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Randomized Policy Evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM)

Abstract

Background

The Veterans Health Administration (VHA) developed a dashboard Stratification Tool for Opioid Risk Mitigation (STROM) to guide clinical practice interventions. VHA released a policy mandating that high-risk patients of an adverse event based on the STORM dashboard are to be reviewed by an interdisciplinary team of clinicians.

Aim

Randomized program evaluation to evaluate if patients in the oversight arm had a lower risk of opioid-related serious adverse events (SAEs) or death compared to those in the non-oversight arm.

Setting and Participants

One-hundred and forty VHA facilities (aka medical centers) were randomly assigned to two groups: oversight and non-oversight arms. VHA patients who were prescribed opioids between April 18, 2018, and November 8, 2019, were included in the cohort.

Program Description

We hypothesized that patients cared for by VHA facilities that received the policy with the oversight accountability language would achieve lower opioid-related SAEs or death.

Program Evaluation

We did not observe a relationship between the oversight arm and opioid-related SAEs or death. Patients in the non-oversight arm had a significantly higher chance of receiving a case review compared to those in the oversight arm.

Discussion

Even though our findings were unexpected, the STORM policy overall was likely successful in focusing the provider’s attention on very high-risk patients.

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Correspondence to Taeko Minegishi MS, PhD.

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Conflict of Interest

This work is supported by Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development (QUERI PEC 16-001) and HSR&D SDR 16-19. The contents do not represent the views of the U.S. Department of Veterans Affairs, the United States Government, Northeastern University, Boston University, or Harvard University.

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Minegishi, T., Garrido, M.M., Lewis, E.T. et al. Randomized Policy Evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM). J GEN INTERN MED (2022). https://doi.org/10.1007/s11606-022-07622-1

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  • DOI: https://doi.org/10.1007/s11606-022-07622-1

KEY WORDS

  • Veterans Health Administration
  • randomization
  • policy
  • opioids