Evidence map›Paper›PMID 29754987›Full record

ArticleAddictive behaviors2018

A statewide effort to reduce high-dose opioid prescribing through coordinated care organizations.

Daniel M Hartung, Lindsey Alley, Gillian Leichtling, P Todd Korthuis, Christi Hildebran

Abstract read
In one paragraph

Article in Addictive behaviors, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
0.7field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Misalignment of Stakeholder Incentives in the Opioid Crisis.International journal of environmental research and public health · 2020
    Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Daniel M HartungOregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Oregon State University College of Pharmacy, 2730 SW Moody Ave., CL5CP, Portland, OR 97201, United States. Electronic address: hartungd@ohsu.edu.
Lindsey AlleyHealthInsight Oregon, 2020 SW 4th Avenue, Suite 520, Portland, OR 97201, United States.
Gillian LeichtlingHealthInsight Oregon, 2020 SW 4th Avenue, Suite 520, Portland, OR 97201, United States.
P Todd KorthuisOregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
Christi HildebranHealthInsight Oregon, 2020 SW 4th Avenue, Suite 520, Portland, OR 97201, United States.
HealthInsight · USOregon Health & Science University · USOregon State University · US

Funding

Western States Node of the National Drug Abuse Treatment Clinical Trials Network (TMS for CUD) UG1DA015815 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Keith N. Humphreys, Philip Todd Korthuis · 2015 to 2026
$24.6M
Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study Cost ExtensionUH3DA044831 · NIDA · OREGON HEALTH & SCIENCE UNIVERSITY · PI KORTHUIS, PHILIP TODD · 2019 to 2022
$4.0M
Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) StudyUG3DA044831 · NIDA · OREGON HEALTH & SCIENCE UNIVERSITY · PI KORTHUIS, PHILIP TODD · 2017 to 2018
$895k
NCIPC CDC HHS U01 CE002786NIDA NIH HHS UG1 DA015815NIDA NIH HHS UG3 DA044831NIDA NIH HHS UH3 DA044831
6 · The paper itself

Abstract

backgroundOregon's Medicaid program is delivered through 16 Coordinated Care Organizations (CCOs) participating in a statewide performance improvement program to reduce high-dose opioid prescribing. CCOs were allowed flexibility to develop their own dose targets and any policies, trainings, guidelines, and/or materials to meet these targets. In this study, we characterize CCO strategies to reduce high-dose opioid prescribing across the 16 CCOs.

methodsWe reviewed relevant CCO documents and conducted semi-structured interviews with CCO administrators to acquire opioid-related policies, practices, timelines and contextual factors. We applied a systematic coding procedure to develop a comprehensive description of each CCO's strategy. We used administrative data from the state to summarize contextual utilization data for each CCO.

resultsMost CCOs selected a target daily morphine milligram equivalent (MME) dose of 90 mg. Sixteen issued quantity limits related to dose, eight restricted specific drug formulations (short-acting or long-acting), and 11 allowed for time-limited taper plan periods for patients over threshold. Many CCOs also employed provider trainings, feedback reports, and/or onsite technical assistance. Other innovations included incentive measures, electronic health record alerts, and toolkits with materials on local alternative therapy resources and strategies for patient communication. CCOs leveraging collaborations with regional partners appeared to mount a greater intensity of interventions than independently operating CCOs.

conclusionsCCOs developed a diversity of interventions to confront high-risk opioid prescribing within their organization. As healthcare systems mount interventions to reduce risky opioid prescribing, it is critical to carefully describe these activities and examine their impact on process and health outcomes.

Indexed as

Pain ManagementPractice Patterns, Physicians'Analgesics, OpioidCommunity Health ServicesHumansMedicaidOregonOrganizational PolicyUnited StatesAnalgesics, OpioidCoordinated careOpioidOpioid policyOpioid safety interventionsPrescribing limitsTapering

Identifiers

PMID29754987
PMCPMC6078786
OpenAlexW2801862068

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.