VA Health Care System's STORM Tool Aims to Reduce Opioid Risk, Improve Patient Outcomes

Ongoing research published in Implementation Science aims to evaluate the implementation strategies and factors associated with case review completion rates in the Veterans Affairs (VA) health care system's efforts to mitigate risks of adverse outcomes from opioids, providing valuable insights for improving future opioid safety initiatives. 

The VA health care system has developed a dashboard called the Stratification Tool for Opioid Risk Management (STORM) to help clinicians evaluate and mitigate the risks associated with opioids. STORM calculates a "risk score" for adverse outcomes based on variables in the patient's medical record, such as suicide-related events, overdoses, and overdose deaths. It also provides recommendations for risk mitigation strategies and non-opioid pain treatments.  

In March 2018, the VA issued a policy notice requiring VA Medical Centers to conduct case reviews for patients identified as very high-risk by STORM, with additional support and oversight for centers that failed to meet the required percentage of case reviews. Researchers will use a stepped-wedge cluster randomized design to further randomize centers to conduct case reviews for an expanded pool of patients starting 9 or 15 months after the notice was released, creating 4 different arms. The VA has commissioned an evaluation to understand the implementation strategies and factors associated with case review completion rates. 

This mixed-method study involves an online survey of all VAMCs to identify implementation strategies and interviews at a subset of facilities to determine implementation barriers and facilitators. The survey utilizes the Expert Recommendations for Implementing Change (ERIC) project, which established consensus on 73 implementation strategies. Researchers will use regression models to compare the quantity and types of implementation strategies across different groups, assessing their impact on case review completion rates.  

Furthermore, researchers will interview stakeholders at 40 VAMCs with the highest and lowest adherence to opioid therapy guidelines using questions sourced from the Consolidated Framework for Implementation Research. 

“By 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,” said researchers.  

Reference  

Chinman M, Gellad W F, McCarthy S, et all. Protocol for evaluating the nationwide implementation of the VA Stratification Tool for Opioid Risk Management (STORM). Implement Sci. 2019;14(1):5. doi:10.1186/s13012-019-0852-z