Opioid Use
Conditions
Keywords
implementation, primary care, organizational change, Centers for Disease Control opioid prescribing guidelines, clinical guidelines, systems consultation
Brief summary
This study aims to understand the optimal sequencing and combination of implementation strategies that specific types of clinics and prescribers need to adopt clinical guidelines for opioid prescribing. The pragmatic goal is to give health systems a tool they can use to predict which clinics and prescribers will benefit most from which sequence and combination of implementation strategies.
Detailed description
The proposed study evaluates a sequence and combination of implementation strategies that is tailored to the needs of stakeholders at different levels (health system, clinic, and prescriber). We will deliver an adaptive version of systems consultation that progressively and adaptively drills down to offer more and more personalized levels of implementation support. The intervention starts with academic detailing, a systems-level strategy consisting of an expert-led training session plus distance-based follow up support. This strategy continues for the 21-month intervention for all clinics, but at 3 months, half of the clinics will be randomized to receive practice facilitation. Practice facilitation is a clinic-level strategy in which a highly-skilled external change agent helps clinics improve processes related to opioid prescribing. At 6 months, half of prescribers will be randomized to receive physician peer coaching. Physician peer coaching is a clinic-level strategy in which a physician expert gives one-on-one support to prescribers in managing their patients on long-term opioid therapy. These 3 discrete strategies will be delivered in a sequential, multiple-assignment randomized trial to 38 clinics from 2 Wisconsin health systems. The study has 3 specific aims: 1. Compare the effect over 21 months of (1). An adaptive systems consultation implementation strategy (intervention group) vs. (2). Academic detailing alone (control group) on average morphine milligram equivalent dose (the primary outcome). 2. Develop an assessment of contextual factors that influence the effectiveness of different implementation strategies. This aim will test 4 moderators and assess other factors that affect implementation. The goal is to develop a tool that decision-makers can use to predict which implementation strategies will be most effective in different settings. 3. Estimate the costs of delivering 4 different sequences and combinations of strategies, including the incremental cost effectiveness of adding facilitation and physician peer coaching. Results will help decision-makers weigh the costs and effects of using different implementation strategies.
Interventions
OTHERSystems consultation
Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 21 months. AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing. PF: clinics will be randomized to receive practice facilitation. Facilitators will meet with each clinic. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly. PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing.
Sponsors
National Institute on Drug Abuse (NIDA)
University of Wisconsin, Madison
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
The intervention will assess outcomes at the clinic and prescriber level. Prescribers are the population of interest.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Clinics will be eligible for the study if they: * are a primary care clinic (non-pediatric primary care, internal medicine, or family medicine); * have not received the systems consultation intervention; * do not explicitly prohibit initiating opioid therapy; * do not exceed the performance on key measures of guideline concordance (fewer than 80% of long-term opioid patients have treatment agreements and a urine drug screen in the past 12 months) Prescribers will be eligible if they: * are a primary care provider at the clinic; * are not temporary providers who do not manage stable panels or patients; While patients are not subjects of study, de-identified prescriber panel data will be used to assess outcome measures. To be included in the de-identified prescriber panel data, patients must: * have a primary care provider at the clinic; * are prescribed opioid therapy for at least 3 consecutive months; * do not have a cancer diagnosis or are receiving hospice care.
