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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