Opioid Use in Older Adults Compendium of Resources
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While there have been extensive efforts to address the opioid epidemic, little attention has been given to the risks and effects of opioid use, misuse, and opioid use disorder (OUD) in older adults. Resources and tools for managing opioid use, misuse, and OUD cannot be one-size-fits-all; rather their effectiveness depends on how well they address the specific concerns and conditions of patients and how clinicians apply those tools and resources (with whom and when).
The purpose of this change package, known as the Compendium, is to support efforts by primary care practices and healthcare systems to improve opioid medication management and prevent opioid misuse and OUD in older adults in primary care. The Compendium was developed through a three-stage process. First, we developed a draft Compendium based on an environmental scan and literature review that identified knowledge gaps, tools, and resources. Next, we sought input from experts in quality improvement, geriatrics, and pain management. Finally, we convened two learning collaboratives to support primary care practices in testing and modifying the Compendium strategies. The practices that participated in the learning collaboratives 1) identified specific areas for improvement known as high leverage changes, 2) selected and used strategies for implementing the resources and tools from the Compendium to make planned improvements in their practices, and 3) integrated these improvements into routine workflows. The participating practices were a mix of academic medical centers focusing on geriatrics, mid-sized family clinics/ambulatory centers, and two inner city clinics focusing on the unhoused population. Based on the experience of participating practices, we refined and finalized the Compendium.
Innovative resources and tools developed by the practices that participated in the learning collaboratives are embedded within the “Resource or Tool” section and identified by this icon.
Resources and tools that are specific to older adults (as opposed to the general population) are identified by this icon.
How to use the Compendium
This Compendium is structured as a change package. It identifies key areas in which change may be needed, called high leverage changes (HLCs), and offers interventions in the form of key activities and resources/tools to bring about the desired change that practices and systems can use to improve primary care clinicians’ opioid management and prevention of misuse and OUD in older adults.
The Compendium is organized into seven HLC areas. Practices can select any HLC that reflects their priority and any, or all, strategies and activities within that HLC to drive the change. Once the practice determines which change activity(ies) it wants to implement, it can choose accompanying resources and tools to use for implementing the desired change.
We encourage healthcare teams using this Compendium to accomplish their improvement goals to follow the Institute for Healthcare Improvement’s (IHI’s) approach to quality improvement1. The typical order of activities is:
- Forming the team.
- Assessing and analyzing the system, as a team, to decide which HLC to select (refer to the Self-Assessment section below).
- Setting time-specific and measurable aims.
- Establishing quantitative measures.
- Selecting changes: select one HLC your practice would like to work on, then choose the key activity(ies) and accompanying resources or tools. You can also choose to work on more than one HLC at a time.
- Testing changes.
- Implementing changes.
- Spreading changes.
We strongly encourage practices and systems to engage patients in the quality improvement process using resources and tools provided in this Compendium. Healthcare systems might consider adding a patient to the team working on process change or host codesign events for any materials, workflows, or other products they develop and test with this Compendium.
How to use the Opioid Use in Older Adults Compendium (3 minutes, 36 seconds)
Healthcare teams are encouraged to conduct a self-assessment to determine which HLCs they have the capacity to implement and which ones are a priority. The Self-Assessment is best completed during a group discussion with all staff involved in this work. The Self-Assessment form aligns with the Compendium.
How to Complete the Practice Self-Assessment Tool (PDF, 256 KB)
How to Complete the Practice Self-Assessment Tool Instructions (4 minutes, 58 seconds)
Five case studies were developed based on the testing of the Compendium strategies by the primary care practices that participated in the AHRQ Learning Collaboratives. Each case study includes information on the quality improvement activities the practice implemented, the tools they used, barriers and facilitators to implementation, lessons learned, and next steps.
- Using an Electronic Health Record System to Prevent Opioid Use Disorder in Older Adults in Primary Care Practices Case Study (PDF, 880 KB)
- Creating a Work-Around to Implement Fall Risk Screening for Older Adults Using Appointment Notes Case Study (PDF, 414 KB)
- Implementing Opioid Risk Screening for Older Adults Using Automated Patient Reminders in an Electronic Health Record Case Study (PDF, 218 KB)
- New Clinical Processes and Improving Workflows for Opioid Management in a Geriatric Clinic: Using Input from The Team Case Study (PDF, 225 KB)
- Supporting Clinical Staff Who Prescribe Opioids to Older Adults: Providing Targeted Educational Sessions to Meet Needs Case Study (PDF, 737 KB)
1. IHI. Science of Improvement: How to Improve. http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx