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Effect of a Predictive Analytics-Targeted Program in Patients on Opioids: a Stepped-Wedge Cluster Randomized
Kiersten L Strombotne1,2, Aaron Legler3, Taeko Minegishi4,3,5
1Department of Health Law, Policy and Management, Boston University of Public Health, Boston, MA, USA. kiersten@bu.edu.
Journal of General Internal Medicine
|May 2, 2022
Summary
Mandatory case reviews for high-risk opioid patients significantly decreased all-cause mortality within four months. This predictive analytics approach improved patient outcomes by increasing risk mitigation strategies.
Area of Science:
- Public Health
- Health Informatics
- Clinical Medicine
Background:
- Opioid analgesics are associated with elevated risks of overdose, suicide, and adverse outcomes in specific patient populations.
- The Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM) to identify high-risk patients using predictive analytics.
Purpose of the Study:
- To evaluate the impact of a mandated case review on serious adverse events (SAEs) and all-cause mortality in high-risk Veterans prescribed opioids.
- To assess the effectiveness of the STORM tool in stratifying patients based on overdose and suicide risk.
Main Methods:
- A 23-month stepped-wedge cluster randomized controlled trial was conducted across 140 VHA medical centers.
- The study included 44,042 patients prescribed opioid analgesics with high STORM risk scores (top 1-5% for overdose/suicide risk).
- The intervention involved a mandate for providers to conduct case reviews for high-risk patients.
Main Results:
- Mandated case reviews were associated with a significant decrease in all-cause mortality within four months (OR: 0.78).
- No significant effect was observed on serious adverse events (SAEs).
- Patients under the mandate were five times more likely to receive a case review and received more risk mitigation strategies.
Conclusions:
- Mandating interdisciplinary case reviews for high-risk opioid patients in the VHA system reduced all-cause mortality.
- Predictive analytics and interdisciplinary collaboration can improve patient outcomes in population health management.
- The STORM tool facilitates targeted interventions for patients at risk of overdose or suicide.
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