Exclusion criteria
Clinics will be excluded if they are not a primary care clinic, have received the systems consultation intervention, prohibit initiating opioid therapy, or exceed the threshold on key measures of guideline concordance. Prescribers will be excluded if they don't have prescribing privileges or are temporary providers who do not manage stable panels or patients. De-identified prescriber panel data will be excluded from outcome measures if they do not have a primary care provider at the clinic, are not prescribed opioid therapy for at least 3 consecutive months, or have a cancer diagnosis or are receiving hospice care.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average Morphine Milligram Equivalent (MME) Per Day of Chronic Opioid Prescriptions of Clinics | up to 30 months | The average morphine milligram equivalent will be reported at the clinic level. Patients included in this outcome are those who are prescribed at least 3 opioid orders in the last 3 consecutive months. For a comparison of opioids doses, a conversion factors were developed to equate the many different opioids into one standard value. This standard value is based on morphine and its potency, referred to as morphine milligram equivalents (MME) or morphine equivalent doses (MED). |
| Average Morphine Milligram Equivalent of Chronic Opioid Prescriptions of Prescribers | up to 30 months | The average morphine milligram equivalent will be reported at the prescriber level. Patients included in this outcome are those who are prescribed at least 3 opioid orders in the last 3 consecutive months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Clinicians Who Participated in the Study | up to 30 months | The number of eligible clinicians who participated in the study |
| Number of Patients at Clinics | up to 30 months | The total number of patients seen at clinics will be used to assess clinic size. |
| Average Hours of Intervention Received Per Clinic | up to 30 months | The average time (in hours) of intervention that clinics received. |
| Average Hours of Intervention Received Per Prescriber | up to 30 months | The average time (in hours) of intervention that prescribers received. The average time the prescriber received the intervention (in hours) is the same amount of time as the average intervention time that each clinic receives, because our intervention is at the clinic level. |
| Estimated Cost of Each Study Arm in US Dollars | up to 30 months | The estimated cost of each implementation sequence and combination in US dollars. The result is derived from the number of intervention hours calculated for each arm, multiplied by the average salary of the staff who gave the intervention (e.g., the facilitators, providers, and IT coordinator), referenced from publicly reported data (Medscape Family Medicine Physician Compensation Report). |
| Number of Clinicians Who Attended the Intervention Meetings | up to 30 months | The number of clinicians who attended the meeting for practice facilitation, physician peer consulting, and follow-up meetings. |
| Number of Eligible Clinics That Participated | up to 30 months | The number of eligible clinics that participated in the study. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Emergency Room Visits and Hospitalizations Per Patient | up to 30 months | The number of hospital or emergency room visits per patient among patients who are prescribed at least 3 opioid orders in 3 consecutive months. |
| Number of Patients Who Attend Their Scheduled Clinic Visits | up to 30 months | The number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who attend their scheduled clinic visits. |
| Quality Improvement Experience of the Clinics | up to 30 months | A assessment tool is under development to capture the quality improvement experience level of clinics. |
| Average Morphine Milligram Equivalent of Patients Who Are Co-prescribed Opioids and Benzodiazepines | up to 30 months | The average morphine milligram equivalent of patients who are prescribed at least 3 opioid orders in 3 consecutive months at the clinic level. |
| Total Number of Patients in a Clinic Who Have Chronic Opioid Prescriptions | up to 30 months | The total number of patients who are prescribed at least 3 opioid orders in 3 consecutive months. The number will be reported at the clinic level. |
| Components of System-level Opioid Prescribing Policy of the Health Systems | up to 30 months | A list and count of the components of the participating health systems' opioid prescribing policy. |
| Number of Adaptations Made to the Intervention During Intervention Period | up to 30 months | A list and count of adaptations that were made to the intervention during the intervention period will be documented. |
| Number of Patients of a Prescriber Who Have Chronic Opioid Prescriptions | up to 30 months | The number of patients who are prescribed at least 3 opioid orders in 3 consecutive months. The number will be reported at the prescriber level. |
| Number of Patients Completing Urine Drug Screens in the Past 12 Months | up to 30 months | Number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who have had a urine drug screen documented within the past 12 months. |
| Number of Patients Completing Screening for Mental Health and Substance Abuse Within the Past 12 Months | up to 30 months | Number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who have a Patient Health Questionnaire (PHQ-9) documented within the past 12 months. The study team is not administering the screening tool, data will be provided by Wisconsin Collaborative for Healthcare Quality (WCHQ). The PHQ-9 is a 9-question instrument given to patients in a primary care setting to screen for the presence and severity of depression. It is the 9-question depression scale from the Patient Health Questionnaire. Total score can range from 1-27. Interpretation of total scores is as follows: 1-4=Minimal depression, 5-9=Mild depression, 10-14= Moderate depression, 15-19=Moderately severe depression, 20-27= Severe depression. |
| Number of Patients With Treatment Agreements Within the Past 12 Months | up to 30 months | The number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who have documented treatment agreements within the past 12 months. |
| Number of Patients With a Daily Morphine Milligram Equivalent Above 90 Milligrams | up to 30 months | The number of patients who are prescribed at least 3 opioid orders in 3 consecutive months and have a daily morphine milligram equivalent over 90 milligrams. |
| Number of Patients Who Are Co-prescribed Opioids and Benzodiazepines | up to 30 months | Number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who also have a concurrent benzodiazepine prescription. |
Countries
United States
Participant flow
Recruitment details
The study team focused outreach efforts toward clinics to build awareness about this study. An email was sent to clinic medical directors of the health system to instruct them how to opt-out if they wish to decline participation in the study and future contact from the study team. The study team enrolled 'providers' as participants and focused on clinic-level data.
