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Factors That Affect Opioid Quality Improvement Initiatives in Primary Care: Insights from Ten Health Systems

Ellen Childs, Catherine L. Hersey, Nicole Keane, Sarah J. Shoemaker-Hunt, Abt Global; Colette A. Tano (formerly Abt Global, currently The Health Initiative); Christina A.Mikosz, Jan L. Losby, Centers for Disease Control and Prevention; Michael L. Parchman, Kaiser Permanente Washington Health Institute


December 2, 2022

To improve patient safety and pain management, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain (CDC Guideline). Recognizing that a guideline won’t transform practice, CDC supported an Opioid Quality Improvement (QI) Collaborative. It consisted of 10 health care systems that represent more than 120 practices across the U.S. The research team identified factors related to implementation success using the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) implementation science framework.

The framework helped identify factors that affected implementation related to the context, innovation, recipient, and facilitation. Contextual characteristics were at the clinic, health system, and broader external context, including staffing and leadership support, previous QI experience, and state laws. Characteristics of innovation were its adaptability and challenges operationalizing the measures. Recipient characteristics included belief in the importance of the innovation but challenges engaging in the initiative. Finally, facilitation characteristics producing different outcomes included staffing and available time of the QI team, the ability to make changes, and experience with QI.

The CDC released an updated and expanded Clinical Practice Guideline for Prescribing Opioids for Pain in November 2022. While clinical guidance is always evolving, health care organizations and practices considering implementing any opioid management initiative may benefit from the insights in our findings to prepare for and overcome implementation challenges.