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A statewide effort to reduce high-dose opioid prescribing through coordinated care organizations. | LitMetric

A statewide effort to reduce high-dose opioid prescribing through coordinated care organizations.

Addict Behav

HealthInsight Oregon, 2020 SW 4th Avenue, Suite 520, Portland, OR 97201, United States.

Published: November 2018

AI Article Synopsis

  • Oregon's Medicaid program operates through 16 Coordinated Care Organizations (CCOs) that aim to lower high-dose opioid prescriptions by creating their own targets and strategies for reducing usage.* -
  • The study involved examining documents and interviewing CCO administrators to analyze policies, practices, and local utilization data related to opioid prescriptions.* -
  • Most CCOs set a target of 90 mg daily morphine equivalents, implementing various strategies such as training, restrictions on specific drugs, and collaboration with local partners to enhance intervention effectiveness.*

Article Abstract

Background: Oregon's Medicaid program is delivered through 16 Coordinated Care Organizations (CCOs) participating in a statewide performance improvement program to reduce high-dose opioid prescribing. CCOs were allowed flexibility to develop their own dose targets and any policies, trainings, guidelines, and/or materials to meet these targets. In this study, we characterize CCO strategies to reduce high-dose opioid prescribing across the 16 CCOs.

Methods: We reviewed relevant CCO documents and conducted semi-structured interviews with CCO administrators to acquire opioid-related policies, practices, timelines and contextual factors. We applied a systematic coding procedure to develop a comprehensive description of each CCO's strategy. We used administrative data from the state to summarize contextual utilization data for each CCO.

Results: Most CCOs selected a target daily morphine milligram equivalent (MME) dose of 90 mg. Sixteen issued quantity limits related to dose, eight restricted specific drug formulations (short-acting or long-acting), and 11 allowed for time-limited taper plan periods for patients over threshold. Many CCOs also employed provider trainings, feedback reports, and/or onsite technical assistance. Other innovations included incentive measures, electronic health record alerts, and toolkits with materials on local alternative therapy resources and strategies for patient communication. CCOs leveraging collaborations with regional partners appeared to mount a greater intensity of interventions than independently operating CCOs.

Conclusions: CCOs developed a diversity of interventions to confront high-risk opioid prescribing within their organization. As healthcare systems mount interventions to reduce risky opioid prescribing, it is critical to carefully describe these activities and examine their impact on process and health outcomes.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078786PMC
http://dx.doi.org/10.1016/j.addbeh.2018.04.020DOI Listing

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