Table 1.

Six Building Blocks Program

Building Block and DescriptionKey Activities
Leadership and consensusClinical 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 workflowsRevise 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 careDevelop 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 visitsTrain 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 patientsIdentify 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 successIdentify 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 TeamDescription
Kickoff visitSite 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/coachingGuidance 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 callsMonthly virtual learning collaboratives between participating sites
Brainstorm ideas for overcoming existing challenges
Share successful strategies and resources
Clinical educationTwice-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