MSN FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation
I will be discussing the current quality improvement initiative and it’s critical aspects, evaluating it against national benchmarks, how interprofessional collaboration is key to the success, and recommendations for future needs.
Background of Quality Improvement Initiative
What is a Quality Initiative ?
Medication Assisted Therapy for Opioid Overdoses
Quality initiatives are actions organizations must implement to move forward and create a sustainable reputation of delivering high standards of care (Upadhyaya, 2018). Emergency departments are one critical component of the strategy that Cigna uses to attempt to move the needle on medication assisted treatment to combat the opioid crisis in the United States (Cigna, 2022).
Emergency departments are a root cost department where patients with an opioid use disorder (OUD) present to frequently (Khatri et al, 2022). Implementing an OUD medication assisted therapy protocol is key to survival rates of these patients.
MSN FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation
Background of Quality Improvement Initiative
What is Opioid Use Disorder?
Did you know?
Every 12 mins
Every day
Cigna is fighting the opioid-related overdoses
Rationale Supporting the Quality Improvement Initiative
Opioid Use Disorder is defined as the chronic use of opioids that causes clinically significant distress or impairment (Dydyk, 2022). Many things contribute to the diagnosis of opioid use disorder including multiple failed attempts to stop using, excessive time spent craving and obtaining the opioids, not fulfilling other obligations in life, interpersonal conflict, giving up on important things in a person’s life and having high tolerance and withdrawal of the substance. It has become and epidemic in the United States (CDC, 2022).
Did you know?
People are dying every 12 minutes from an opioid overdose (Cigna, 2022).
Each day roughly 136 families lose someone from an opioid overdose in the United States (CDC, 2022).
Men have a higher rate of overdose than women (Marsh, et al., 2018).
Along with the CDC, Cigna Health Insurer has also committed to reducing the opioid-related overdoses. Cigna’s goal was to see a 25% reduction in overdoses by the end of 2021.
To aid in the war against overdoses Cigna has created a community approach to improve access to care and services (Cigna, 2018).
Cigna used precise predictive analytics to identify patients who are more likely to be impacted by an overuse and overdoses. They have armed providers and the community with tools to help prevent the overdose from happening.
Analysis of Quality Improvement Initiative
The beginning of the opioid crisis started a long time ago. There were three waves that started in 1999 with a rise in prescription opioid deaths. Fast forward to 2010 and we started to see an increase in heroin related deaths. The third wave started around 2013 with a rise in synthetic opioid overdoses and deaths (CDC, 2022).
With this information the CDC started focusing their overuse disorder and overdose work by monitoring trends, advancing research for treatment and quality, building capacity at the state and local levels, partnering with healthcare systems, providers, and payers, and increasing public awareness (CDC, 2022). This is were the work Cigna is doing comes into play.
Collaboration is key for success in preventing opioid overdose deaths. Cigna has partnered with market hospital systems, including their emergency departments, and primary care providers. The collaboration should not stop there. Many people in the health and law enforcement community as well as public safety officials bring awareness, resources, and expertise to address this complex and fast-moving epidemic. Together, we can better integrate efforts to prevent opioid overdoses and deaths (CDC, 2022).
Analysis of Quality Improvement Initiative
The Importance of the Quality Improvement Initiative
Emergency Departments
Primary and Specialty Care Providers
Community Resources
Specific Implications of the Quality Improvement Initiative
How is Cigna specifically working to combat the opioid overdoses?
In the past three to four years Cigna has worked to start population based initiatives and provide precision support to very high risk customers (Cigna, 2022).
Expanding access to quality care: Cigna has increased the number of individual contracted behavioral health care professionals providing Medication Assisted Therapy (MAT) by 40 percent since 2017 and has added 92 comprehensive MAT programs in 2019. Cigna has also launched a Substance Use Centers of Excellence program with more than 300 access points nationwide, which includes a subset of 53 locations for the treatment of opioid use disorder (Cigna,2022).
Cigna has provided tools and resources for primary care providers to have behavioral integration in their practices (Cigna, 2022).
Cigna is also working with dentists to increase awareness on opioid misuse and to prescribe safer alternatives to opioids for short term pain management(Cigna,2022).
Cigna partnered with the Department of Veteran’s Affairs to help educate veterans about safe opioid use and improve the delivery of care and health outcomes for veterans (Cigna,2022).
Cigna’s Veterans Support Line (855-244-6211) helps veterans, families and caregivers with services and resources for pain management, substance use counseling and treatment, and more (Cigna,2022).
The First Day: Cigna is partnering with The First Day Project and Center on Addiction to bring “The First Day” film and educational resources to communities (Cigna,2022).
