New York group's opioid guidelines, education program improve care

A recent case study from NewYork-Presbyterian Hospital finds that clinical standard adherence and reduced opioid prescription dosages can be achieved through a series of guidelines, monitoring and benchmarking of prescriptions and provider communication.

A May 23 case study by Rishikesh P. Dalal, MD, MPH, former medical director of the physician services division at NewYork-Presbyterian, published by NEJM Catalyst, outlines how the hospital’s innovative program helped reduce the burden on the emergency department (visits for use disorders "more than doubled between 2015 and 2017") and champion a new approach for improved treatments.

Dalal’s case study outlined five key steps for achieving improved adherence to clinical standards and reduction in high-risk prescription combinations:

1. Establish best-practice guidelines for clinical prescription of opioid therapy
2. Communicate the guidelines across the clinical team
3. Measure key metrics related to prescriptions
4. Assess which providers require additional education to ensure adherence
5. Confidentially share feedback with providers and review charts for improvement opportunities

As Dalal outlines, total morphine equivalents prescribed per patient across all specialties dropped by 24% from January to September 2017, while pain management consultation referrals "nearly doubled" for the same period.

But "clinical champions should be convened early in the process" to begin defining best-practice prescribing guidelines.

Combating the Opioid Epidemic: Effective Policies and Communication Strategies, an upcoming MGMA Research & Analysis report, details similar findings regarding the need for clear, established prescribing guidelines within a medical group; understanding implications for the Merit-based Incentive Payment System (MIPS); educating providers and patients about opioid therapy; managing referrals; using electronic prescribing; and conducting ongoing monitoring of prescribing levels for effective treatments that minimize the risk of opioid abuse. Visit mgma.com/research-analysis in mid-July to access the report.