Participants by arm
| Arm | Count |
|---|---|
| Academic Detailing Only Clinicians will attend an educational meeting and receive audit and feedback reports for 18 months.
Systems consultation: Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 18 months.
AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing.
PF: clinics will be randomized to receive practice facilitation. Facilitators will travel to each clinics. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly.
PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing. | 60 |
| Academic Detailing Only Clinicians will attend an educational meeting and receive audit and feedback reports for 18 months.
Systems consultation: Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 18 months.
AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing.
PF: clinics will be randomized to receive practice facilitation. Facilitators will travel to each clinics. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly.
PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing. | 8 |
| Academic Detailing+Practice Facilitation Clinicians of this group will attend an educational meeting and receive a monthly audit and feedback report for 18 months.
At month 3, clinics will be randomized to receive practice facilitation. Clinics will be asked to follow-up with the facilitators via phone or video chat monthly for months 4-6, then quarterly for months 7-18.
Systems consultation: Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 18 months.
AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing.
PF: clinics will be randomized to receive practice facilitation. Facilitators will travel to each clinics. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly.
PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing. | 65 |
| Academic Detailing+Practice Facilitation Clinicians of this group will attend an educational meeting and receive a monthly audit and feedback report for 18 months.
At month 3, clinics will be randomized to receive practice facilitation. Clinics will be asked to follow-up with the facilitators via phone or video chat monthly for months 4-6, then quarterly for months 7-18.
Systems consultation: Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 18 months.
AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing.
PF: clinics will be randomized to receive practice facilitation. Facilitators will travel to each clinics. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly.
PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing. | 8 |
| Academic Detailing+Practice Facilitation+Physician Peer Consul Clinicians will receive academic detailing at month 0 and practice facilitation at month 3. At month 6, clinics will be randomized to receive physician peer consulting. Clinicians of the clinics will meet up to 4 times, quarterly, with the physician peer consultant.
Systems consultation: Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 18 months.
AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing.
PF: clinics will be randomized to receive practice facilitation. Facilitators will travel to each clinics. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly.
PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing. | 66 |
| Academic Detailing+Practice Facilitation+Physician Peer Consul Clinicians will receive academic detailing at month 0 and practice facilitation at month 3. At month 6, clinics will be randomized to receive physician peer consulting. Clinicians of the clinics will meet up to 4 times, quarterly, with the physician peer consultant.
Systems consultation: Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 18 months.
AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing.
PF: clinics will be randomized to receive practice facilitation. Facilitators will travel to each clinics. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly.
PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing. | 8 |
| Academic Detailing+Physician Peer Consulting Clinicians of this group will attend an educational meeting and will receive a monthly audit and feedback report for 18 months.
At month 6, clinicians of the clinics will meet up to 4 times, quarterly, with the physician peer consultant.
Systems consultation: Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 18 months.
AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing.
PF: clinics will be randomized to receive practice facilitation. Facilitators will travel to each clinics. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly.
PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing. | 77 |
| Academic Detailing+Physician Peer Consulting Clinicians of this group will attend an educational meeting and will receive a monthly audit and feedback report for 18 months.
At month 6, clinicians of the clinics will meet up to 4 times, quarterly, with the physician peer consultant.
Systems consultation: Systems consultation consists of three implementation strategies: academic detailing (AD), practice facilitation (PF), and physician peer consulting (PPC). Clinics will receive a combination of these strategies for 18 months.
AD: Clinicians will attend an educational meeting that will detail the study and Center for Disease Control guidelines for opioid prescribing in primary care. Clinicians will then will get a monthly audit & feedback report on their prescribing.
PF: clinics will be randomized to receive practice facilitation. Facilitators will travel to each clinics. Facilitators walk through the clinic, identify areas of opioid prescribing workflow improvement, conduct a nominal group technique with the change team, and set a Plan-Do-Study-Act cycle. Clinics will follow-up with the facilitators monthly.
PPC: Clinicians of the clinics will meet quarterly with the physician peer consultant to discuss tough patient cases and panels regarding opioid prescribing. | 8 |
| Total | 300 |
Baseline characteristics
| Characteristic | Academic Detailing Only | Total | Academic Detailing+Physician Peer Consulting | Academic Detailing+Practice Facilitation+Physician Peer Consul | Academic Detailing+Practice Facilitation |
|---|---|---|---|---|---|
| Average MME per day for most recent 3 months | 44.9938 morphine milligram equivalents per day STANDARD_DEVIATION 22.4591 | 43.3 morphine milligram equivalents per day STANDARD_DEVIATION 19.7 | 48.9800 morphine milligram equivalents per day STANDARD_DEVIATION 20.1475 | 36.6330 morphine milligram equivalents per day STANDARD_DEVIATION 15.7656 | 39.6526 morphine milligram equivalents per day STANDARD_DEVIATION 17.2418 |
| Percent of patients with average MME greater than or equal to 90 mg/day | 0.1142 percent of patients STANDARD_DEVIATION 0.1175 | 0.109 percent of patients STANDARD_DEVIATION 0.109 | 0.1326 percent of patients STANDARD_DEVIATION 0.108 | 0.0741 percent of patients STANDARD_DEVIATION 0.0954 | 0.1033 percent of patients STANDARD_DEVIATION 0.1014 |
| Percent of patients with co-prescribed Benzodiazepine in the last quarter | 0.1600 percent of patients STANDARD_DEVIATION 0.092 | 0.132 percent of patients STANDARD_DEVIATION 0.1 | 0.1178 percent of patients STANDARD_DEVIATION 0.1095 | 0.1351 percent of patients STANDARD_DEVIATION 0.1097 | 0.1123 percent of patients STANDARD_DEVIATION 0.0817 |
| Percent of patients with PEG-3 pain screen in last 12 months | 0.1234 percent of patients STANDARD_DEVIATION 0.207 | 0.069 percent of patients STANDARD_DEVIATION 0.151 | 0.0919 percent of patients STANDARD_DEVIATION 0.1602 | 0.0073 percent of patients STANDARD_DEVIATION 0.0157 | 0.0291 percent of patients STANDARD_DEVIATION 0.0596 |
| Percent of patients with PHQ-8/9 depression screen in last 12 months | 0.2791 percent of patients STANDARD_DEVIATION 0.1936 | 0.258 percent of patients STANDARD_DEVIATION 0.18 | 0.2346 percent of patients STANDARD_DEVIATION 0.1563 | 0.2673 percent of patients STANDARD_DEVIATION 0.2101 | 0.2464 percent of patients STANDARD_DEVIATION 0.1584 |
| Percent of patients with treatment in last 12 months | 0.3302 percent of patients STANDARD_DEVIATION 0.1946 | 0.16 percent of patients STANDARD_DEVIATION 0.188 | 0.1341 percent of patients STANDARD_DEVIATION 0.1711 | 0.1982 percent of patients STANDARD_DEVIATION 0.1593 | 0.1316 percent of patients STANDARD_DEVIATION 0.2047 |
| Percent of patients with urine drug screen in last 12 months | 0.3302 percent of patients STANDARD_DEVIATION 0.2577 | 0.298 percent of patients STANDARD_DEVIATION 0.234 | 0.3276 percent of patients STANDARD_DEVIATION 0.2087 | 0.2628 percent of patients STANDARD_DEVIATION 0.2089 | 0.2555 percent of patients STANDARD_DEVIATION 0.2343 |
| Race and Ethnicity Not Collected | — | 0 Participants | — | — | — |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Average Morphine Milligram Equivalent (MME) Per Day of Chronic Opioid Prescriptions of Clinics
The average morphine milligram equivalent will be reported at the clinic level. Patients included in this outcome are those who are prescribed at least 3 opioid orders in the last 3 consecutive months. For a comparison of opioids doses, a conversion factors were developed to equate the many different opioids into one standard value. This standard value is based on morphine and its potency, referred to as morphine milligram equivalents (MME) or morphine equivalent doses (MED).
