Thursday, April 25, 2024
4/25/2024
The University of Colorado's project Improving Emergency Department pain management through dissemination and implementation of best practices for alternatives to opioids will use simple electronic health record (EHR) interventions at 12 diverse Colorado EDs to decrease opioid exposures and achieve pain relief with non-opioid alternatives to improve care in our communities. This project will provide evidence for a cost-effective solution that is not interruptive or workload intensive for providers and can be easily scaled to other emergency departments and health systems. We will use EHR based clinical decision support (CDS) to make it easier for providers to align with evidence based best practices for alternatives to opioids (ALT). Our logical approach starts with (Goal 1) using modular educational tools to train staff on ALT treatments and existing ALT treatment protocols to prioritize the use of non-opioid pain management. Educational success will be measured by participation and pre/post quizzes. Building on this foundation, we will use evidence based CDS interventions to (Goal 2) increase utilization of ALT treatments and decrease opioid use both in the ED and on ED discharge. Specifically, CDS tools will preferentially recommend ALTs when pain medications are ordered and prompt providers to use recently implemented ALT treatment pathways for conditions where evidenced-based guidelines recommend non-opioid treatments. Existing ALT pathways include (# of visits in 2019): back pain (39,496), dental pain (6,350), headache (32,180), vomiting/abdominal pain (86,672), musculoskeletal pain (87,493), and nephrolithiasis (12,472). The success of these interventions will be measured in CDS/pathway utilization, opioid use and prescribing, ALT use and patient outcomes (Goal 3). There is an important knowledge gap regarding the donwstream impact of ALT vs. opioid use in EDs. To address this, we will (Goal 3) quantify post-ED patient outcomes by leveraging our existing "honest broker" system to merge EHR, prescription drug monitoring program (PDMP), and insurance data. This will allow us to follow patients for 6 months after ED discharge to measure future opioid use, opioid abuse, ED visits, hospitalizations, and deaths. The project will include all 12 hospital-based EDs in the UCHealth system, cumulatively with >500,000 ED visits among 372,700 unique individuals in 2019. ED patient demographics: insurance (Medicaid 37%, private 30%, Medicare 19%, indigent care 13%), race/ethnicity (white 60%, Hispanic 21%, black 11%). Based on 2019 ED opioid use in our system approximately 70,000 unique patients would have triggered proposed CDS interventions for in-ED opioid use and approximately 30,000 for discharge prescribing per year for an approximate three year total of 300,000 patients served. Convincing busy providers and systems to change their practice is challenging. This project will demonstrate how to improve care reinforced by much needed data on patient centered outcomes following treatment in the ED.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
