• Kiersten L Strombotne, Aaron Legler, Taeko Minegishi, Jodie A Trafton, Elizabeth M Oliva, Eleanor T Lewis, Pooja Sohoni, Melissa M Garrido, Steven D Pizer, and Austin B Frakt.
• Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA. kiersten@bu.edu.
• J Gen Intern Med. 2023 Feb 1; 38 (2): 375381375-381.

BackgroundRisk of overdose, suicide, and other adverse outcomes are elevated among sub-populations prescribed opioid analgesics. To address this, the Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM)-a provider-facing dashboard that utilizes predictive analytics to stratify patients prescribed opioids based on risk for overdose/suicide.ObjectiveTo evaluate the impact of the case review mandate on serious adverse events (SAEs) and all-cause mortality among high-risk Veterans.DesignA 23-month stepped-wedge cluster randomized controlled trial in all 140 VHA medical centers between 2018 and 2020.ParticipantsA total of 44,042 patients actively prescribed opioid analgesics with high STORM risk scores (i.e., percentiles 1% to 5%) for an overdose or suicide-related event.InterventionA mandate requiring providers to perform case reviews on opioid analgesic-prescribed patients at high risk of overdose/suicide.Main MeasuresNine serious adverse events (SAEs), case review completion, number of risk mitigation strategies, and all-cause mortality.Key ResultsMandated review inclusion was associated with a significant decrease in all-cause mortality within 4 months of inclusion (OR: 0.78; 95% CI: 0.65-0.94). There was no detectable effect on SAEs. Stepped-wedge analyses found that mandated review patients were five times more likely to receive a case review than non-mandated patients with similar risk (OR: 5.1; 95% CI: 3.64-7.23) and received more risk mitigation strategies than non-mandated patients (0.498; CI: 0.39-0.61).ConclusionsAmong VHA patients prescribed opioid analgesics, identifying high risk patients and mandating they receive an interdisciplinary case review was associated with a decrease in all-cause mortality. Results suggest that providers can leverage predictive analytic-targeted population health approaches and interdisciplinary collaboration to improve patient outcomes.Trial RegistrationISRCTN16012111.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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