Opioid Dashboard Improves Adherence to Guidelines
Primary care physicians may ramp up their use of tools designed to address opioid abuse if they are provided with clinically relevant information, according to new research. A study of patients in Connecticut health clinics showed more use of urine drug testing, signed opioid treatment agreements, assessments of pain-related functional status, visits with a behavioral health provider, and a reduction in prescriptions of opioids after an opioid dashboard was implemented.
The dashboard provided actionable data for providers to use in planning care for patients because it focuses on process measures rather than patient outcome measures. While the patients in the clinics were medically underserved, the results would likely be useful for physicians who treat injured workers.
“Clinical dashboards are condition-specific, web-based health information technology (HIT) applications for quality reporting and patient management that can help health care teams by providing them with timely, clinically relevant information at the practice or individual provider level,” according to the research. “Dashboards can display adherence to care measures, provide performance improvement comparisons, (e.g., individual performance against that of the entire clinic) and ‘drill down’ from population level to individual-patient level data.”
The authors used electronic health record data from patients receiving chronic opioid therapy between April 2011 and March 31, 2013, and included evaluations of patients pre- and post-implementation of the dashboard. Their findings were published in the Clinical Journal of Pain.
“Dashboards have been developed to support specific quality improvement initiatives and for a variety of conditions but have not, to our knowledge, been developed for opioid analgesic management,” they wrote. “To improve adherence to practice guidelines and agency policies for chronic opioid therapy, we developed, implemented, and evaluated a clinical dashboard for opioid analgesic management in a large, multisite Federally Qualified Health Center.”
The dashboard served as a central data repository where physicians and other medical providers at the facilities had access to information about their own patients receiving opioids. They were also able to see their adherence rates compared with those of their colleagues in the facilities.
The following improvements in adherence to opioid prescribing guidelines were reported in the post-implementation year compared with the pre-implementation year:
- An increase from 49 percent to 63 percent of patients with a signed opioid treatment agreement.
- An increase from 66 percent to 86 percent of patients given urine drug testing.
- An increase from 33 percent to 46 percent of patients with a documented assessment of functional status.
- An increase from 24 percent to 28 percent of patients with a behavioral health visit.
- A decrease from 3.4 percent to 3.1 percent in the proportion of patients prescribed chronic opioid therapy, a change the authors said was small but statistically significant.
“Many PCPs utilized the dashboard during morning ‘huddles’ during which they reviewed the dashboard with their support staff, noted which patients were due for pain management follow-up care, and assigned tasks to the appropriate staff member to obtain the needed items,” the report said. “This observation suggests that improvements may be partly attributable to the motivation gain effect. This effect is seen when an individual’s performance and motivation improves as a member of a team working under conjunctive task demands, than the individual working alone, especially when that individual feels indispensable to the team.”
The researchers also speculated that the adherence data on the webpage may have led to increased competition among the physicians, as well as the desire to create a favorable impression among their peers.
“HIT is increasingly being used to improve the quality and efficiency of health care delivery, patient safety, and patient-centered care,” the study said. “Our study is unique in its use of HIT to improve opioid prescribing for pain, but consistent with other studies that have demonstrated the use of HIT to improve medication adherence, increase the safety of electronic prescribing, and increase physician adherence to treatment protocols.”