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