{"id":75437,"date":"2025-02-25T16:18:47","date_gmt":"2025-02-26T00:18:47","guid":{"rendered":"https:\/\/www.qualityhealth.org\/bree\/?page_id=75437"},"modified":"2026-01-27T17:44:28","modified_gmt":"2026-01-28T01:44:28","slug":"managing-pain","status":"publish","type":"page","link":"https:\/\/www.qualityhealth.org\/bree\/implementation-guide-home-page\/managing-pain\/","title":{"rendered":"Managing Pain"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row overlay_dotted=&#8221;&#8221; el_id=&#8221;managing-pain-guidelines-row&#8221;][vc_column][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; title=&#8221;Collaborative Care for Chronic Pain&#8221; el_id=&#8221;collaborative-care-tour&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1705962508610-b3bf3d0d-0034&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<h4>Guideline title: Collaborative Care for Chronic Pain Report and Guidelines<\/h4>\n<p><strong>Publication Status:<\/strong> Active<\/p>\n<p><strong>Date of publication<\/strong>: 2018<\/p>\n<p><strong>Date of last evidence search: <\/strong>2018<\/p>\n<p><strong>Scope:<\/strong> Patient self-management, minimum standards of care, care team, treatment, population health.<strong><br \/>\n<\/strong><\/p>\n<p><strong>Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n<p><strong>Description: <\/strong>The goals for collaborative care focused on chronic pain with life activity impacts are improved function, increased quality of life, and greater patient autonomy rather than a primary focus on pain relief. The workgroup aimed to define areas within collaborative care unique to chronic pain with life activity impacts while also developing a system to recognize and limit the transition from acute and subacute pain to chronic pain. Ideally, both acute and chronic pain will be managed and treated over time using a systems approach to allow patients to stay within primary care supported by the minimum standards of collaborative care including: patient identification and population management, a care team, a care management function, basing treatments in evidence-informed care, and patient-centered supported self-management<strong>.<\/strong><strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><br \/>\n<\/span><\/span><\/strong><\/p>\n<h4>Supporting Materials<\/h4>\n<p><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/02\/Letter-from-HCA-accepting-collaborative-care-for-chronic-pain.pdf\" rel=\"\"><span class=\"doc\">Letter from the Health Care Authority Accepting the Collaborative Care for Chronic Pain Recommendations<\/span><br \/>\n<\/a><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/01\/Chronic-Pain-Charter-Roster-Final-2018.pdf\" rel=\"\">Collaborative Care for Chronic Pain Workgroup Charter and Roster<\/a><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Read On-line&#8221; tab_id=&#8221;1705962509144-9644df23-bb2d&#8221;][vc_column_text]<\/p>\n<h3><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/01\/Recommendations-Chronic-Pain-Final-2018.pdf\">Collaborative Care for Chronic Pain Report and Guidelines<\/a><\/h3>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Resources and Tools&#8221; tab_id=&#8221;1705962532432-3c9b4a29-3846&#8243;][vc_toggle title=&#8221;Resources and Tools&#8221;]<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/03\/Appendix-D-Enhanced-Chronic-Pain-Care-Resource-Grid-\u2013-Health-care-resources.pdf\">Appendix D: Enhanced Chronic Pain Care Resource Grid \u2013 Health care resources<\/a><\/p>\n<p><a href=\"https:\/\/wmc.wa.gov\/resources\/pain-management-resources\/patient-pain-management-resources\">Washington Medical Commission Pain Management Resources\u00a0<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Metrics and Evaluation Tools&#8221; tab_id=&#8221;1705962562329-74dce5de-e7ed&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p>To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n<p>To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n<p>Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n<p>[\/vc_column_text][vc_toggle title=&#8221;Primary Care&#8221;]<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/05\/Primary-care-Score-Card_CC_Draft.xlsx\">Primary care Score Card<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Systems&#8221;]<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/05\/system-Score-Card-Copy.xlsx\">System Score Card\u00a0 <\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Plans&#8221;]<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/05\/Health-Plan-Score-Card_CC_draft.xlsx\">Health Plan Score Card_<\/a>[\/vc_toggle][vc_toggle title=&#8221;Employers\/Purchasers&#8221;]<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/05\/Employer_Score-Card_Draft.xlsx\">Employer_Score Card<\/a>[\/vc_toggle][vc_toggle title=&#8221;Guideline Metrics&#8221;]The work group did not recommend specific metrics, however audience specific evaluation score cards and other prescribing metrics developed by the Bree Collaborative can be useful. These measures can be found on the Washington State Common Measure Set. For all of these measure a decrease is improvement.<\/p>\n<ul>\n<li>New Opioid Patient Days Supply of First Opioid Prescription\n<ul>\n<li><span id=\"page10R_mcid41\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients with at least one opioid prescription in the current by days\u2019 supply (day <\/span><span dir=\"ltr\" role=\"presentation\">supply categories: &lt;3, 4-7, 8-13 and &gt;14).<\/span><\/span><span id=\"page10R_mcid42\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Patients with at least one opioid prescription in the current quarter who have no opioids <\/span><span dir=\"ltr\" role=\"presentation\">prescribed in the prior quarter; Age stratify and report results for two groups: children\/adolescents aged 17 <\/span><span dir=\"ltr\" role=\"presentation\">and younger, and adults aged 18 and older.