343 posters, 5 videos, 2 audios, 18 topics, 33 sessions, 263 authors, 202 institutions

24th Annual Pain Medicine Meeting 2025

November 13-15, 2025| JW Marriott Austin, Austin, Texas

2197846

Insights from a multi-year improvement journey in system-wide patient-provider agreement completion for chronic opioid therapy

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Poster Presenter

David Dickerson

Authors

David Dickerson

Affiliations

Endeavor Health

Part of Topic

Scientific Abstracts > Chronic Pain

Insights from a multi-year improvement journey in system-wide patient-provider agreement completion for chronic opioid therapy

David M. Dickerson, MD1,2, Steve Reinhart, MBA 3, Nia Moragne, MPH1, Andrew R. Locke 1, Tom Hensing, MD 2,4, Lakshmi Halasyamani, MD 2,4

1Department of Anesthesiology, Critical Care & Pain Medicine, Endeavor Health, Evanston, IL; 2Pritzker School of Medicine, University of Chicago, Chicago, IL; 3 Department of Ambulatory Quality, Endeavor Health, Evanston, IL
4Department of Medicine, Endeavor Health, Evanston, IL

Introduction

Guidelines for safe opioid prescribing recommend a myriad of elements to ensure safe and appropriate use.1,2 Patient-provider agreements (PPA) detail practices for patients and clinicians, aligning mutual expectations and patient care. 3

Tracking annual patient-provider agreement (PPA) completion and chronic opioid treatment (COT) across a large integrated health system is challenging and little is published on this opioid safety intervention. This retrospective study illustrates the monthly incidence of COT, the % of patient-provider agreement completion for this population, and the tactics deployed to augment performance in a multiyear improvement journey.

Methods

After Endeavor Health IRB approval, analysis was completed of prospectively collected prescribing and PPA completion data from 10/01/2019 to 12/31/2022.

Four key periods are demarcated by 4 improvement tactics (P1-P4) that were deployed at specific times and represented in the data set:

I.Change to annual PPA completion requirement

II.Implementation of PPA Completion Best Practice Alert for clinicians and staff

III.Creation of a .smartphrase and searchable data element for virtual PPA completion

IV.Data reporting of care gaps to clinical teams.

•Patients 18 or older who received at least three opioid prescriptions in the prior 12 weeks define the PPA-eligible denominator.

•Patients in that cohort with a PPA completed in the prior 12 months comprised the numerator.

•Descriptive analysis was used to evaluate percentage change over time between P1-P4. Linear regression was performed to assess trends in the rate of change in prescribing longitudinally.

Results and discussion

•The deployment of the .smartphrase (P3) resulted in the most significant change in PPA completion with a 40% increase in rate of completion.

•Access to standardized PPA documentation with a .smartphrase serving as a searchable data element enabled this safety practice for both patients and providers.

•This new process was utilized in tele-visits and was a critical workflow change during the COVID pandemic. Prior to this, PPA completion could solely be completed via an in-person, face-to-face workflow.

•This option remained highly utilized with the return to in-office care.

•While COT was reduced by a statistically significant 35% from the beginning to the end of the cohort, this trend may also have been influenced by other factors such as national prescribing trends.

In summary, annual completion of a PPA for COT was influenced by multiple factors: clinician engagement, improvement prioritization by system leadership, analytic support for data tracking and reporting, informatics alerts, accessible workflows for completion, and monthly performance score card tracking. Future work should examine functional outcomes in patients receiving COT as well as trends in prescribing