The health care system is failing to respond to the opioid misuse crisis in a data-driven way, Darshak Sanghavi and colleagues at OptumLabs write in Health Affairs—and to help solve the problem, they proposed 29 claims-based measures to track the epidemic.
Better data needed to fight opioid misuse
The researchers argue that the health care system is struggling to track the opioid misuse epidemic, in part because the crisis is moving too fast for federally-endorsed performance measures to keep up.
"Typically, federally-endorsed performance measures … require a high degree of evidence and testing prior to widespread deployment," the researchers note. "The development process is not typically geared to rapid-cycle quality improvement programs," and as such, "formal federal measure development has not kept pace with the rapid cadence of the opioid epidemic."
For example, they cite several misuse measures developed by the Pharmacy Quality Alliance in 2015 that even now are several years away from being broadly adopted by federal payment programs.
About the new framework
To help address this gap, the researchers write, they sought "to develop a comprehensive framework of 29 claims-based measures for the opioid crisis," drawing on support from a panel of experts that included representatives of the CDC and the Substance Abuse and Mental Health Services Administration.
The researchers identified key metrics in four main domains:
- Appropriate acute and chronic pain treatment;
- Maternal/child health;
- Opioid use disorder treatment; and
To calculate the metrics, the researchers drew on OptumLabs' Data Warehouse, which includes de-identified data on about 150 million Americans who are currently or previously have been enrolled in commercial or Medicare Advantage plans.
The researchers' data shined a new light on the opioid misuse epidemic: They discovered that in 2016, for example, the compliance rate with CDC's first-opioid prescribing recommendations was around 55%. But they also discovered that the compliance rate varied greatly across the country, "suggesting that local factors may strongly impact prescribing volume and guideline-adherence."
According to the researchers, the prevalence of opioid use disorder increased by 50% between 2014 and 2016, likely because of "both higher incidence and improved coding with ICD-10 adoption." The researchers' data also revealed that nearly 98% of new opioid filers avoid chronic use, and that about 28% of patients with opioid use disorder were receiving medication-assisted treatment.
How implementing the new data 'snapshot' can support new practices
The researchers hope that, by implementing their "comprehensive diagnostic snapshot," providers and other stakeholders will be able to more quickly assess the effectiveness of their interventions.
For example, the researchers assessed the effect of new first-fill drug utilization rules, which hundreds of OptumLabs' clients implemented in July, using data included in their proposed "snapshot."
After two months, the program achieved an 82% relative reduction in excessive dosage and a 65% reduction in excessive duration of new opioid prescriptions. "In this manner," the researchers write, "'just in time' frameworks may permit a precision-medicine approach to the opioid epidemic based on a common set of data-driven metrics" (Sanghavi, et. al., Health Affairs, 12/18).
*Editor's note: Daily Briefing is published by Advisory Board, a division of Optum, which also owns OptumLabs.
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Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.
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