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>New Opioid Patients Transitioning to Chronic Opioids\n<ul>\n<li><span id=\"page10R_mcid57\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients who are prescribed &gt;60 days\u2019 supply of opioids in the current calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter with at least one opioid prescription in the previous quarter and no opioid prescription in the prior <\/span><span dir=\"ltr\" role=\"presentation\">quarter.<\/span><\/span><span id=\"page10R_mcid58\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span><\/em> <span dir=\"ltr\" role=\"presentation\">Number of patients with at least one opioid prescription in the previous quarter who have no <\/span><span dir=\"ltr\" role=\"presentation\">opioids prescribed in the prior quarter. Report as incidences per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Patients Prescribed High-Dose Chronic Opioid Therapy\n<ul>\n<li><span id=\"page10R_mcid73\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids at &gt;50 mg\/day or <\/span><span dir=\"ltr\" role=\"presentation\">&gt;90 mg\/day MED.<\/span><\/span><span id=\"page10R_mcid74\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids in the calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter. <\/span><\/span><span id=\"page10R_mcid75\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">Report each result as prevalence per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Use of Opioids at High Dosage (HDO)\n<ul>\n<li><span id=\"page10R_mcid89\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">The proportion of members 18 years and older who received prescription opioids at a high dosage (average <\/span><span dir=\"ltr\" role=\"presentation\">morphine milligram equivalent dose [MME] \u226590) for \u226515 days during the measurement year.<\/span><\/span><span id=\"page10R_mcid90\" class=\"markedContent\"> <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Examples of Implementation &#8211; IN DEVELOPMENT&#8221; tab_id=&#8221;1705962616168-d41fa267-4da5&#8243;][\/vc_tta_section][vc_tta_section title=&#8221;WorkGroup Members&#8221; tab_id=&#8221;1739898860285-a5b0a236-9af0&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table width=\"100%\">\n<tbody>\n<tr>\n<td width=\"29%\"><strong>Name<\/strong><\/td>\n<td width=\"34%\"><strong>Title<\/strong><\/td>\n<td width=\"35%\"><strong>Organization<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Leah Hole-Marshall, JD (chair)<\/td>\n<td width=\"34%\">Counsel and Chief Strategist<\/td>\n<td width=\"35%\">Washington Health Benefit Exchange<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Ross Bethel, MD<\/td>\n<td width=\"34%\">Physician<\/td>\n<td width=\"35%\">Selah Family Medicine<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">LuAnn Chen, MD, MHA, FAAFP<\/td>\n<td width=\"34%\">Medical Director<\/td>\n<td width=\"35%\">Community Health Plan of Washington<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Lynn DeBar, PhD, MPH<\/td>\n<td width=\"34%\">Senior Investigator<\/td>\n<td width=\"35%\">Kaiser Permanente Washington Health Research Institute<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Stuart Freed MD<\/td>\n<td width=\"34%\">Chief Medical Officer<\/td>\n<td width=\"35%\">Confluence Health<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Andrew Friedman, MD<\/td>\n<td width=\"34%\">Physiatrist<\/td>\n<td width=\"35%\">Virginia Mason Medical Center<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Mark Murphy, MD<\/td>\n<td width=\"34%\">President<\/td>\n<td width=\"35%\">Washington Society of Addiction Medicine<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Mary Kay O\u2019Neill, MD, MBA<\/td>\n<td width=\"34%\">Partner<\/td>\n<td width=\"35%\">Mercer<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Jim Rivard, PT, DPT, MOMT, OCS, FAAOMPT<\/td>\n<td width=\"34%\">President<\/td>\n<td width=\"35%\">MTI Physical Therapy<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Kari A. Stephens, PhD<\/td>\n<td width=\"34%\">Assistant Professor \u2013 Psychiatry &amp; Behavioral Sciences<\/td>\n<td width=\"35%\">University of Washington Medicine<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Mark Sullivan, MD, PhD<\/td>\n<td width=\"34%\">Professor, psychiatry; Adjunct professor, anesthesiology and pain medicine<\/td>\n<td width=\"35%\">University of Washington Medicine<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Nancy Tietje<\/td>\n<td width=\"34%\">Patient Advocate<\/td>\n<td width=\"35%\"><\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Emily Transue, MD, MHA<\/td>\n<td width=\"34%\">Associate Medical Director<\/td>\n<td width=\"35%\">Washington State Health Care Authority<\/td>\n<\/tr>\n<tr>\n<td width=\"29%\">Michael Von Korff, ScD<\/td>\n<td width=\"34%\">Senior Investigator<\/td>\n<td width=\"35%\">Kaiser Permanente Washington Health Research Institute<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Archived Meeting Materials&#8221; tab_id=&#8221;1740176897605-7d7e7f35-c5eb&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table border=\"0\">\n<tbody>\n<tr>\n<td><strong>Date<\/strong><\/td>\n<td><strong>Agenda<\/strong><\/td>\n<\/tr>\n<tr>\n<td>January 12<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/12\/Agenda-Collaborative-Care-Workgroup-18-0112.pdf\" rel=\"\"><span class=\"doc\">Agenda January 12<\/span><br \/>\n<\/a><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/01\/Chronic-Pain-Charter-Roster-Draft-2018.pdf\" rel=\"\">Chronic Pain Workgroup Charter and Roster<\/a><\/span><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/12\/Agenda-Collaborative-Care-Workgroup-18-0112.pdf\" rel=\"\"><br \/>\n<\/a><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/03\/Slides-Collaborative-Care-from-LI-Conference-1.pdf\" rel=\"\">Slides