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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.
Background:
The Veterans Health Administration (VHA) developed a dashboard Stratification Tool for Opioid Risk Mitigation (STROM) to guide clinical practice interventions. VHA released a policy mandating that high-risk patients of an adverse event based on the STORM dashboard are to be reviewed by an interdisciplinary team of clinicians.
Aim:
Randomized program evaluation to evaluate if patients in the oversight arm had a lower risk of opioid-related serious adverse events (SAEs) or death compared to those in the non-oversight arm.
Setting And Participants:
One-hundred and forty VHA facilities (aka medical centers) were randomly assigned to two groups: oversight and non-oversight arms. VHA patients who were prescribed opioids between April 18, 2018, and November 8, 2019, were included in the cohort.
Program Description:
We hypothesized that patients cared for by VHA facilities that received the policy with the oversight accountability language would achieve lower opioid-related SAEs or death.
Program Evaluation:
We did not observe a relationship between the oversight arm and opioid-related SAEs or death. Patients in the non-oversight arm had a significantly higher chance of receiving a case review compared to those in the oversight arm.
Discussion:
Even though our findings were unexpected, the STORM policy overall was likely successful in focusing the provider's attention on very high-risk patients.
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