To focus specifically on emergency departments (ED), Cigna has provided resources as critical touchpoints for encounters among patients with opioid use disorder, but implementation of ED initiated treatment and harm reduction programs has lagged. Describing national patient, visit and hospital-level characteristics of ED OUD visits and characterize EDs with high rates of OUD visits in order to impact policies will optimize ED OUD care. (Khatri, 2022). We must start the treatment in the ED as research shows a higher success rate for patients who start treatment and have a primary care provider (Khatri, 2022). Recent studies show a substantial mortality reduction of 50% when MAT is started in the ED and the patient has follow up outpatient support (Khatri, et al., 2022).
Evaluation of the Quality Improvement Initiative
National Benchmarks Supporting the Quality Improvement Initiative
Analysis of the Benchmarks Related to the Quality Improvement Initiative
Even with all of the efforts by the CDC, Cigna, and other health insurance payers alike, you can see on the slide there are five national benchmarks that are moving in the wrong direction with the top ones being hospital inpatient stays and emergency visits involving opioid related diagnoses and drug overdoses (AHRQ, 2022).
The ones getting better are the outpatient prescriptions are decreasing.
Now that we know where the opportunities are the work that Cigna is focused on is critical to moving the needle on the epidemic. The focus needs to be on more life saving reversal medications, treatment options, virtual health, and CDC and governmental policies (CDC, 2022).
Evaluation of the Quality Improvement Initiative
Successful Quality Improvement Initiative Outcomes
Network Reimbursements
Insurance benefits
Policies
Provider Partnerships
Community
Some other areas of success in the initiative include network reimbursements, changes to behavioral benefits, and coverage policies have been updated (Cigna, 2022).
In addition provider partnerships have strengthened with behavioral health integration and our communities have been impacted through education and awareness (Cigna, 2022).
MSN FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation
Critical Aspects of the Quality Improvement Initiative
To recap what we are attempting to show with this initiative is that we need all tools and resources on deck to combat the war on overdoses. Through expanding access to and use of Narcan at the community level, increasing initiation of medication assisted treatment in the emergency departments, and working with our primary care providers we can save the members of our communities (CDC, 2022).
Let’s take a minute to understand how can we expand access to Narcan. By implementing standing orders at pharmacies, free distribution through community organizations, and by giving law enforcement and medical staff training on how to administer it (CDC, 2022).
Together we can bridge the gap between addiction and recovery.
Interprofessional Team
Interprofessional Team Members Involved in the Quality Improvement Initiative
Team Member Perspectives
Impact of Team Member Perspectives on the Quality Improvement Initiative
Collaboration amongst all providers and the community must be present to help in preventing opioid overdose deaths. (CDC, 2022).
Dr. Michael Parchman who is part of a team at Kaiser Permante health system implemented a team based approach to improving opioid management in primary care offices. The system is called the Six Building Blocks program. It focuses on evidence-based quality improvement guidelines for patients with chronic pain and long-term opioid therapy. The six components focus on providing supportive leadership and building consensus; policy and workflow changes, tracking patient care, preparation, resources, and measuring and celebrating successes (AHRQ, 2022). While this process is his method he knows there are other things that have to happen and we have discussed those throughout the presentation.
Recommendations for the Future:
New Protocols to Enhance Quality OUD Initiatives
HEDIS
Standardized measures
Health Equity
New Technology to Enhance Outcomes through provider dashboards
Through national organizational changes like implementing new HEDIS measures related to opioids and rolling out standardized quality measures providers will have to make the necessary changes to keep their revenue streams coming into the practices and better patient outcomes (Saunders, et al., 2019).
The production of health equity indicators for organizations with direct responsibility for purchasing and planning healthcare is an essential first step for policy makers who are serious about reducing social inequalities in healthcare access and outcomes surrounding OUD. The next step is to use these indicators to evaluate organization-wide initiatives and help decision makers learn how to reduce costly emergency admissions associated with deprived populations (Cookson, et al., 2018).
Clinical dashboards provide a lot of information to PCPs and are likely to become more extensive and provide valuable feedback as healthcare systems continue to focus on improving population health. The dashboards on their own may not be sufficient to impact clinical quality improvement (Towig, et al., 2019). Actions need to occur.
Questions
Thank you for participating today!
Thank you for your time listening to why we are working to improve overdose treatment in our community and nation. Now I am going to open it up for questions.
MSN FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation
References
Agency for Healthcare Research and Quality (January 2022). Implementing what works. https://www.ahrq.gov/opioids/implementing-what-works.html
Centers for Disease Control and Prevention (CDC, 2022). CDC guideline for prescribing opioids for chronic pain. Cdc.gov. https://www.cdc.gov/drugoverdose/prescribing/guideline.html
Cigna, (2022). Opioid Addiction and Overdose: Confronting the Epidemic Together. https://newsroom.cigna.com/confronting-opioid-addiction-and-overdoseepidemic#:~:text=Opioid%20Addiction%20and%20Overdose%3A%20Confronting%20the%20Epidemic%20Together
Cookson, R., Asaria, M., Ali,S., Shaw, R., Doran, T., Goldblatt, P. (2018). Health equity monitoring for healthcare quality assurance, social science & medicine. 198 (148-156). https://doi.org/10.1016/j.socscimed.2018.01.004.
Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder (2022). StatPearls 2022 Jan. https://www.ncbi.nlm.nih.gov/books/NBK553166
Khatri, U. G., Samuels, E. A., Xiong, R., Marshall, B. D. L., Perrone, J., & Delgado, M. K. (2022). Variation in emergency department visit rates for opioid use disorder: Implications for quality improvement initiatives. The American Journal of Emergency Medicine, 51, 331-337. http://dx.doi.org.library.capella.edu/10.1016/j.ajem.2021.10.047
Agency for Healthcare Research and Quality (January, 2022). Implementing what works. https://www.ahrq.gov/opioids/implementing-what-works.html
Centers for Disease Control and Prevention (CDC, 2022). CDC guideline for prescribing opioids for chronic pain. CDC.gov. https://www.cdc.gov/drugoverdose/prescribing/guideline.html
Cigna, (2022). Opioid Addiction and Overdose: Confronting the Epidemic Together. Retrieved from
https://newsroom.cigna.com/confronting-opioid-addiction-and-overdose-epidemic#:~:text=Opioid%20Addiction%20and%20Overdose%3A%20Confronting%20the%20Epidemic%20Together
Cookson, R., Asaria, M., Ali,S., Shaw, R., Doran, T., Goldblatt, P. (2018). Health equity monitoring for healthcare quality assurance, social science & medicine. 198 (148-156).
https://doi.org/10.1016/j.socscimed.2018.01.004.
Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder (2022). StatPearls 2022 Jan. https://www.ncbi.nlm.nih.gov/books/NBK553166
Khatri, U. G., Samuels, E. A., Xiong, R., Marshall, B. D. L., Perrone, J., & Delgado, M. K. (2022). Variation in emergency department visit rates for opioid use disorder: Implications for
quality improvement initiatives. The American Journal of Emergency Medicine, 51, 331-337. http://dx.doi.org.library.capella.edu/10.1016/j.ajem.2021.10.047
Marsh, J.C., Park, K., Lin, Y., Bersamira, C., (2018), Gender differences in trends for heroin use and nonmedical prescription opioid use. Journal of Substance Abuse Treatment, Volume 87, 2018, pgs 79-85, ISSN 0740-5472. https://doi.org/10.1016/j.jsat.2018.01.00
Saunders, E. C., Moore, S. K., Gardner, T., Farkas, S., Marsch, L. A., McLeman, B., Meier, A., Nesin, N., Rotrosen, J., Walsh, O., & McNeely, J. (2019). Screening for substance use in rural primary care: A Qualitative Study of Providers and Patients. Journal of General Internal Medicine,34(12), 2824–2832. https://doi.org/10.1007/s11606-019-05232-y
Twohig, P.A., Rivington, J.R., Gunzler, D. et al. Clinician dashboard views and improvement in preventative health outcome measures: a retrospective analysis. BMC Health Serv Res 19, 475 (2019). https://doi.org/10.1186/s12913-019-4327-3
Upadhyaya, G., & Subrahmanya, B. K. (2019). Quality initiatives, quality awards and performance; contingency effect. Measuring Business Excellence, 23(3), 335-349. http://dx.doi.org/10.1108/MBE-11-2018-0090
Marsh, J.C., Park, K., Lin, Y., Bersamira, C., (2018), Gender differences in trends for heroin use and nonmedical prescription opioid use. Journal of
Substance Abuse Treatment, Volume 87, 2018, pgs 79-85, ISSN 0740-5472. https://doi.org/10.1016/j.jsat.2018.01.00
Saunders, E. C., Moore, S. K., Gardner, T., Farkas, S., Marsch, L. A., McLeman, B., Meier, A., Nesin, N., Rotrosen, J., Walsh, O., & McNeely, J. (2019). Screening for substance use in rural primary care: A qualitative
study of providers and patients. Journal of General Internal Medicine, 34(12), 2824–2832. https://doi.org/10.1007/s11606-019-05232-y
Twohig, P.A., Rivington, J.R., Gunzler, D. et al. Clinician dashboard views and improvement in preventative health outcome measures: a retrospective analysis. BMC Health Serv Res 19, 475 (2019).
https://doi.org/10.1186/s12913-019-4327-3
Upadhyaya, G., & Subrahmanya, B. K. (2019). Quality initiatives, quality awards and performance; contingency effect. Measuring Business Excellence, 23(3), 335-349. http://dx.doi.org/10.1108/MBE-11-2018-0090