Collaborative Care from L&amp;I Conference<\/a><\/span><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/12\/Agenda-Collaborative-Care-Workgroup-18-0112.pdf\" rel=\"\"><br \/>\n<\/a><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/01\/Bree-Process-2016.pdf\" rel=\"\">Bree Collaborative Process<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>February 9<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/02\/Agenda-Collaborative-Care-Workgroup-18-0209.pdf\" rel=\"\">Agenda February 9<\/a><\/span><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/02\/Minutes-Chronic-Pain-Workgroup-18-0112.pdf\" rel=\"\"><span class=\"doc\">Minutes January 12<\/span><br \/>\n<\/a><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/03\/Recommendations-Chronic-Pain-Draft-18-0130-1.pdf\" rel=\"\">Draft Collaborative Care for Chronic Pain Recommendations<\/a><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/02\/Minutes-Chronic-Pain-Workgroup-18-0112.pdf\" rel=\"\"><br \/>\n<\/a><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/03\/Slides-Collaborative-Care-from-LI-Conference-1.pdf\" rel=\"\">Slides Collaborative Care from L&amp;I Conference<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>March 9<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/03\/Agenda-Collaborative-Care-Workgroup-18-0309.pdf\" rel=\"\">Agenda March 9<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/03\/Minutes-Chronic-Pain-Workgroup-18-0209.pdf\" rel=\"\">Minutes February 9<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/03\/Collaborative-Care-Matrix-18-0223.xlsx\" rel=\"\">Collaborative Care Matrix<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/03\/Recommendations-Chronic-Pain-Draft-18-0227.pdf\" rel=\"\">Draft Chronic Pain Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>April 13<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/04\/Agenda-Collaborative-Care-Workgroup-18-0413.pdf\" rel=\"\">Agenda April 13<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/04\/Minutes-Chronic-Pain-Workgroup-18-0309.pdf\" rel=\"\">Meeting Minutes March 9<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/04\/Recommendations-Chronic-Pain-Draft-18-0404.pdf\" rel=\"\">Draft Collaborative Care for Chronic Pain Recommendations<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/04\/Supported-Self-Management-Toolkit.pdf\" rel=\"\">Supported Self-Management Toolkit<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>May 11<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/05\/Agenda-Collaborative-Care-Workgroup-18-0511.pdf\" rel=\"\">Agenda May 11<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/05\/Minutes-Chronic-Pain-Workgroup-18-0413.pdf\" rel=\"\">Minutes April 13<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/05\/Recommendations-Chronic-Pain-Draft-18-0417.pdf\" rel=\"\">Draft Collaborative Care for Chronic Pain Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>June 15<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/06\/Agenda-Collaborative-Care-Workgroup-18-0615.pdf\" rel=\"\"><span class=\"doc\">Agenda June 15<\/span><br \/>\n<\/a><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/06\/Minutes-Chronic-Pain-Workgroup-18-0511.pdf\" rel=\"\"><span class=\"doc\">Minutes May 11<\/span><br \/>\n<\/a><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/06\/Recommendations-Chronic-Pain-Draft-18-0606.pdf\" rel=\"\">Draft Recommendations Collaborative Care<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>July 13<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/07\/Agenda-Collaborative-Care-Workgroup-18-0713.pdf\" rel=\"\">Agenda July 13<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/06\/Minutes-Chronic-Pain-Workgroup-18-0615.pdf\" rel=\"\">Minutes June 15<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/07\/Recommendations-Chronic-Pain-Draft-18-0626.docx\" rel=\"\">Draft Recommendations Collaborative Care for Chronic Pain<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>August 10<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/08\/Agenda-Collaborative-Care-Workgroup-18-0810.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Agenda August 10<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/08\/Minutes-Chronic-Pain-Workgroup-18-0713.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Minutes July 13<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/08\/Recommendations-Chronic-Pain-Draft-18-0810-1.pdf\" rel=\"\">Draft Recommendations Collaborative Care for Chronic Pain<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>September 14<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/09\/Agenda-Collaborative-Care-Workgroup-18-0914.pdf\" rel=\"\">Agenda September 14<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/09\/Minutes-Chronic-Pain-Workgroup-18-0810.pdf\" rel=\"\">Minutes August 10<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/08\/Recommendations-Chronic-Pain-Draft-18-0810.pdf\" rel=\"\">Draft Collaborative Care for Chronic Pain Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>November 2<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/11\/Agenda-Collaborative-Care-Workgroup-18-1102.pdf\" rel=\"\">Agenda November 2<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/11\/Minutes-Chronic-Pain-Workgroup-18-0914.pdf\" rel=\"\">Minutes September 14<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/11\/Recommendations-Chronic-Pain-Draft-18-1031.pdf\" rel=\"\">Draft Recommendations Chronic Pain<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/11\/Non-Medical-Chronic-Pain-Experiences-Draft-by-Nancy-Tietje.pdf\" rel=\"\">Non-Medical Pain Experiences<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/11\/Non-Medical-pain-management.pdf\" rel=\"\">Non Medical Pain Management<\/a><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Awards&#8221; tab_id=&#8221;1739898861188-fa392a79-9e0a&#8221;][\/vc_tta_section][\/vc_tta_tour][vc_separator