• Alexander C Buscaglia, Meenah C Paik, Eleanor Lewis, Jodie A Trafton, and VA Opioid Metric Development Team.
• Department of Veterans Affairs, Center for Innovation to Implementation, Menlo Park.
• Clin J Pain. 2015 Sep 1; 31 (9): 803-812.

ObjectivesThe purpose of this study was to determine baseline adherence to key recommendations from the 2010 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Pain at Veterans Health Administration (VA) facilities. We hoped to understand practice patterns at the time of guideline release to guide quality improvement and implementation efforts.MethodsOverall practice patterns were examined at each of the 140 VA Health Care Systems based on quality metrics developed to assess adherence to the VA/DOD Clinical Practice Guideline.ResultsClinical practice varied widely across facilities on measures of use of urine drug screens, substance use disorder treatment for diagnosed substance use disorder patients, and use of rehabilitative treatments. Less variation was observed in measures of sedative coprescription and use of adjunctive pharmacotherapy. Use of guideline recommended practices was generally more frequent for patients prescribed long-acting opioid formulations and those with chronic use. Relative facility-level implementation was correlated across most measures. Overall implementation of guideline recommended practices was lower at less complex facilities and facilities in the Western United States.DiscussionIn 2010, guideline-recommended practices for opioid prescribing were variably used across VA health care systems. Efforts to disseminate practices used at high-performing sites, and increase consistency of use of recommended practices across patients and facilities should be considered to improve pain management and reduce adverse events.

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