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Michigan OPEN

How we Iterate: A Closer Look at OPEN’s Prescribing Recommendations

Apr 24, 2023

One of OPEN’s most important initiatives is our opioid Prescribing Recommendations. Earlier this year, we developed recommendations for a new set of pediatric procedures. In 2022, we added recommendations for additional pediatric procedures and updated many of the existing recommendations for adult surgical procedures. How do we actually go about making these changes? How did OPEN start making these recommendations?

“We recognized that surgeons were determining the number of opioids based on what was taught as senior residents over evidence or direct data,” said Dr. Chad Brummett, MD, Co-director of OPEN. “This is an opportunity to fill a critical gap.” Seeing this practice and knowing changes had to be made, OPEN turned to one of their partners to help.

“MSQC [Michigan Surgical Quality Collaborative] started collecting opioid use consumption and Patient Reported Outcomes (PROs) data as part of a pilot project,” recounted Vidhya Gunaseelan, Senior Data Analyst at OPEN. After obtaining nine months of PROs for multiple procedures, OPEN released the first set of Prescribing Recommendations in September 2017. “There is no data out there, and we have nine months of data from various hospitals across the state, so we should use this data to create the first iteration.”

After the release of the first iteration, OPEN continued to partner with MSQC to receive data, and aimed to refine the existing recommendations. “We start by reviewing the data from MSQC, then we look to see if there have been any changes in the number of pills patients are consuming,” stated Sarah Evilsizer, Clinical Implementation Specialist at OPEN. “The recommendations are based on patient consumption, and patient consumption changes over time. We want to make sure we are developing recommendations as practice changes. If the patients aren’t consuming as much, we don’t need to prescribe as much. Especially if their pain scores aren’t higher and their satisfaction levels aren’t lower,” added Gunaseelan.

After seeing the new data, OPEN started work on their second iteration of prescribing recommendations by continuing to analyze the data obtained from MSQC. If OPEN sees a change from the current recommendation in consumption at the 75th percentile of PROs, then we know it’s time to update the recommendation. “We need to have enough data, enough practice change to see if consumption has changed and if the recommendation is ready for an update” said Gunaseelan. 

As of March of 2023, OPEN has released their fifth iteration of prescribing recommendations. Evilsizer noted “As we implement projects and monitor what patients are consuming, we are able to continue to lower that recommendation based on what patients are consuming and how their pain level and satisfaction are after surgery.”

Looking over the last six years of work, team members at OPEN can see what a great achievement this is. “We have been expanding the number of procedures for which we have recommendations and revising recommendations for many procedures based on new data. We have seen a large reduction in both prescribing and consumption. The number of patients and hospitals that we use data from has increased over the years,” said Gunaseelan. “There is a sense of accomplishment knowing the recommendations we put out do genuinely make a difference in people’s lives.”

Dr. Brummett shared this sentiment, stating that he is “Excited to see patient data in satisfaction and pain scores have stayed the same and that there is no adverse effect on pain or satisfaction based on the data.” Evilsizer added “Seeing how far these recommendations have come just feels amazing.”

Going forward, OPEN hopes to continue making a difference in Michigan communities and hopes to help not only patients who need opioids, but also those who don’t require them. “We want to discover better guidance for people who don’t need them at all, to get a better sense of how to differentiate those populations and tailor care depending on the individual patient’s needs,’ said Dr. Brummett.

“None of this could’ve happened without our partnership with MSQC and their willingness to share their data with us,” noted Gunaseelan. This partnership has helped create a safer way to prescribe in Michigan, and OPEN couldn’t have completed this work without the help of MSQC. Evilsizer ended with “Seeing where these recommendations are now is such a testament to the amount of work everyone in the state has been doing.” 

You can find our most recent iteration of our Prescribing Recommendations here.