color=&#8221;custom&#8221; border_width=&#8221;10&#8243; accent_color=&#8221;#145e61&#8243;][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; el_id=&#8221;dental-prescribing-tour&#8221; title=&#8221;Dental Opioid Prescribing&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1682978478320-2a004084-7374&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<h4>Guideline title: Dental Guidelines on Prescribing Opioids for Acute Pain Management Report<\/h4>\n<p><strong>Publication Status:<\/strong> Active<strong><br \/>\n<\/strong><\/p>\n<p><strong>Date of publication<\/strong>: 2017<\/p>\n<p><strong>Date of last evidence search: <\/strong>2017<\/p>\n<p><strong>Scope: <\/strong>Perioperative period, <span dir=\"ltr\" role=\"presentation\">Intraoperative<\/span> <span dir=\"ltr\" role=\"presentation\">Period, Postoperative Period prescribing considerations<br \/>\n<\/span><\/p>\n<p><strong>Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n<p><strong>Description: <\/strong><span dir=\"ltr\" role=\"presentation\">This <\/span><span dir=\"ltr\" role=\"presentation\">is<\/span> <span dir=\"ltr\" role=\"presentation\">an<\/span> <span dir=\"ltr\" role=\"presentation\">easy<\/span><span dir=\"ltr\" role=\"presentation\">\u2010<\/span><span dir=\"ltr\" role=\"presentation\">to<\/span><span dir=\"ltr\" role=\"presentation\">\u2010<\/span><span dir=\"ltr\" role=\"presentation\">use<\/span> <span dir=\"ltr\" role=\"presentation\">reference<\/span> <span dir=\"ltr\" role=\"presentation\">to<\/span> <span dir=\"ltr\" role=\"presentation\">help<\/span> <span dir=\"ltr\" role=\"presentation\">dentists,<\/span> <span dir=\"ltr\" role=\"presentation\">oral<\/span> <span dir=\"ltr\" role=\"presentation\">surgeons,<\/span> <span dir=\"ltr\" role=\"presentation\">and<\/span> <span dir=\"ltr\" role=\"presentation\">others<\/span> <span dir=\"ltr\" role=\"presentation\">follow<\/span> <span dir=\"ltr\" role=\"presentation\">a<\/span> <span dir=\"ltr\" role=\"presentation\">set<\/span> <span dir=\"ltr\" role=\"presentation\">of<\/span> <span dir=\"ltr\" role=\"presentation\">clinical guidelines <\/span>\u00a0<span dir=\"ltr\" role=\"presentation\">and<\/span> <span dir=\"ltr\" role=\"presentation\">access<\/span> <span dir=\"ltr\" role=\"presentation\">supporting<\/span> <span dir=\"ltr\" role=\"presentation\">evidence<\/span> <span dir=\"ltr\" role=\"presentation\">and<\/span> <span dir=\"ltr\" role=\"presentation\">resources<\/span> <span dir=\"ltr\" role=\"presentation\">in<\/span> <span dir=\"ltr\" role=\"presentation\">the<\/span> <span dir=\"ltr\" role=\"presentation\">appendices<\/span> <span dir=\"ltr\" role=\"presentation\">to<\/span> <span dir=\"ltr\" role=\"presentation\">align<\/span> <span dir=\"ltr\" role=\"presentation\">opioid <\/span><span dir=\"ltr\" role=\"presentation\">prescribing<\/span> <span dir=\"ltr\" role=\"presentation\">with<\/span> <span dir=\"ltr\" role=\"presentation\">current<\/span> <span dir=\"ltr\" role=\"presentation\">evidence.<\/span> <span dir=\"ltr\" role=\"presentation\">We<\/span> <span dir=\"ltr\" role=\"presentation\">recommend<\/span> <span dir=\"ltr\" role=\"presentation\">revising<\/span> <span dir=\"ltr\" role=\"presentation\">office<\/span><span dir=\"ltr\" role=\"presentation\">\u2010<\/span><span dir=\"ltr\" role=\"presentation\">prescribing<\/span> <span dir=\"ltr\" role=\"presentation\">practices<\/span> <span dir=\"ltr\" role=\"presentation\">as<\/span> <span dir=\"ltr\" role=\"presentation\">necessary<\/span> <span dir=\"ltr\" role=\"presentation\">to <\/span><span dir=\"ltr\" role=\"presentation\">be<\/span> <span dir=\"ltr\" role=\"presentation\">consistent<\/span> <span dir=\"ltr\" role=\"presentation\">with<\/span> <span dir=\"ltr\" role=\"presentation\">this<\/span> <span dir=\"ltr\" role=\"presentation\">guideline,<\/span> <span dir=\"ltr\" role=\"presentation\">the<\/span> <span dir=\"ltr\" role=\"presentation\">American<\/span> <span dir=\"ltr\" role=\"presentation\">Dental<\/span> <span dir=\"ltr\" role=\"presentation\">Association<\/span> <span dir=\"ltr\" role=\"presentation\">(ADA)<\/span> <span dir=\"ltr\" role=\"presentation\">statement,<\/span> <span dir=\"ltr\" role=\"presentation\">and<\/span> <span dir=\"ltr\" role=\"presentation\">the<\/span> <span dir=\"ltr\" role=\"presentation\">Centers<\/span> <span dir=\"ltr\" role=\"presentation\">for <\/span><span dir=\"ltr\" role=\"presentation\">Disease<\/span> <span dir=\"ltr\" role=\"presentation\">Control<\/span> <span dir=\"ltr\" role=\"presentation\">and<\/span> <span dir=\"ltr\" role=\"presentation\">Prevention<\/span> <span dir=\"ltr\" role=\"presentation\">(CDC)<\/span> <span dir=\"ltr\" role=\"presentation\">guideline.<\/span> <span dir=\"ltr\" role=\"presentation\">We<\/span> <span dir=\"ltr\" role=\"presentation\">also<\/span> <span dir=\"ltr\" role=\"presentation\">recommend<\/span> <span dir=\"ltr\" role=\"presentation\">considering<\/span> <span dir=\"ltr\" role=\"presentation\">the<\/span> <span dir=\"ltr\" role=\"presentation\">feasibility<\/span> <span dir=\"ltr\" role=\"presentation\">of <\/span><span dir=\"ltr\" role=\"presentation\">embedding<\/span> <span dir=\"ltr\" role=\"presentation\">key<\/span> <span dir=\"ltr\" role=\"presentation\">practices<\/span> <span dir=\"ltr\" role=\"presentation\">from<\/span> <span dir=\"ltr\" role=\"presentation\">these<\/span> <span dir=\"ltr\" role=\"presentation\">guidelines<\/span> <span dir=\"ltr\" role=\"presentation\">into<\/span> <span dir=\"ltr\" role=\"presentation\">electronic<\/span> <span dir=\"ltr\" role=\"presentation\">health<\/span> <span dir=\"ltr\" role=\"presentation\">record<\/span> <span dir=\"ltr\" role=\"presentation\">systems.