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Randomized Policy Evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation
Taeko Minegishi1,2,3, Melissa M Garrido4,5, Eleanor T Lewis6,7
1Partnered Evidence-Based Policy Research Center, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA. taeko.minegishi@va.gov.
Journal of General Internal Medicine
|June 17, 2022
Summary
The Stratification Tool for Opioid Risk Mitigation (STORM) policy did not reduce opioid-related serious adverse events (SAEs). However, the policy successfully focused provider attention on high-risk patients, indicating potential indirect benefits for patient safety.
Area of Science:
- Health Services Research
- Clinical Informatics
- Opioid Use Disorder Management
Background:
- The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard to guide clinical interventions.
- A VHA policy mandated interdisciplinary team reviews for high-risk patients identified by the STORM dashboard.
Purpose of the Study:
- To evaluate if patients in an oversight arm experienced fewer opioid-related serious adverse events (SAEs) or deaths compared to a non-oversight arm.
- To assess the impact of the STORM policy on patient safety outcomes within the VHA.
Main Methods:
- A randomized program evaluation involving 140 VHA facilities assigned to either an oversight or non-oversight arm.
- Analysis of VHA patients prescribed opioids between April 2018 and November 2019.
Main Results:
- No significant relationship was observed between the oversight arm and reduced opioid-related SAEs or death.
- Patients in the non-oversight arm were more likely to receive a case review than those in the oversight arm.
Conclusions:
- The STORM policy's direct impact on reducing opioid-related SAEs or death was not demonstrated in this evaluation.
- The policy may have been successful in increasing provider focus on high-risk patients, potentially improving care indirectly.
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