STEM THE TIDE - AHA

1 1 American Hospital Association (AHA)STEM THE TIDE:OPIOID STEWARDSHIP MEASUREMENT IMPLEMENTATION GUIDE > > > > > >The analyses upon which this report is based were performed under Contract Number HHSM-500-2016- 00067C, entitled Hospital Improvement and Innovation Network (HIIN), sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Citation: American Hospital Association. (2020). Stem the Tide: Opioid Stewardship Measurement Implementation Guide. Chicago, IL. Accessible at : or (312) 422-2600 2020 American Hospital AssociationA Project of: American Hospital Association (AHA) Opioid Stewardship Measures Advisory Group Centers for Medicare & Medicaid Services (CMS)STEM THE TIDE: OPIOID STEWARDSHIP MEASUREMENT IMPLEMENTATION GUIDE> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > 3 AHA CENTER FOR HEALTH INNOVATIONMary Andrawis-Refila, PharmD, MPH, CPHQE xecutive Director, Performance ImprovementMegan McVane, LCSW, CPHQ Performance Improvement CoachDanielle Franzese, PMP Program Specialist Molly J.

2 Ekstrand, BPharm, BCACP, AE-C Principal ConsultantREVIEWING ORGANIZATIONSA merican Academy of Addiction Psychiatry American Society of Addiction Medicine American Society of Anesthesiologists American Society of Health-System Pharmacists Centers for Disease Control and Prevention, National Center for Injury Prevention and Control National Quality Forum Northeast Ohio Hospital Opioid ConsortiumADVISORY GROUP MEMBERSA imee Moulin, MD, MAS UC Davis Health, Sacramento, CaliforniaAndrew Geller, MD Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaBarry R. Meisenberg, MD anne arundel Health System, Annapolis, MarylandBenjamin Kum, DO Geisinger community Medical Center, Scranton, PennsylvaniaCasey Grover, MD community Hospital of the Monterey, Peninsula, CaliforniaElizabeth Seese, MS, CCRC Michigan OPEN, University of Michigan, Ann Arbor, MichiganEric Chiang, MD Cleveland Clinic, Cleveland, OhioGabriel Molina, MBA, CPHQ community Hospital of the Monterey Peninsula, CaliforniaHannah Snyder, MD University of California, San Francisco, and California Bridge, CaliforniaHeidi DelVecchio, BSN, RN, CPHQ University Hospitals of Cleveland, Cleveland, OhioHolly L.

3 Geyer, MD, FASAM Mayo Clinic, Phoenix, ArizonaHonora Englander, MD Oregon Health & Science University, Portland, OregonJan Losby, PhD, MSW Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaJeanne C. Marsh, PhD, MSW University of Chicago, Chicago, IllinoisJoan Maxwell Patient- and Family-centered Care (PFCC) Partners, Long Beach, CaliforniaJodie Dvorkin, MD, MPH Institute for Clinical Systems Improvement (ICSI), Bloomington, MinnesotaJoe Bianco, MD Essentia Health, Ely Clinic, Ely, MinnesotaJoseph Moates, MD VAMC, Birmingham, AlabamaKelly Black, BS, MA Essentia Health, Duluth, MinnesotaLaurie Willhite, PharmD, CPHQ, CSPI Hennepin Healthcare, Minneapolis, MinnesotaMartie Carnie, AS Brigham & Women s Hospital, Boston, MassachusettsMichele Matthews, PharmD, BCACP, CPE, FASHP MCPHS University.

4 Brigham & Women s Hospital, Boston, MassachusettsMonica Walker, MSA, RN, NE-BC Michigan OPEN, University of Michigan, Ann Arbor, MichiganNikki King, MHSA Margaret Mary Health, Batesville, IndianaRachel Holliman, LMSW Dell Seton Medical Center, University of Texas, Austin, TexasRichard Bottner, PA-C Dell Medical School, University of Texas, Austin, TexasScott Weiner, MD, MPH, FACEP, FAAEM American College of Emergency Physicians (ACEP), Irving, TexasSherry L. Cox, MA, RN, BC VAMC Birmingham, AlabamaSophia Chhay, PharmD American Society of Health-System Pharmacists (ASHP), Bethesda, MarylandTakia Richardson, LICSW, LCSW National Association of Social Workers (NASW), Washington, DCThe American Hospital Association Performance Improvement Team would like to acknowledge the Advisory Group for contributing their time and expertise to the development of this Guide, as well as the reviewing organizations that provided thoughtful OF CONTENTS.