<\/span> <span dir=\"ltr\" role=\"presentation\">Lastly,<\/span> <span dir=\"ltr\" role=\"presentation\">we <\/span><span dir=\"ltr\" role=\"presentation\">recommend<\/span> <span dir=\"ltr\" role=\"presentation\">educating<\/span> <span dir=\"ltr\" role=\"presentation\">office<\/span> <span dir=\"ltr\" role=\"presentation\">staff<\/span> <span dir=\"ltr\" role=\"presentation\">and<\/span> <span dir=\"ltr\" role=\"presentation\">patients<\/span> <span dir=\"ltr\" role=\"presentation\">about<\/span> <span dir=\"ltr\" role=\"presentation\">the<\/span> <span dir=\"ltr\" role=\"presentation\">risks<\/span> <span dir=\"ltr\" role=\"presentation\">and<\/span> <span dir=\"ltr\" role=\"presentation\">benefits<\/span> <span dir=\"ltr\" role=\"presentation\">of<\/span> <span dir=\"ltr\" role=\"presentation\">opioids,<\/span> <span dir=\"ltr\" role=\"presentation\">individualizing <\/span><span dir=\"ltr\" role=\"presentation\">pain<\/span> <span dir=\"ltr\" role=\"presentation\">management<\/span> <span dir=\"ltr\" role=\"presentation\">strategies<\/span> <span dir=\"ltr\" role=\"presentation\">for<\/span> <span dir=\"ltr\" role=\"presentation\">each<\/span> <span dir=\"ltr\" role=\"presentation\">patient\u2019s<\/span> <span dir=\"ltr\" role=\"presentation\">clinical<\/span> <span dir=\"ltr\" role=\"presentation\">situation,<\/span> <span dir=\"ltr\" role=\"presentation\">and<\/span> <span dir=\"ltr\" role=\"presentation\">avoiding<\/span> <span dir=\"ltr\" role=\"presentation\">\u201cjust<\/span> <span dir=\"ltr\" role=\"presentation\">in<\/span> <span dir=\"ltr\" role=\"presentation\">case\u201d<\/span> <span dir=\"ltr\" role=\"presentation\">prescribing.<\/span><span id=\"page15R_mcid2\" class=\"markedContent\"><\/span><strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><br \/>\n<\/span><\/span><\/strong><\/p>\n<h4>Supporting Materials<\/h4>\n<p><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/10\/HCA-Letter-Accepting-Dental-Opioid-Recommendations-2017.pdf\" rel=\"\">Letter from the HCA Accepting Dental Prescribing Guidelines<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2016\/05\/Opioid-Implementation-Charter-2016.pdf\" rel=\"\">Opioid Guideline Implementation Charter<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2015\/06\/2015AMDGOpioidGuideline.pdf\">Agency Medical Directors Group Interagency Guideline on Prescribing Opioids for Pain<\/a><br \/>\n<a href=\"http:\/\/www.agencymeddirectors.wa.gov\/Files\/FY16-288SummaryAMDGOpioidGuideline_FINAL.pdf\">AMDG Guideline Summary<\/a>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Read On-line&#8221; tab_id=&#8221;1682978478884-45b46326-1181&#8243;][vc_column_text]<\/p>\n<h3><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/09\/Dental-Opioid-Recommendations-Final-2017.pdf\">Dental Guideline on Prescribing Opioids for Acute Pain Management Report<\/a><\/h3>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Resources and Tools&#8221; tab_id=&#8221;1682978497673-02a17bea-c5a7&#8243;][vc_toggle title=&#8221;Resources and Tools&#8221;]<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/03\/Opioid-Patient-Brochure.pdf\">Dental Treatment Pain Management for Children and Adults Brochure\u00a0<\/a><\/p>\n<p><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/03\/Med-Tracker-for-Dentists-to-Patients.pdf\">Over-the-Counter Pain Relief for Adults Med Tracker<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Metrics and Evaluation Tools&#8221; tab_id=&#8221;1682978526887-5b64a164-04ed&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p>To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n<p>To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n<p>Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n<p>[\/vc_column_text][vc_toggle title=&#8221;Health Systems, Dental Care Providers&#8221;]Health System Evaluation Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-System-Score-Card-_-dental-Rx.xlsx\">Health System Score Card _ dental Rx<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health and Dental Plans&#8221;]Health Plan Evaluation Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-Plan-Score-Card-_-Dental-Rx.xlsx\">Health Plan Score Card _ Dental Rx<\/a>[\/vc_toggle][vc_toggle title=&#8221;Guideline Metrics&#8221;]<em>New Opioid Patient Days Supply of First Opioid Prescription<\/em><\/p>\n<p><strong>Numerator:<\/strong> Number of patients with at least one opioid prescription in the current by days\u2019 supply (day supply categories: &lt;3, 4-7, 8-13 and &gt;14).<br \/>\n<strong>Denominator:<\/strong> Patients with at least one opioid prescription in the current quarter who have no opioids prescribed in the prior quarter; Age stratify and report results for two groups: children\/adolescents aged 17 and younger, and adults aged 18 and older.<\/p>\n<p><em>New Opioid Patients Transitioning to Chronic Opioids<\/em><\/p>\n<p><strong>Numerator:<\/strong> Number of patients who are prescribed &gt;60 days\u2019 supply of opioids in the current calendar quarter with at least one opioid prescription in the previous quarter and no opioid prescription in the prior quarter.<br \/>\n<strong>Denominator:<\/strong> Number of patients with at least one opioid prescription in the previous quarter who have no opioids prescribed in the prior quarter. Report as incidences per 1,000 population, age and sex adjusted.<\/p>\n<p><em>Use of Opioids at High Dosage (HDO)<\/em><\/p>\n<p>The proportion of members 18 years and older who received prescription opioids at a high dosage (average morphine milligram equivalent dose [MME] \u226590) for \u226515 days during the measurement year. (Bree Collaborative recommendations: track for adolescents)[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Examples of Implementation &#8211; NEW!&#8221; tab_id=&#8221;1682978623987-7a3339d9-4761&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<h3><b>Changing Dental Opioid Prescribing Practices Through Education and Monitoring<\/b><\/h3>\n<p>This project was a collaboration between Delta Dental of Washington, two of their largest purchasers, the Acora Foundation, and Healthentic. One purchaser voiced an interest in addressing prescribing practices for individuals under the age of 25.