources Measuring success Identify aims and success metrics Continuously monitor progress and improve with experience. Measure success and continue improvements Mechanisms of Support from the Six Building Blocks Facilitation Team Description Kickoff visit Site visit where all members of the organization's clinics (clinicians, nurses, medical assistants, front desk staff) come together to discuss making improvements to opioid management Clinic-wide learning about evidence and guidelines Small-group activity to self-assess current opioid management practices and to identify priorities for improvement Practice facilitation/coaching Guidance in creating an opioid quality improvement team Ongoing guidance to develop and implement action plans to make improvements to opioid management based on best practices Connection to tools and resources to support improvements (e.g., example policy, agreement, and workflows) Shared learning calls Monthly virtual learning collaboratives between participating sites Brainstorm ideas for overcoming existing challenges Share successful strategies and resources Clinical education Twice-monthly virtual clinical education run by a clinician pain specialist Didactic presentations on topics identified as important by the sites (e.g., functional assessment, addiction assessment;, exercise and pain) Presentations and discussions of difficult cases Participant Group No. of Sites No. of Participants Per Site Sample Method Type of Data Collection Length, Minutes Opioid improvement team 6 1 to 2 (e.g., clinician champion, quality lead) Purposive sampling Interview 60 to 90 Clinicians (MDs, DOs, PAs, NPs) 5 5 to 10 Convenience sample Focus group 45 to 60 Staff (MAs, nurses, front desk staff) 6 5 to 10 Convenience sample Focus group 45 to 60 MD, medical doctors; DO, doctors of osteopathic medicine; PA, physician assistants; NP, nurse practitioners; MA, medical assistant.
- Table 3.
Questions from Quality Improvement Team Leader Interviews and Clinician and Staff Focus Groups
Question When you first signed up to take part in this study, what were you hoping would take place as a result of participating? To what degree did you meet these goals? What are the major changes that your practice has made in the management of chronic opioid therapy patients?· Tell me about how the changes affect your daily work. What do you do differently now? Reflecting on these changes that your practice has made in the management of chronic opioid therapy patients, what do you see as the key benefits (for the practice overall, for clinicians, for staff, for patients)? Have there been any negative consequences of these changes that your practice has made in the management of chronic opioid therapy patients (for the practice overall, for clinicians, for staff, for patients)? What surprised you as these changes in the practice or in your daily work started to be implemented? (FG)/What surprised you about the work? (I) How have the changes that your practice has made influenced your attitudes toward your chronic opioid therapy patients? (FG)/How do you think attitudes toward chronic opioid therapy patients have changed through the implementation of this quality improvement initiative? (Among clinicians? Among staff? For you?) A key objective of the project was to engage the clinical team in helping in the care of these chronic pain patients. What changes did your clinic make in the roles of the clinical team and how did this work out? What were the barriers to achieving this? FG, focus group; I, interview.
Primary Code Sub-Code Confidence and comfort Quality of care Work processes Role Collaboration Between different roles Between the same role Administrative Insurance Liability Parent company Government Improved relationships Surprise at receptivity Fewer negative interactions Better relationship Stress Overall reduction in stress
