PENNSYLVANIA OPIOID SURGICAL STEWARDSHIP ENTERPRISE Henry A. Pitt, M.D. Chief Quality Officer, Temple Health Pennsylvania NSQIP Consortium, October 18, 2018
PENNSYLVANIA OPIOID SURGICAL
STEWARDSHIP ENTERPRISE
Henry A. Pitt, M.D.
Chief Quality Officer, Temple Health
Pennsylvania NSQIP Consortium, October 18, 2018
• US epidemic • POSSE
• Role of surgery • Agreements
• MSQC/ISQIC • Guidelines
• PANC • Procedures
• HCIF • Data collection
POSSE
OVERVIEW
POSSE
OVERDOSE DEATHS
2000 – prescription opioid deaths
2010 – heroin opioid deaths
2013 – synthetic opioid deaths
POSSE
POST SURGICAL OPIOID USE*
• New persistent
opioid use after
surgery is common
and is not different
between minor and
major surgical
procedures
*Brummett et al JAMA Surgery 2017; 152:1-9
POSSE
PARTNERS PLAYBOOK
• National Quality Forum
• National Quality Partners
• Provides essential guidance for opioid stewardship
• Includes concrete examples, tactics, practical tools and resources
• Identifies drivers of change
POSSE
MSQC – OPEN
• Michigan Surgical Quality
Collaborative – BCBS MI
• U Michigan – Healthcare
Policy & Innovation –
multiple publications in
2017 and 2018
• Michigan Opioid
Prescribing Engagement
Network (OPEN)
POSSE
ISQIC• Stewardship Toolkit
• Multidisciplinary team
• Preoperative expectations
• Screening for at risk
behavior
• Optimizing perioperative
practices
• Lowering quantity
prescribed
• Safe storage and disposal
POSSE
PANC HOSPITALS
Abington – Jefferson Health* Pennsylvania Hospital*
Fox Chase Cancer Center* Reading Hospital
Hahnemann University Hosp Robert Packer Hospital
Hosp University of PA* Temple Health – Jeanes*
Lancaster General Health* Temple Univ Hospital*
Methodist – Jefferson Health* Thomas Jefferson Univ Hosp*
Penn State Hershey MC York Hospital
*Also Health Care Improvement Foundation (HCIF)
POSSE
HCIF – P4PC • Healthcare Improvement
Foundation (HCIF)
– Independent, nonprofit
– Leads multiple initiatives
– 18 stakeholder hospitals
• Partnership for Patient
Care since 2006
• Institute for Safe
Medication Practices
POSSE
HCIF – NON-PANC HOSPITALS
Aria – Torresdale Grand View Hospital
Aria – Frankford Holy Redeemer
Aria – Bucks Lankenau Hospital
Bryn Mawr Hospital Mercy Health System
Chester Co Hospital Paoli Mem Hospital
Crozier – Keystone Penn Presbyterian MC
Doylestown Hospital Riddle Mem Hospital
Einstein Med Center St. Chirstopher’s Hosp
Einstein Montgomery St. Mary Med Center
POSSE
OPIOID SURGICAL STEWARDSHIP
• 24 month collaborative
• HCIF and PANC
• Funded by Amerisource
Bergen Foundation
• Steering Committee
• Hospital Agreements
• Patient-Centered Domain
• Provider-Centered Domain
HCIF
PANC
ASBF
POSSE
STEERING COMMITTEE • Executive Champion – Henry A. Pitt, M.D.
Temple University Health System
• Surgeon Champion – Matt Philp, M.D.
Temple University Hospital
• PANC Surgeon Advisor – Scott Cowan, M.D.
Thomas Jefferson University Hospital
• Surg Clinical Reviewer – Christine Schleider, RN
Thomas Jefferson University Hospital
• HCIF Team – Pam Braun, Susan Cosgrove, and
Kelsey Salazar
• Non-Panc Surgeon Advisor – Being recruited
POSSE
HCIF – HOSPITAL AGREEMENTS • PANC hospitals
• Non PANC hospitals
• Multidisciplinary team
• Survey current practice
• Implement QI strategies
• Participate in POSSE events
• PANC gather data
• Surg Champion signs
• SCR signs agreement
PANC
Non PANC
POSSE
PATIENT-CENTERED DOMAIN
• Convene Patient and
Family Advisory Council
• Collect and evaluate
educational materials
• Develop and disseminate
health literate patient
educational materials
POSSE
PROVIDER-CENTERED DOMAIN • Preoperative expectation
setting efforts
• High-risk screening
• Intra- and postoperative
utilization of alternatives
• Adoption of procedure-
specific opioid
prescribing guidelines
POSSE
MEDICAL ADVISORY COMMITTEE
• Steering Committee
• PANC leadership
• HCIF partners
• PFAC members
• Institute for Safe
Medication Practices
• Philadelphia Department
of Public Health
• Pennsylvania Department
of Health
POSSE
TIMELINE – YEAR 1*
• Q1 - Planning meetings • Q3 - Share survey results
- PANC meeting #1 - PANC meeting #2
- Survey development - Pt edu materials
- Measure development - Shared workspace
• Q2 - Webinar #1 • Q4 - PFAC meetings
- Hospital enrollment - Pt edu materials
- Administer survey - Webinar #2
- Finalize measures - Begin data collection
- Form PFAC
*September 1, 2018 – August 31, 2019
POSSE
TIMELINE – YEAR 2*
• Q1 - Distribute patient • Q3 - PANC meeting #4
edu materials - Continue data collect
- PANC meeting #3 - Submit grant
- Continue data collect proposals
• Q2 - Webinar #3 • Q4 - Complete data collect
- Continue data collect - Write final report
- Consider future - Webinar #4
funding options - Present results
*September 1, 2018 – August 31, 2019
POSSE
PANC SPECIALTIES*
• General Surg ─ 13 • Cardiac Surg ─ 1
• Gynecology ─ 9 • Neurosurg ─ 6
• Orthopedics ─ 9 • Otolaryngol ─ 6
• Urology ─ 11 • Plastic Surg ─ 8
• Vascular ─ 13 • Thoracic Surg ─ 7
*Number of hospitals
POSSE
PANC PROCEDURES
• General • Orthopedics
- Appendectomy - Total knee
- Cholecystectomy - Total hip
- Colectomy
- Hiatal hernia • Urology
- Inguinal hernia - Nephrectomy
- Ventral hernia
• Vascular Surg
• Gynecology - Aortoiliac
- Hysterectomy - EVAR
POSSE
PANC DATA COLLECTION
• Principle procedure – CPT Code
• Primary surgeon
• Fibromyalgia, chronic pain,
substance use?
• New opioid prescriptions?
– Type, strength, number, frequency
• Active benzodiazepine prescription?
• Any refill request?
POSSE
NEXT STEPS • Review agreements*
• Which guidelines*
• Decide specialties*
• Decide procedures*
• Discuss data*
• Sign agreements
• Complete survey
• Recommend PFAC
members
*Today