Time frame: up to 30 months
Population: Outcome measure provides clinic-level data. Participants enrolled are providers.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Academic Detailing+Practice Facilitation | Average Morphine Milligram Equivalent (MME) Per Day of Chronic Opioid Prescriptions of Clinics | 320.69 average MME/day | Standard Deviation 11.8 |
| Academic Detailing Only | Average Morphine Milligram Equivalent (MME) Per Day of Chronic Opioid Prescriptions of Clinics | 372.33 average MME/day | Standard Deviation 20.04 |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Average Morphine Milligram Equivalent (MME) Per Day of Chronic Opioid Prescriptions of Clinics | 275.55 average MME/day | Standard Deviation 16.78 |
| Academic Detailing+Physician Peer Consulting | Average Morphine Milligram Equivalent (MME) Per Day of Chronic Opioid Prescriptions of Clinics | 455.62 average MME/day | Standard Deviation 19.59 |
Primary
Average Morphine Milligram Equivalent of Chronic Opioid Prescriptions of Prescribers
The average morphine milligram equivalent will be reported at the prescriber level. Patients included in this outcome are those who are prescribed at least 3 opioid orders in the last 3 consecutive months.
Time frame: up to 30 months
Population: Outcome measure provides prescriber-level data. Participants enrolled are providers.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Academic Detailing+Practice Facilitation | Average Morphine Milligram Equivalent of Chronic Opioid Prescriptions of Prescribers | 39.65 average MME/day | Standard Deviation 17.24 |
| Academic Detailing Only | Average Morphine Milligram Equivalent of Chronic Opioid Prescriptions of Prescribers | 45.00 average MME/day | Standard Deviation 22.46 |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Average Morphine Milligram Equivalent of Chronic Opioid Prescriptions of Prescribers | 36.63 average MME/day | Standard Deviation 15.77 |
| Academic Detailing+Physician Peer Consulting | Average Morphine Milligram Equivalent of Chronic Opioid Prescriptions of Prescribers | 48.98 average MME/day | Standard Deviation 20.15 |
Secondary
Average Hours of Intervention Received Per Clinic
The average time (in hours) of intervention that clinics received.
Time frame: up to 30 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Academic Detailing+Practice Facilitation | Average Hours of Intervention Received Per Clinic | 12.5 hours | Standard Deviation 17.5 |
| Academic Detailing Only | Average Hours of Intervention Received Per Clinic | 4.571428571 hours | Standard Deviation 1.673469388 |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Average Hours of Intervention Received Per Clinic | 14.875 hours | Standard Deviation 31.609375 |
| Academic Detailing+Physician Peer Consulting | Average Hours of Intervention Received Per Clinic | 6.125 hours | Standard Deviation 9.609375 |
Secondary
Average Hours of Intervention Received Per Prescriber
The average time (in hours) of intervention that prescribers received. The average time the prescriber received the intervention (in hours) is the same amount of time as the average intervention time that each clinic receives, because our intervention is at the clinic level.
