Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA.
Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA.
J Gen Intern Med. 2023 Feb;38(2):375-381. doi: 10.1007/s11606-022-07617-y. Epub 2022 May 2.
Risk of overdose, suicide, and other adverse outcomes are elevated among sub-populations prescribed opioid analgesics. To address this, the Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM)-a provider-facing dashboard that utilizes predictive analytics to stratify patients prescribed opioids based on risk for overdose/suicide.
To evaluate the impact of the case review mandate on serious adverse events (SAEs) and all-cause mortality among high-risk Veterans.
A 23-month stepped-wedge cluster randomized controlled trial in all 140 VHA medical centers between 2018 and 2020.
A total of 44,042 patients actively prescribed opioid analgesics with high STORM risk scores (i.e., percentiles 1% to 5%) for an overdose or suicide-related event.
A mandate requiring providers to perform case reviews on opioid analgesic-prescribed patients at high risk of overdose/suicide.
Nine serious adverse events (SAEs), case review completion, number of risk mitigation strategies, and all-cause mortality.
Mandated review inclusion was associated with a significant decrease in all-cause mortality within 4 months of inclusion (OR: 0.78; 95% CI: 0.65-0.94). There was no detectable effect on SAEs. Stepped-wedge analyses found that mandated review patients were five times more likely to receive a case review than non-mandated patients with similar risk (OR: 5.1; 95% CI: 3.64-7.23) and received more risk mitigation strategies than non-mandated patients (0.498; CI: 0.39-0.61).
Among VHA patients prescribed opioid analgesics, identifying high risk patients and mandating they receive an interdisciplinary case review was associated with a decrease in all-cause mortality. Results suggest that providers can leverage predictive analytic-targeted population health approaches and interdisciplinary collaboration to improve patient outcomes.
ISRCTN16012111.
在接受阿片类镇痛药处方的亚人群中，药物过量、自杀和其他不良后果的风险增加。为了解决这个问题，退伍军人健康管理局 (VHA) 开发了一种针对阿片类药物风险缓解的分层工具 (STORM) - 一个面向提供者的仪表板，利用预测分析根据药物过量/自杀风险对开处阿片类药物的患者进行分层。
评估案例审查任务对高危退伍军人的严重不良事件 (SAE) 和全因死亡率的影响。
2018 年至 2020 年期间，在所有 140 个退伍军人健康管理局医疗中心进行了为期 23 个月的分步楔形集群随机对照试验。
共有 44042 名积极服用阿片类镇痛药的患者，这些患者的风险评分较高（即 1% 至 5% 之间的百分位），有药物过量或自杀相关事件的风险。
要求提供者对有药物过量/自杀风险的阿片类药物处方患者进行案例审查的任务。
九个严重不良事件 (SAE)、案例审查完成情况、风险缓解策略数量和全因死亡率。
纳入审查任务与纳入后 4 个月内全因死亡率的显著下降相关（OR：0.78；95%CI：0.65-0.94）。对 SAE 没有可检测到的影响。分步楔形分析发现，与风险相似的非强制审查患者相比，强制审查患者进行案例审查的可能性高出五倍（OR：5.1；95%CI：3.64-7.23），并且接受的风险缓解策略多于非强制审查患者（0.498；CI：0.39-0.61）。
在接受阿片类镇痛药处方的退伍军人健康管理局患者中，确定高风险患者并强制要求他们接受跨学科案例审查与全因死亡率下降相关。结果表明，提供者可以利用预测分析靶向人群健康方法和跨学科合作来改善患者结局。
ISRCTN85334369。
