PENNSYLVANIA OPIOID SURGICAL STEWARDSHIP ENTERPRISE Henry A. Pitt, M.D. Chief Quality Officer, Temple Health Pennsylvania NSQIP Consortium, October 18, 2018
OVERVIEW US epidemic Role of surgery Agreements MSQC/ISQIC Guidelines PANC Procedures HCIF Data collection
OVERDOSE DEATHS 2000 prescription opioid deaths 2010 heroin opioid deaths 2013 synthetic opioid deaths
POST SURGICAL OPIOID USE* New persistent opioid use after surgery is common and is not different between minor and major surgical procedures *Brummett et al JAMA Surgery 2017; 152:1-9
PARTNERS PLAYBOOK National Quality Forum National Quality Partners Provides essential guidance for opioid stewardship Includes concrete examples, tactics, practical tools and resources Identifies drivers of change
MSQC OPEN Michigan Surgical Quality Collaborative BCBS MI U Michigan Healthcare Policy & Innovation multiple publications in 2017 and 2018 Michigan Opioid Prescribing Engagement Network (OPEN)
Stewardship Toolkit Multidisciplinary team ISQIC Preoperative expectations Screening for at risk behavior Optimizing perioperative practices Lowering quantity prescribed Safe storage and disposal
PANC HOSPITALS Abington Jefferson Health* Fox Chase Cancer Center* Hahnemann University Hosp Hosp University of PA* Lancaster General Health* Pennsylvania Hospital* Reading Hospital Robert Packer Hospital Temple Health Jeanes* Temple Univ Hospital* Methodist Jefferson Health* Thomas Jefferson Univ Hosp* Penn State Hershey MC York Hospital *Also Health Care Improvement Foundation (HCIF)
HCIF P4PC Healthcare Improvement Foundation (HCIF) Independent, nonprofit Leads multiple initiatives 18 stakeholder hospitals Partnership for Patient Care since 2006 Institute for Safe Medication Practices
HCIF NON-PANC HOSPITALS Aria Torresdale Aria Frankford Aria Bucks Bryn Mawr Hospital Chester Co Hospital Crozier Keystone Doylestown Hospital Einstein Med Center Einstein Montgomery Grand View Hospital Holy Redeemer Lankenau Hospital Mercy Health System Paoli Mem Hospital Penn Presbyterian MC Riddle Mem Hospital St. Chirstopher s Hosp St. Mary Med Center
OPIOID SURGICAL STEWARDSHIP 24 month collaborative HCIF and PANC Funded by Amerisource Bergen Foundation HCIF Steering Committee Hospital Agreements PANC Patient-Centered Domain Provider-Centered Domain ASBF
STEERING COMMITTEE Executive Champion Henry A. Pitt, M.D. Temple University Health System Surgeon Champion Matt Philp, M.D. Temple University Hospital PANC Surgeon Advisor Scott Cowan, M.D. Thomas Jefferson University Hospital Surg Clinical Reviewer Christine Schleider, RN Thomas Jefferson University Hospital HCIF Team Pam Braun, Susan Cosgrove, and Kelsey Salazar Non-Panc Surgeon Advisor Being recruited
HCIF HOSPITAL AGREEMENTS PANC hospitals Non PANC hospitals Multidisciplinary team Survey current practice Implement QI strategies PANC Participate in events PANC gather data Surg Champion signs SCR signs agreement Non PANC
PATIENT-CENTERED DOMAIN Convene Patient and Family Advisory Council Collect and evaluate educational materials Develop and disseminate health literate patient educational materials
PROVIDER-CENTERED DOMAIN Preoperative expectation setting efforts High-risk screening Intra- and postoperative utilization of alternatives Adoption of procedurespecific opioid prescribing guidelines
MEDICAL ADVISORY COMMITTEE Steering Committee PANC leadership HCIF partners PFAC members Institute for Safe Medication Practices Philadelphia Department of Public Health Pennsylvania Department of Health
TIMELINE YEAR 1* Q1 - Planning meetings Q3 - Share survey results - PANC meeting #1 - PANC meeting #2 - Survey development - Pt edu materials - Measure development - Shared workspace Q2 - Webinar #1 Q4 - PFAC meetings - Hospital enrollment - Pt edu materials - Administer survey - Webinar #2 - Finalize measures - Begin data collection - Form PFAC *September 1, 2018 August 31, 2019
TIMELINE YEAR 2* Q1 - Distribute patient Q3 - PANC meeting #4 edu materials - Continue data collect - PANC meeting #3 - Submit grant - Continue data collect proposals Q2 - Webinar #3 Q4 - Complete data collect - Continue data collect - Write final report - Consider future - Webinar #4 funding options - Present results *September 1, 2018 August 31, 2019
PANC SPECIALTIES* General Surg 13 Cardiac Surg 1 Gynecology 9 Neurosurg 6 Orthopedics 9 Otolaryngol 6 Urology 11 Plastic Surg 8 Vascular 13 Thoracic Surg 7 *Number of hospitals
PANC PROCEDURES General Orthopedics - Appendectomy - Total knee - Cholecystectomy - Total hip - Colectomy - Hiatal hernia Urology - Inguinal hernia - Nephrectomy - Ventral hernia Vascular Surg Gynecology - Aortoiliac - Hysterectomy - EVAR
PANC DATA COLLECTION Principle procedure CPT Code Primary surgeon Fibromyalgia, chronic pain, substance use? New opioid prescriptions? Type, strength, number, frequency Active benzodiazepine prescription? Any refill request?
NEXT STEPS Review agreements* Which guidelines* Decide specialties* Decide procedures* Discuss data* Sign agreements Complete survey Recommend PFAC members *Today