Implementing What Works

Once effective interventions have been identified, AHRQ projects and grants develop and test tools and strategies to implement what works for practice improvement and patient safety.

Clinical Decision Support

CDS Connect demonstrates how evidence-based care can be more rapidly incorporated into clinical practice through interoperable decision support. CDS Connect has built several of its projects around helping patients, clinicians, and health systems respond to the opioids crisis.

• The Pain Management Summary gives providers a structured view of relevant medical record data and decision support to guide individualized chronic pain management.
  • Two recently funded projects will build on the CDS Connect experience to include developing, implementing, disseminating, and evaluating CDS for both patients and clinicians in the area of chronic pain management.
    • Project one focuses on evaluating and developing reusable and shareable CDS knowledge artifacts to reduce the time to implementation.
    • Project two will track and manage pain and daily function to support opioid-dose reductions.
• Opioids and Pain Management artifacts facilitate integration of recommendations from the CDC 2016 Opioid Prescribing Guidelines directly into an EHR.

In addition, a new grant, "Scaling Interoperable Clinical Decision Support for Patient-Centered Chronic Pain Care," will implement AHRQ's interoperable CDS tool, Pain Manager, across eight clinics within the OneFlorida Clinical Research Consortium system to evaluate effectiveness for increasing shared decision making for pain treatment.

Patient Centered Clinical Decision Support (PCCDS)

PCCDS is CDS that supports individual patients and their approved care givers and/or care teams in health-related decisions and actions by leveraging information from patient-centered outcomes research (PCOR) findings and/or patient-specific information. The PCCDS has released a Stakeholder-driven Action Plan (PDF) for Improving Pain Management, Opioid Use, and Opioid Use Disorder Treatment Through Patient-Centered Clinical Decision Support. Highlights of the report include:

• 19 PCCDS tools that support patient care for pain, opioids, and opioid use disorder (OUD).
• 5 Future Scenarios that illustrate the uses of PCCDS for pain management and opioids.
• 11 stakeholder groups and recommended actions for them to improve care through PCCDS.
• 4 areas in which PCCDS implementation efforts are already underway.

A Team-Based Approach to Improving Opioid Management in Primary Care

Six Building Blocks is a structured systems-based approach for improving management of patients on chronic opioid therapy. The Six Building Blocks program provides an evidence-based quality improvement roadmap to help primary care teams implement effective, guideline-driven care for their chronic pain and long-term opioid therapy patients. The Six Building Blocks project has also just released a new Self-Service How-To Guide that can be downloaded and printed. Learn more from this Q&A with AHRQ grantee Michael Parchman: Six Building Blocks help small rural clinics to manage opioids better.

Unhealthy Alcohol Use Tools & Resources

Unhealthy Alcohol Use Tool and Resources is a collection of tools and resources for managing unhealthy alcohol use in primary care, intended for use by providers, organizational leadership, other team members, and patients.

Integrating Behavioral Health and Primary Care

The Academy for Integrating Behavioral Health and Primary Care Opioid & Substance Use Resources has developed several resources for providers treating opioid use disorder in primary care practices, including:

• Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care includes an Environmental Scan (PDF, 609 KB) and an online searchable Tools and Resources Collection to support those in primary care settings who are implementing medication-assisted treatment (MAT) for opioid use disorder.
• The MAT for OUD Playbook serves as a comprehensive guide for implementing MAT in primary care and other ambulatory care settings. This interactive, web-based Playbook contains the latest guidance, tools, and resources that address all aspects of implementation. Key features include:
  • A 58-item self-assessment that can be used to track progress and customize a program’s approach
  • Links to more than 100 resources that will facilitate implementation of MAT for OUD
  • Guidance on the North Star, a reflection of an ideal MAT program integrated into an ambulatory care setting.
  • What not to do and other obstacles to avoid, in order to help programs successfully implement MAT
  • The Academy Community that serves as a forum for playbook users to ask questions, offer insight, and share resources
  • The ability to save notes and bookmarks to record progress, thoughts, and to-do’s for future reference
• The Academy's Expert Insight page includes articles, blog posts, success stories, videos, and webcasts about managing Opioid Use Disorder in Primary Care.

Making Naloxone Available in Communities

Protect.org is a grantee-developed resource designed for people seeking to learn about or obtain naloxone in their community, and for community based organizations and leaders to improve awareness of and access to naloxone for their communities. The site provides:

• Patients and their families and friends with factual, commercially unbiased information on how to obtain and use naloxone.
• Community-based organizations with freely downloadable materials, resources, and tools for raising awareness and making naloxone more available.