\u00a0 After looking at the data, the problem that Delta Dental identified was that a small percentage of their contracted dentists were routinely prescribing quantities of opioid medications that were inconsistent with published best-practice guidelines.<\/p>\n<p>Delta Dental used Bree Collaborative guidelines, along with other information on best practices, to design an intervention consisting of patient education, provider education, and provider monitoring and consulting. During the course of their intervention, a second purchaser group was added, providing opportunities for further impacting over-prescribing of opioids for youth during dental encounters.<\/p>\n<p>A summary of their work can be found <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2023\/06\/Case-study-onepager-Delta-Dental-Final-25_0416.pdf\">HERE<\/a>. More information on the outcomes and examples of their interventions materials will be posted as they become available.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;WorkGroup Members&#8221; tab_id=&#8221;1739898882276-9aa6f0b9-635b&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table width=\"100%\">\n<tbody>\n<tr>\n<td width=\"174\"><strong>Name<\/strong><\/td>\n<td width=\"227\"><strong>Title<\/strong><\/td>\n<td width=\"282\"><strong>Organization<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Chris Baumgartner<\/td>\n<td width=\"227\">Director Prescription Monitoring Program<\/td>\n<td width=\"282\">Washington State Department of Health<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">David Buchholz, MD<\/td>\n<td width=\"227\">Medical Director<\/td>\n<td width=\"282\">Premera Blue Cross<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Rolf Christensen, DDS<\/td>\n<td width=\"227\">Dental Urgent Care Clinic Director<\/td>\n<td width=\"282\">University of Washington School of Dentistry<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Tom Dodson, DMD, MPH<\/td>\n<td width=\"227\">Professor &amp; Chair, Oral and Maxillofacial Surgery<\/td>\n<td width=\"282\">University of Washington School of Dentistry<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gary Franklin, MD, MPH (Chair)<\/td>\n<td width=\"227\">Medical Director<\/td>\n<td width=\"282\">Washington State Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Charissa Fontinos, MD<\/td>\n<td width=\"227\">Deputy Chief Medical Officer<\/td>\n<td width=\"282\">Washington State Health Care Authority<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Bea Gandara, DDS<\/td>\n<td width=\"227\">Professor<\/td>\n<td width=\"282\">University of Washington School of Dentistry<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Frances Gough, MD<\/td>\n<td width=\"227\">Chief Medical Officer<\/td>\n<td width=\"282\">Molina Healthcare<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Dan Kent, MD<\/td>\n<td width=\"227\">Chief Medical Officer<\/td>\n<td width=\"282\">UnitedHealthcare<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Kathy Lofy, MD<\/td>\n<td width=\"227\">Chief Science Officer<\/td>\n<td width=\"282\">Washington State Department of Health<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Jaymie Mai, PharmD<\/td>\n<td width=\"227\">Pharmacy Manager<\/td>\n<td width=\"282\">Washington State Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Theresa Madden, DDS, MS, PhD<\/td>\n<td width=\"227\">Fellow<\/td>\n<td width=\"282\">International College of Dentists<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Ron Marsh, DDS<\/td>\n<td width=\"227\">Member<\/td>\n<td width=\"282\">Washington State Dental<br \/>\nQuality Assurance Commission<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Mellani McAleenan, JD<\/td>\n<td width=\"227\">Director of Government Relations<\/td>\n<td width=\"282\">Washington State Dental Association<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Shirley Reitz, PharmD<\/td>\n<td width=\"227\">\u200eClinical Pharmacist Client Manager<\/td>\n<td width=\"282\">OmedaRx, Cambia<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gregory Rudolph, MD<\/td>\n<td width=\"227\">Addiction Medicine<\/td>\n<td width=\"282\">Swedish Pain Services<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Mark Stephens<\/td>\n<td width=\"227\">President<\/td>\n<td width=\"282\">Change Management Consulting<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">David Tauben, MD<\/td>\n<td width=\"227\">Chief of Pain Medicine<\/td>\n<td width=\"282\">University of Washington Medical Center<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gregory Terman MD, PhD<\/td>\n<td width=\"227\">Professor<\/td>\n<td width=\"282\">Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Michael Von Korff, ScD<\/td>\n<td width=\"227\">Senior Investigator<\/td>\n<td width=\"282\">Kaiser Permanente Washington Research Institute<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Awards&#8221; tab_id=&#8221;1739898883216-3993e09d-ed11&#8243;][vc_column_text css=&#8221;&#8221;]Award winners for Best Practices in Dental Opioid Prescribing:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-76835\" src=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2026\/01\/Copy-of-Trailblazer-award-web-OPIC-2025-1.gif\" alt=\"\" width=\"350\" height=\"350\" \/><\/p>\n<ul>\n<li><a href=\"https:\/\/www.chpw.org\/\"><strong>Community Health Plan of Washington (2023)<\/strong><\/a><\/li>\n<li><strong><a href=\"https:\/\/www.uhc.com\/lp\/find-affordable-health-plans?cid=ps:ifp-acquisition:5535e3aa&amp;WT.mc_id=8030435&amp;tfn=1-877-525-8849&amp;mrcid=ps:google:brand-uhc%7CUHC-Brand-GGL-UHC-BG-Generic-PM-8030435%7CUHC%7CBrandGeneric:2022:8030435&amp;leadsourcename=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;utm_term=unitedhealthcare+insurance&amp;utm_source=GOOGLE&amp;utm_medium=cpc&amp;utm_campaign=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;gclid=CjwKCAiArLyuBhA7EiwA-qo80KYe8CVPuTaG48HKK3mQEbgMN5mb8Ga15OvdUreaj87mrnwsFdeJmBoCY6oQAvD_BwE&amp;gclsrc=aw.ds\">UnitedHealthcare (2024)<\/a><\/strong><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_separator color=&#8221;custom&#8221; border_width=&#8221;10&#8243; accent_color=&#8221;#145e61&#8243;][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; title=&#8221;Long-term Opioid Prescribing Management&#8221; el_id=&#8221;long-term-opioid-prescribing-tour&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1705962072270-09e0f60b-f2ed&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<h4>Guideline title: <strong>Long-term Opioid Prescribing Management Report and Guidelines<\/strong><\/h4>\n<p><strong>Publication Status:<\/strong> Active<\/p>\n<p><strong>Date of publication<\/strong>: 2019<\/p>\n<p><strong>Date of last evidence search: <\/strong>2019<\/p>\n<p><strong>Scope: <\/strong>Patient engagement; assessment; treatment plan development; treatment pathways; reimbursement; collaborative care<strong><br \/>\n<\/strong><\/p>\n<p><strong>Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n<p><strong>Description: <\/strong>Providers managing patients on long-term opioid therapy should start with patient engagement followed by thorough assessment and careful deliberation regarding an appropriate treatment pathway. Management should be individualized and should focus, in addition to reducing the intensity of pain, on goals of improving function and quality of life, and optimizing patient independence, while avoiding serious adverse outcomes.<strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><br \/>\n<\/span><\/span><\/strong><\/p>\n<h4>Supporting Materials<\/h4>\n<p><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/10\/Letter-from-HCA-accepting-perscribing-guidelines.pdf\" rel=\"\">Letter from the Health Care Authority Accepting the Postoperative Prescribing Guidelines<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/10\/HCA-Letter-Accepting-Dental-Opioid-Recommendations-2017.pdf\" rel=\"\">Letter from the HCA Accepting Dental Prescribing Guidelines<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/08\/HCA-Letter-Accepting-Metrics-2017.pdf\" rel=\"\">Letter from Health Care Authority Accepting Opioid Prescribing Metrics<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2016\/05\/Opioid-Implementation-Charter-2016.pdf\" rel=\"\">Opioid Guideline Implementation Charter<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2015\/06\/2015AMDGOpioidGuideline.pdf\">Agency Medical Directors Group Interagency Guideline on Prescribing Opioids for Pain<\/a><br \/>\n<a href=\"http:\/\/www.agencymeddirectors.wa.gov\/Files\/FY16-288SummaryAMDGOpioidGuideline_FINAL.pdf\">AMDG Guideline Summary<\/a>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Read On-line&#8221; tab_id=&#8221;1705962072731-c5247c41-c75a&#8221;][vc_column_text]<\/p>\n<h3><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/05\/Bree-Long-Term-Opioid-Use-Recommendations-FINAL-20-05.pdf\">Long-term Opioid Prescribing Management Report and Guidelines<\/a><\/h3>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Resources and Tools&#8221; tab_id=&#8221;1705962086292-57d2f6a8-201f&#8221;][vc_toggle title=&#8221;Resources and Tools&#8221;]<a href=\"https:\/\/www.hhs.gov\/system\/files\/Dosage_Reduction_Discontinuation.pdf\">HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics<\/a><\/p>\n<p><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/03\/Appendix-E-Validated-Tools-for-Screening-and-Assessment.pdf\">Appendix E: Validated Tools for Screening and Assessment<\/a><\/p>\n<p><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/03\/Appendix-H-Algorithm-for-Managing-Long-term-Opioid-Therapy.pdf\">Appendix H: Algorithm for Managing Long-term Opioid Therapy<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Metrics and Evaluation Tools&#8221; tab_id=&#8221;1705962106291-4a405017-d81a&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p>To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n<p>To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n<p>Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n<p>[\/vc_column_text][vc_toggle title=&#8221;Delivery Site and Health Systems&#8221;]Health System Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-System-Score-Card-LT-Rx.xlsx\">Health System Score Card LT Rx<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Care Professionals&#8221;]Health Care Providers Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Provider-Score-Card-_LT-Rx.xlsx\">Provider Score Card _LT Rx<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Plans&#8221;]Health Plan Score Cards <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-Plan-Score-Card-_-Long-term-Rx.xlsx\">Health Plan Score Card _ Long term Rx<\/a>[\/vc_toggle][vc_toggle title=&#8221;Guideline Metrics&#8221;]The work group did not recommend specific metrics, however other prescribing metrics developed by the Bree Collaborative can be useful. These measures can be found on the Washington State Common Measure Set. For all of these measure a decrease is improvement.<\/p>\n<ul>\n<li>New Opioid Patient Days Supply of First Opioid Prescription\n<ul>\n<li><span id=\"page10R_mcid41\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients with at least one opioid prescription in the current by days\u2019 supply (day <\/span><span dir=\"ltr\" role=\"presentation\">supply categories: &lt;3, 4-7, 8-13 and &gt;14).<\/span><\/span><span id=\"page10R_mcid42\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Patients with at least one opioid prescription in the current quarter who have no opioids <\/span><span dir=\"ltr\" role=\"presentation\">prescribed in the prior quarter; Age stratify and report results for two groups: children\/adolescents aged 17 <\/span><span dir=\"ltr\" role=\"presentation\">and younger, and adults aged 18 and older.