WSHA, in partnership with the Washington State Medical Association, is empowering Washington State providers to be good stewards of opioid prescriptions. New legislation (H.B.1427) extends access of the Prescription Drug Monitoring Program database to WSHA for analysis and performance improvement. Beginning in 2019, hospital CMOs may opt-in to receive Opioid Prescribing Reports to review prescribing patterns by specialty group.
Reported measures are intended to inform targeted quality improvement action to decrease unnecessary opioid prescribing among provider specialty groups. The first measures focus on new opioid prescribing to opiate naïve patients during acute episodes of pain and are derived from the Bree Collaborative.
The Washington Health Care Authority (HCA) policy limits the quantity of opioids that can be prescribed to opiate naïve patients for non-cancer pain. The limits are:
- No more than 18 doses (approximately a 3-day supply) for patients age 20 or younger.
- No more than 42 doses (approximately a 7-day supply) for patients age 21 or older.
Non-Compliant Opioid Prescriptions: Count of opioid prescriptions exceeding 18 doses (3-day supply) for those under age 20, or 42 doses (7-day supply) for adults (age 20+) among patients who were not prescribed opioids in the previous quarter (considered “opioid naïve”).
Compliant Opioid Prescriptions: Count of opioid prescriptions at or below HCA limits for opioid naïve patients.
Notes: “Acute” time period is generally defined as <60 days. This measure aligns most closely with the Bree Collaborative measure #5, “New opioid patients days’ supply of first opioid prescription” using a one quarter (105 day) look-back period to detect “opioid naïve” patients. The count of “non-compliant” aligns with HCA 2017 clinical opioid policy; providers may still note exemptions. “Dose” is calculated as a pill count, and “opioid date filled” is used instead of “date written” to more accurately account for patient use.
State Benchmarks: For a hospital facility or system report, a benchmark was created for each provider specialty group. The average rate of non-compliance prescribing was calculated for each provider specialty across Washington State. The benchmark denotes the anticipated volume of non-compliant prescriptions that would be written if the providers prescribing patterns were consistent with the state average.
For example, if on average family medicine prescribes non-compliant prescriptions 20% of the time, we would anticipate 20% of Clinic A’s opioid prescriptions written by family medicine doctors to be non-compliant. If the total volume of opioid prescriptions for family medicine at Clinic A is 1,000, the benchmark would be noted at 200.
Chronic opioid, high dose and concurrent prescribing of benzodiazepines or sedatives are currently under development. All measures are designed to inform and guide quality improvement efforts to promote patient safety.
The Washington State Prescription Drug Monitoring Program (PMP) database is the original source of opioid prescribing data for these reports. No identifiable patient data is shared, therefore exclusions based on cancer treatment or palliative care are not possible.
WSHA/WSMA Opioid Prescribing Reports are disseminated quarterly to the Chief Medical Officers (CMO) and designated quality leaders at participating hospital systems. The first reports, finalized May 2019, reflect 2018 dispensed Schedule II, III, IV and V drugs across all patient types.
Provider specialty groups are based on the primary CMS Healthcare Provider Taxonomy Code affiliated with a provider’s National Provider Identifier (NPI). To ensure robust sample size for peer benchmarks within specialty, the taxonomy groups may be combined in system level reports.
Opioids may not be the most effective approach for all types of acute pain management. Multi-modal alternatives to opioids provide evidence-based treatment without risk of opioid addiction. When opioids are indicated, use the smallest effective dose.
- Alternatives to Opioids for Pain Management (ALTO) Program
- Michigan Opioid Prescribing Engagement Network (OPEN)
- AMDG Prescribing Opioids for Postoperative Pain
- IHI Advancing the Safety of Acute Pain Management
- Washington: Opioid-Involved Deaths and Related Harms | National Institute on Drug Abuse (NIDA)
- Opioid Stewardship Collaborative | AHA
- HIIN-opioid-guide-0520.pdf (aha.org)
- EHRA CDC Opioid Guideline Implementation Guide for EHRs (chimecentral.org)