Time frame: up to 30 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Academic Detailing+Practice Facilitation | Average Hours of Intervention Received Per Prescriber | 12.5 hours | Standard Deviation 17.5 |
| Academic Detailing Only | Average Hours of Intervention Received Per Prescriber | 4.571428571 hours | Standard Deviation 1.673469388 |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Average Hours of Intervention Received Per Prescriber | 14.875 hours | Standard Deviation 31.609375 |
| Academic Detailing+Physician Peer Consulting | Average Hours of Intervention Received Per Prescriber | 6.125 hours | Standard Deviation 9.609375 |
Secondary
Estimated Cost of Each Study Arm in US Dollars
The estimated cost of each implementation sequence and combination in US dollars. The result is derived from the number of intervention hours calculated for each arm, multiplied by the average salary of the staff who gave the intervention (e.g., the facilitators, providers, and IT coordinator), referenced from publicly reported data (Medscape Family Medicine Physician Compensation Report).
Time frame: up to 30 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Academic Detailing+Practice Facilitation | Estimated Cost of Each Study Arm in US Dollars | 7933.2 dollars |
| Academic Detailing Only | Estimated Cost of Each Study Arm in US Dollars | 2307.84 dollars |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Estimated Cost of Each Study Arm in US Dollars | 9015 dollars |
| Academic Detailing+Physician Peer Consulting | Estimated Cost of Each Study Arm in US Dollars | 4399.32 dollars |
Secondary
Number of Clinicians Who Attended the Intervention Meetings
The number of clinicians who attended the meeting for practice facilitation, physician peer consulting, and follow-up meetings.
Time frame: up to 30 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Academic Detailing+Practice Facilitation | Number of Clinicians Who Attended the Intervention Meetings | 6.118461538 average participants | Standard Deviation 11.36059744 |
| Academic Detailing Only | Number of Clinicians Who Attended the Intervention Meetings | 6.741935484 average participants | Standard Deviation 18.26451613 |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Number of Clinicians Who Attended the Intervention Meetings | 6.228070175 average participants | Standard Deviation 22.34556254 |
| Academic Detailing+Physician Peer Consulting | Number of Clinicians Who Attended the Intervention Meetings | 6.15 average participants | Standard Deviation 28.32195122 |
Secondary
Number of Clinicians Who Participated in the Study
The number of eligible clinicians who participated in the study
Time frame: up to 30 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Academic Detailing+Practice Facilitation | Number of Clinicians Who Participated in the Study | 65 participants |
| Academic Detailing Only | Number of Clinicians Who Participated in the Study | 60 participants |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Number of Clinicians Who Participated in the Study | 66 participants |
| Academic Detailing+Physician Peer Consulting | Number of Clinicians Who Participated in the Study | 77 participants |
Secondary
Number of Eligible Clinics That Participated
The number of eligible clinics that participated in the study.
Time frame: up to 30 months
| Arm | Measure | Value (COUNT_OF_UNITS) |
|---|---|---|
| Academic Detailing+Practice Facilitation | Number of Eligible Clinics That Participated | 8 Clinics |
| Academic Detailing Only | Number of Eligible Clinics That Participated | 7 Clinics |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Number of Eligible Clinics That Participated | 8 Clinics |
| Academic Detailing+Physician Peer Consulting | Number of Eligible Clinics That Participated | 8 Clinics |
Secondary
Number of Patients at Clinics
The total number of patients seen at clinics will be used to assess clinic size.
Time frame: up to 30 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Academic Detailing+Practice Facilitation | Number of Patients at Clinics | 2486 patients |
| Academic Detailing Only | Number of Patients at Clinics | 2427 patients |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Number of Patients at Clinics | 2044 patients |
| Academic Detailing+Physician Peer Consulting | Number of Patients at Clinics | 2021 patients |
Other Pre-specified
Average Morphine Milligram Equivalent of Patients Who Are Co-prescribed Opioids and Benzodiazepines
The average morphine milligram equivalent of patients who are prescribed at least 3 opioid orders in 3 consecutive months at the clinic level.
