To improve the safe use of opioids within VA, the Office of Mental Health Operations (OMHO) collaborated with the National Pain Management Program to develop a predictive model to estimate the risk of adverse behavioral outcomes (e.g., suicide-related events, overdoses, and accidents) among patients prescribed opioid therapy by VA providers. In addition to estimating risk, this Stratification Tool for Opioid Risk Management (STORM) uses a real-time data dashboard to present individual patients' level of risk, display patient-specific clinical risk factors, and track use of recommended risk mitigation strategies (e.g., naloxone kits, reduction in opioid dosage) and non-opioid pain treatments (e.g., physical therapy, acupuncture) for individual patients. This tool is intended to provide real-time clinical support to help national and regional VA leaders and providers improve the safety of patients receiving opioid medications in the VA.
STORM is currently being refined for rollout to VA facilities in a randomized fashion.
The overall objective of this project is to perform, in collaboration with PEPReC, a broad evaluation of the effectiveness and implementation of the STORM randomized rollout.
In addition to planning activities, our evaluation consists of 2 primary components: (1) a quantitative survey of implementation strategies that will be sent to all randomized facilities, and (2) in-depth qualitative interviews assessing barriers to and facilitators of STORM implementation at a subset of facilities.
For the first component, we will assess STORM implementation strategies used at all facilities as defined by the Expert Recommendations for Implementing Change (ERIC)
For the second component, we will conduct in-depth qualitative interviews with key informants from a select group of facilities to understand the barriers and facilitators to STORM implementation and effectiveness. The interview script will be guided by the Consolidated Framework for Implementation Research (CFIR), which identifies key factors that can influence implementation.
There are no findings to report as we are still in the planning phase. We await the imminent release of the policy memo.
This is the first study to comprehensively examine the effectiveness of a real time, provider-facing opioid risk predictor tool on reduction of adverse behavioral outcomes in Veterans prescribed opioid medications. Key factors to successful implementation will be identified, which will support the future spread of effective practices to improve safety and quality of Veteran care. Additional impacts to be reported after study completed.
We await the imminent release of the policy memo.
- Chinman M, Gellad WF, McCarthy S, Gordon AJ, Rogal S, Mor MK, Hausmann LRM. Protocol for evaluating the nationwide implementation of the VA Stratification Tool for Opioid Risk Management (STORM). Implementation science : IS. 2019 Jan 18; 14(1):5.
- Minegishi T, Frakt AB, Garrido MM, Gellad WF, Hausmann LRM, Lewis ET, Pizer SD, Trafton JA, Oliva EM. Randomized program evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM): A research and clinical operations partnership to examine effectiveness. Substance Abuse. 2019 Jan 8; 40(1):14-19.
- Rogal SS. Implementation Strategies and the Uptake of Hepatitis C Treatment in VA. QUERI Implementation Network [Cyberseminar]. VA HSR&D. 2018 Feb 1.
- Gellad WF. University of Pittsburgh Efforts to Address the Opioid Epidemic: Briefing before the Assistant Secretary for Financial Resources, United States Department of Health and Human Services; 2016 Aug 9; Pittsburgh, PA.