Of all U.S. states and territories, Ohio ranks among the highest for opioid prescribing and is number one in opioid deaths, so it’s no surprise that the Governor’s Cabinet Opiate Action Team (GCOAT) has developed specific opioid usage guidelines for providers treating acute pain, chronic non-terminal pain, and patients presenting with pain in emergency departments (ED) and acute care facilities.

Montgomery is one of the highest ranked counties in Ohio for prescription opioid doses per capita. HSAG, along with a health system in that county, facilitated the implementation of the GCOAT Opioid Prescribing Guidelines among primary care providers (PCPs).

In September 2017, Health Services Advisory Group (HSAG), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Arizona, California, Florida, Ohio and the U.S. Virgin Islands, launched a two-year Special Innovation Project (SIP) in Ohio’s Montgomery and Miami Counties. Montgomery is one of the highest ranked counties in Ohio for prescription opioid doses per capita. HSAG, along with a health system in that county, facilitated the implementation of the GCOAT Opioid Prescribing Guidelines among primary care providers (PCPs).

HSAG measured the current implementation and understanding of the guidelines through interviews with the providers and office staff. Any gaps identified at a system level were taken back to the health system’s leadership. For example, HSAG determined that there was a lack of parity in e-prescribing across provider types, which led to leadership granting advanced practice providers (nurse practitioners, physician assistants) full e-prescribing abilities.

Beyond e-prescribing, HSAG engaged all levels of care to create a different mindset around “opioid stewardship” (similar to antibiotic stewardship) by having a conversation about pain management and opioid misuse with more than just PCP offices. The QIN-QIO began working with prescribers that manage and prescribe opioids throughout the treatment continuum—including emergency physicians, hospitalists, orthopedic surgeons, and psychiatrists—to identify their understanding of state dosing guidelines and any additional knowledge gaps.

Additionally, HSAG determined that behavioral health and addiction services were underutilized by providers due to lack of understanding of conditions, as well as to the inability to identify appropriate patients for referral. The QIN-QIO began working in tandem with a behavioral health system in Montgomery County to identify, organize and coordinate both a more streamlined referral process and better identification of proper treatment. They also collaborated with patients and families to review educational materials focused on safe storage, proper disposal and better provider/patient communication supporting improved patient literacy and provider efforts.  

As a result of the project, the Montgomery County-based health system is creating its first opioid policy reflecting inpatient and outpatient treatment. This policy bridges the identified knowledge gaps between providers and defines how opioid dosing guidelines will be implemented and supported. As of June 2018, in Montgomery and Miami Counties, opioid utilization (average daily morphine equivalent dose), as well as ED utilization for beneficiaries on opiates, have decreased.

Through the end of the contract award in September 2019, HSAG will continue to address barriers identified by providers, bridge gaps across provider types and finalize the opioid policy in progress to aid in ensuring the sustainability of the project.