Time frame: up to 30 months
Other Pre-specified
Components of System-level Opioid Prescribing Policy of the Health Systems
A list and count of the components of the participating health systems' opioid prescribing policy.
Time frame: up to 30 months
Other Pre-specified
Number of Adaptations Made to the Intervention During Intervention Period
A list and count of adaptations that were made to the intervention during the intervention period will be documented.
Time frame: up to 30 months
Other Pre-specified
Number of Emergency Room Visits and Hospitalizations Per Patient
The number of hospital or emergency room visits per patient among patients who are prescribed at least 3 opioid orders in 3 consecutive months.
Time frame: up to 30 months
Other Pre-specified
Number of Patients Completing Screening for Mental Health and Substance Abuse Within the Past 12 Months
Number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who have a Patient Health Questionnaire (PHQ-9) documented within the past 12 months. The study team is not administering the screening tool, data will be provided by Wisconsin Collaborative for Healthcare Quality (WCHQ). The PHQ-9 is a 9-question instrument given to patients in a primary care setting to screen for the presence and severity of depression. It is the 9-question depression scale from the Patient Health Questionnaire. Total score can range from 1-27. Interpretation of total scores is as follows: 1-4=Minimal depression, 5-9=Mild depression, 10-14= Moderate depression, 15-19=Moderately severe depression, 20-27= Severe depression.
Time frame: up to 30 months
Other Pre-specified
Number of Patients Completing Urine Drug Screens in the Past 12 Months
Number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who have had a urine drug screen documented within the past 12 months.
Time frame: up to 30 months
Other Pre-specified
Number of Patients of a Prescriber Who Have Chronic Opioid Prescriptions
The number of patients who are prescribed at least 3 opioid orders in 3 consecutive months. The number will be reported at the prescriber level.
Time frame: up to 30 months
Other Pre-specified
Number of Patients Who Are Co-prescribed Opioids and Benzodiazepines
Number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who also have a concurrent benzodiazepine prescription.
Time frame: up to 30 months
Other Pre-specified
Number of Patients Who Attend Their Scheduled Clinic Visits
The number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who attend their scheduled clinic visits.
Time frame: up to 30 months
Other Pre-specified
Number of Patients With a Daily Morphine Milligram Equivalent Above 90 Milligrams
The number of patients who are prescribed at least 3 opioid orders in 3 consecutive months and have a daily morphine milligram equivalent over 90 milligrams.
Time frame: up to 30 months
Other Pre-specified
Number of Patients With Treatment Agreements Within the Past 12 Months
The number of patients who are prescribed at least 3 opioid orders in 3 consecutive months, who have documented treatment agreements within the past 12 months.
Time frame: up to 30 months
Other Pre-specified
Quality Improvement Experience of the Clinics
A assessment tool is under development to capture the quality improvement experience level of clinics.
Time frame: up to 30 months
Other Pre-specified
Total Number of Patients in a Clinic Who Have Chronic Opioid Prescriptions
The total number of patients who are prescribed at least 3 opioid orders in 3 consecutive months. The number will be reported at the clinic level.
Time frame: up to 30 months
Population: In this outcome measure, we report the number of patients who are prescribed at least 3 opioid orders in 3 consecutive months at the clinic level.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Academic Detailing+Practice Facilitation | Total Number of Patients in a Clinic Who Have Chronic Opioid Prescriptions | 985 patients |
| Academic Detailing Only | Total Number of Patients in a Clinic Who Have Chronic Opioid Prescriptions | 1175 patients |
| Academic Detailing+Practice Facilitation+Physician Peer Consul | Total Number of Patients in a Clinic Who Have Chronic Opioid Prescriptions | 681 patients |
| Academic Detailing+Physician Peer Consulting | Total Number of Patients in a Clinic Who Have Chronic Opioid Prescriptions | 925 patients |