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Table 3 Measures to evaluate the implementation of guideline and health system’s opioid management policy recommendations

From: Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project

Evaluation Component Clinic-Level Measures
Clinically-Relevant Outcomes
EHR-based Measures (aggregate clinic-level data)
Treatment Agreement Percent of eligible patientsa with signed treatment agreement in the past 12 months.
Urine Drug Testing Percent of eligible patientsa with the health system-recommended urine drug testing completed in the past 12 months.
Opioid Therapy Risk Assessment Percent of eligible patientsa with documented screening using the health system-recommended D.I.R.E. opioid misuse risk tool.
Depression Screening Percent of eligible patientsa with documented screening using the health system-recommended PHQ-2 or − 9 depression screening tool.
Co-prescription of Opioids and Benzodiazepinesb Percent of eligible patientsa with presence of active prescriptions for both opioids and benzodiazepines.
PDMP Check Percent of eligible patientsa with documented PDMP database check in the past 12 months.
Process Measures (aggregate clinic-level data)
Clinic Team Surveys Pre- and post-participation surveys will elicit:
1) ordinal responses as well as semi-qualitative comments to questions about current practice patterns;
2) comfort level with selected aspects of care for patients with opioid-treated chronic pain;
3) usefulness of the QI intervention components (post-participation).
Clinic Team Member Participation in the Intervention Components Percent of clinicians and clinical staff per clinic who:
- participated in the academic detailing session
- enrolled in and completed each of the two online educational modules
- participated in the practice facilitation sessions
Data from Practice Facilitators Practice facilitator notes and experiences will enable identification of themes relevant to the implementation of the opioid policy (barriers and facilitators).
  1. D.I.R.E Diagnosis, Intractability, Risk, Efficacy assessment tool, QI Quality Improvement, PDMP Prescription Drug Monitoring Program, PHQ Patient Health Questionnaire
  2. aTarget population: health system’s primary care adult (18 years old or older) patients treated with long-term opioids for chronic non-cancer pain. To be included in the analysis, patients must have met the following criteria: age ≥ 18 years old; active patient status (seen in the past 3 years) in the health system’s January 2016 panel data; have a primary care provider at the health system’s general internal medicine or family medicine clinics; do not have a diagnosis of malignant neoplasm (except non-melanoma skin cancer) or hospice status; and meet at least one of the two health system’s “opioid registry” criteria: Criterion 1: have at least one opioid prescription issued in the prior 45 days AND at least three opioid prescriptions issued in the prior 4 months; Criterion 2: have at least one opioid prescription issued in the prior 45 days, AND chronic pain diagnosis listed, AND a controlled substance agreement
  3. bThis element, although included in the opioid prescribing guidelines, was not a part of the health system’s policy on opioid therapy management