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President Elect, CO-ACEP
ED Associate Medical Director, Swedish Medical Center
Senior Pain Management and Opioid Policy Advisor, CHA
CHA and OpioidSafety
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• Utilized Colorado ACEP 2017 Opioid Prescribing& Treatment Guidelines
• 10 hospital emergency departments (EDs)around the state
• Six-month pilot: June – November 2017
• Focused on limiting exposure to opioids throughuse of Alternatives to Opioids (ALTOs)
Partners
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31%in ALTO
administration
35,000fewer projected
opioidadministrationsduring the pilot thanduring the baseline
period
36%in opioid
administrationMeasured in
MEUs/1,000 ED visitsacross all 10 EDs
2017 vs. 2016
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ED Specific HCAHPS Questions:
1. How well was your pain controlled?
2. How likely are you to recommend this ED?
There were no significant differences in HCAHPS scoresbetween the baseline and project period.
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• Rolls out the successful Colorado Opioid Safety Pilot statewide
• Regional trainings
• On-demand videos
• Toolkits
• Additional resources
www.cha.com/ALTO
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• 9 regional trainings,
including customizedtraining for large systems
• 83 hospitals and health
systems trained byOctober (95% of all acutecare hospitals and CAHs)
• 200 participants trained
to-date• ED Physicians, ED Nurses,
Pharmacists, IT/DataSupport
• Hospitals in varying stagesof implementation but allengaged and movingforward
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• Federal legislation in the House and Senate toprovide grant funding for ALTO projects inhospital EDs (passed the House; likely to passthe Senate this fall)
• HRET HIIN award – CHA honored by theAmerican Hospital Association HealthResearch and Educational Trust for patientsafety work, including the Opioid Safety Pilot
• Alteryx “Outstanding Game Changer” awardfor data and quality improvement initiativework on Opioid Safety Pilot
• Resources provided to other state hospitalassociations; numerous presentations givennationally on the pilot program
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• Award funding from Colorado Office of Behavioral Health through two-yearSAMHSA State Targeted Response to the Opioid Crisis Grant
• Two pilot hospitals – St. Anthony North Health Campus and University ofColorado Hospital
• Introduces medication assisted treatment (MAT) in the ED
• Combines MAT with a “warm handoff” – or care coordination with a substanceuse disorder specialist for long-term treatment
• Pilot timeframe: April 2018 – April 2019
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CHA• Based on results of MAT in the ED pilot, expand to the rest of the state.
• Based on the Colorado ALTO Project, which focused on EDs, expand to other areaswithin the hospital:
o Hospitalists treating inpatients
o Surgeons prescribing opioids for post-surgical pain
• The CHASE board has approved the HQIP workgroup recommendation to incentivizeED ALTO implementation in 2019.
• Focus on care coordination / tools for ED physicians & warm handoff
Beyond CHA• Broaden Medication Assisted Treatment
o Improved access to non-clinical and non-reimbursable serviceso Support greater access to Naloxone (Narcan)o Continue addressing stigma