5 4 EXECUTIVE SUMMARY ..5 BACKGROUND ..6 Definitions and Scope ..7 How to Use This Guide ..8 ELEMENT 1: LEADERSHIP STRATEGY WITH PATIENT ENGAGEMENT ..9 Considerations for Forming a Leadership Team ..9 Inspiring a Patient-focused Vision ..9 Developing a Strategy ..10 Engaging Patients and Information Technology ..11 ELEMENT 2: ENVIRONMENTAL SCAN ..12 Considerations for an Environmental Scan ..12 community Services ..13 Quality Improvement Collaboratives ..14 Local Government Partners ..15 ELEMENT 3: MEASURE SELECTION ..16 Menu of Measures ..16 Measure Prioritization and Matrices ..17 Measure Domains with Examples from the Field ..18An Eye Toward Future Measures ..24 ELEMENT 4: GOAL SETTING AND IMPROVEMENT Baselines and Set Goals ..26 Examples from the Field ..26 ELEMENT 5: POLICIES AND CARE TEAM EDUCATION.

6 30 Recommended Guidelines and Policies ..30 Prescriber and Care Team Education ..31 Engaging Patients in Care Team Education ..33 Educational Atmospheres Vary Across Organizations ..33 Additional Education Resources ..34 ELEMENT 6: PATIENT EDUCATION AND ENGAGEMENT ..35 Components of Patient Education Materials ..35 Health Literacy and Hidden Barriers ..36 Integrating Shared Decision-making ..36 Collaboratively Developing a Pain Management (or Comfort) Plan ..36 Creating an Agreement for Treatment with Medication for Opioid Use Disorder ..36 General Public Education Campaigns ..36 ACTION PLANNING AND MOVING THE WORK FORWARD ..38 APPENDIX ..39 REFERENCES ..42 TOOLS ..45*The American Hospital Association does not endorse or recommend any of the measures included herein for use outside of their intended purpose of internal quality OF CONTENTS5 Stem the Tide initially was published by the American Hospital Association (AHA) in 2017 to provide guidance and information to hospitals and health systems on how they can partner with patients, clinicians and communities to address the opioid epidemic.

7 Since that time, a multitude of best practices, guidelines and literature related to opioid stewardship efforts have emerged. AHA is pleased to continue efforts to stem the tide with this Opioid Stewardship Measurement Implementation Guide and Menu of Measures. The direction for this work was directed by three factors. First, we recognized the complexity of the opioid epidemic. No two communities have the same priorities or resources available when it comes to addressing the various faces of the epidemic. Differences include varying levels of data availability, opioid use, mortality rates, and opioid use disorder prevalence. This complexity is compounded by a rise in chronic pain conditions, underemphasized education for health care providers in pain management, and a limited number of specialists in pain management and addiction medicine.

8 Second, we realize that many hospitals and health systems face a challenge in navigating the latest available literature, federal and state guidelines; best practices; and other available tools and resources to really understand their organization s and community s greatest opportunities for improvement. Analysis paralysis could hamper progress in just knowing where to get started on opioid stewardship. Last, while hospital and health systems across the have dedicated tremendous efforts and resources to opioid stewardship, it has been more difficult for these organizations and their communities to identify and implement methods to measure and track progress and results. To respond swiftly to these concerns, AHA formed an Opioid Stewardship Measures Advisory Group to oversee developing this implementation guide and menu of measures.

9 The advisory group was designed to represent diverse hospital sizes and diverse geographies across the , and members represent multiple specialties and professional disciplines, including patient advocates and patient education specialists. The Guide addresses six critical elements that can support users through a process of implementing a data-driven approach to an opioid stewardship program: 1) developing a leadership strategy; 2) conducting an environmental scan of available resources, existing efforts and available data; 3) selecting measures; 4) setting goals and developing an improvement plan to drive progress on those measures; 5) creating policies and education for care teams; and 6) providing patient education and engaging patients in shared decision-making. We believe that these elements lay the foundation for driving and measuring progress in opioid stewardship.

10 As part of the Guide, a Menu of Measures has been curated, which presents 30 ranked quality improvement measures categorized into the primary focus areas of acute pain management, harm reduction, and identification and treatment of opioid use disorder. The measures have been ranked based on both impact of use and level of effort for implementation. The measures included in this Guide are not intended or recommended for use beyond internal quality improvement purposes. While not all of the measures have extensive or sophisticated definitions available to date, the measure concepts can still be useful guideposts in identifying opportunities for tracking progress. Given the continued negative impact the opioid epidemic is having on our nation, as well as the flood of opioid-related best practices and guidelines being proposed, developed and used, we hope that this Implementation Guide and compiled Menu of Measures will be used by hospitals and health systems to accelerate their journey in identifying opportunities for improvement and measuring progress on opioid stewardship.