Protocol for evaluating the nationwide implementation of the VA Stratification Tool for Opioid Risk Management (STORM)
Protocol for evaluating the nationwide implementation of the VA Stratification Tool for Opioid Risk Management (STORM)
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DOI：
10.1186/s13012-019-0852-z
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发表时间：
2019-01-18
影响因子：
7.2
通讯作者：
Hausmann, Leslie R. M.
中科院分区：
文献类型：
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作者：
Chinman, Matthew;Gellad, Walid F.;Hausmann, Leslie R. M.
背景减轻阿片类药物不良后果的风险至关重要。因此，退伍军人事务部（VA）医疗保健系统开发了阿片类药物风险管理分层工具（STORM），这是一个帮助临床医生进行阿片类药物风险评估和缓解的仪表板。STORM每天更新，计算不良后果的风险评分（例如，自杀相关事件、用药过量、用药过量死亡），并显示该信息沿着推荐的风险缓解策略和非阿片类药物疼痛治疗的文档。2018年3月，VA发布了一项政策通知，要求VA医疗中心（VAMC）完成STORM确定为极高风险（即，风暴风险评分前1%）。一半的VAMC被随机分配的通知，其中还指出，VAMC将需要额外的支持和监督，未能达到既定的案件审查比例。使用阶梯楔形随机分组设计，将进一步随机分配VAMC，以在通知发布后9个月或15个月开始对扩大的患者池（STORM风险评分前5%与1%）进行病例审查，创建4个自然组。VA委托进行评估，以了解实施战略和相关因素的情况下审查完成率，其协议中所描述的本report.MethodsThis混合方法的研究将包括一个在线调查的所有VAMCs，以确定实施战略和采访的一个子集的设施，以确定实施的障碍和促进者。这项调查是根据实施变革的专家建议项目进行的，该项目请专家就73项实施战略达成共识。我们将使用回归模型来比较各研究组实施策略的数量和类型，以及它们与病例审查完成率的关系。使用实施研究综合框架中的问题，我们将采访40个VAMC的利益相关者，他们对阿片类药物治疗指南的依从性最高和最低。讨论通过确定哪些实施策略，障碍和促进因素影响病例审查，以减少阿片类药物相关的不良结果，这一独特的实施评估将使退伍军人事务部能够改进未来阿片类药物安全倡议的设计。ISRCTN注册号为ISRCTN16012111。试验于2017年5月3日首次登记。
BackgroundMitigating the risks of adverse outcomes from opioids is critical. Thus, the Veterans Affairs (VA) Healthcare System developed the Stratification Tool for Opioid Risk Management (STORM), a dashboard to assist clinicians with opioid risk evaluation and mitigation. Updated daily, STORM calculates a risk score of adverse outcomes (e.g., suicide-related events, overdoses, overdose death) from variables in the VA medical record for all patients with an opioid prescription and displays this information along with documentation of recommended risk mitigation strategies and non-opioid pain treatments. In March 2018, the VA issued a policy notice requiring VA Medical Centers (VAMCs) to complete case reviews for patients whom STORM identifies as very high-risk (i.e., top 1% of STORM risk scores). Half of VAMCs were randomly assigned notices that also stated that additional support and oversight would be required for VAMCs that failed to meet an established percentage of case reviews. Using a stepped-wedge cluster randomized design, VAMCs will be further randomized to conduct case reviews for an expanded pool of patients (top 5% of STORM risk scores vs. 1%) starting either 9 or 15months after the notice was released, creating four natural arms. VA commissioned an evaluation to understand the implementation strategies and factors associated with case review completion rates, whose protocol is described in this report.MethodsThis mixed-method study will include an online survey of all VAMCs to identify implementation strategies and interviews at a subset of facilities to identify implementation barriers and facilitators. The survey is based on the Expert Recommendations for Implementing Change (ERIC) project, which engaged experts to create consensus on 73 implementation strategies. We will use regression models to compare the number and types of implementation strategies across arms and their association with case review completion rates. Using questions from the Consolidated Framework for Implementation Research, we will interview stakeholders at 40 VAMCs with the highest and lowest adherence to opioid therapy guidelines.DiscussionBy identifying which implementation strategies, barriers, and facilitators influence case reviews to reduce opioid-related adverse outcomes, this unique implementation evaluation will enable the VA to improve the design of future opioid safety initiatives.Trial registrationThis project is registered at the ISRCTN Registry with number ISRCTN16012111. The trial was first registered on 5/3/2017.