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>New Opioid Patients Transitioning to Chronic Opioids\n<ul>\n<li><span id=\"page10R_mcid57\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients who are prescribed &gt;60 days\u2019 supply of opioids in the current calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter with at least one opioid prescription in the previous quarter and no opioid prescription in the prior <\/span><span dir=\"ltr\" role=\"presentation\">quarter.<\/span><\/span><span id=\"page10R_mcid58\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span><\/em> <span dir=\"ltr\" role=\"presentation\">Number of patients with at least one opioid prescription in the previous quarter who have no <\/span><span dir=\"ltr\" role=\"presentation\">opioids prescribed in the prior quarter. Report as incidences per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Patients Prescribed High-Dose Chronic Opioid Therapy\n<ul>\n<li><span id=\"page10R_mcid73\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids at &gt;50 mg\/day or <\/span><span dir=\"ltr\" role=\"presentation\">&gt;90 mg\/day MED.<\/span><\/span><span id=\"page10R_mcid74\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids in the calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter. <\/span><\/span><span id=\"page10R_mcid75\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">Report each result as prevalence per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Use of Opioids at High Dosage (HDO)\n<ul>\n<li><span id=\"page10R_mcid89\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">The proportion of members 18 years and older who received prescription opioids at a high dosage (average <\/span><span dir=\"ltr\" role=\"presentation\">morphine milligram equivalent dose [MME] \u226590) for \u226515 days during the measurement year.<\/span><\/span><span id=\"page10R_mcid90\" class=\"markedContent\"> <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Examples of Implementation &#8211; IN DEVELOPMENT&#8221; tab_id=&#8221;1705962139374-9ce1cf32-6c75&#8243;][\/vc_tta_section][vc_tta_section title=&#8221;Workgroup Members&#8221; tab_id=&#8221;1739898901916-45202875-c170&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table width=\"683\">\n<tbody>\n<tr>\n<td width=\"173\"><strong>Name<\/strong><\/td>\n<td width=\"228\"><strong>Title<\/strong><\/td>\n<td width=\"282\"><strong>Organization<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Gary Franklin, MD, MPH (Co-Chair)<\/td>\n<td width=\"228\">Medical Director<\/td>\n<td width=\"282\">Washington State Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Charissa Fotinos, MD (Co-Chair)<\/td>\n<td width=\"228\">Deputy Chief Medical Officer<\/td>\n<td width=\"282\">Washington State Health Care Authority<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Andrew Saxon, MD (Co-Chair)<\/td>\n<td width=\"228\">Director, Center of Excellence in Substance Abuse Treatment and Education (CESATE)<\/td>\n<td width=\"282\">VA Puget Sound Health Care System<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Rose Bigham and Cyndi Hoenhous (Co-Chairs)<\/td>\n<td width=\"228\">Patient Advocates<\/td>\n<td width=\"282\">Washington Patients in Intractable Pain<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Pamela Stitzlein Davies, MS, ARNP, FAANP<\/td>\n<td width=\"228\">Nurse Practitioner<\/td>\n<td width=\"282\">Departments of Neurology &amp; Nursing, University of Washington<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Andrew Friedman, MD<\/td>\n<td width=\"228\">Physical Medicine and Rehabilitation<\/td>\n<td width=\"282\">Virginia Mason Medical Center<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Kelly Golob, DC<\/td>\n<td width=\"228\">Chiropractor<\/td>\n<td width=\"282\">Tumwater Chiropractic Center<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Dan Kent, MD<\/td>\n<td width=\"228\">Chief Medical Officer<\/td>\n<td width=\"282\">UnitedHealthcare<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Kathy Lofy, MD<\/td>\n<td width=\"228\">Chief Science Officer<\/td>\n<td width=\"282\">Washington State Department of Health<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Jaymie Mai, PharmD<\/td>\n<td width=\"228\">Pharmacy Manager<\/td>\n<td width=\"282\">Washington State Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Mark Murphy, MD<\/td>\n<td width=\"228\">Addiction Medicine and Pain Management<\/td>\n<td width=\"282\">MultiCare Health System<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Anne Blake-Nickels<\/td>\n<td width=\"228\">Patient Advocate<\/td>\n<td width=\"282\"><\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Gregory Rudolph, MD<\/td>\n<td width=\"228\">Addiction Medicine<\/td>\n<td width=\"282\">Swedish Pain Services<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Jennifer Davies-Sandler<\/td>\n<td width=\"228\">Patient Advocate<\/td>\n<td width=\"282\"><\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Mark Stephens<\/td>\n<td width=\"228\">President<\/td>\n<td width=\"282\">Change Management Consulting<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Mark Sullivan, MD, PhD<\/td>\n<td width=\"228\">Psychiatrist<\/td>\n<td width=\"282\">University of Washington<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">David Tauben, MD<\/td>\n<td width=\"228\">Chief of Pain Medicine<\/td>\n<td width=\"282\">University of Washington Medical Center<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Gregory Terman MD, PhD<\/td>\n<td width=\"228\">Professor<\/td>\n<td width=\"282\">Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">John Vassall, MD, FACP<\/td>\n<td width=\"228\">Physician Executive for Quality and Safety<\/td>\n<td width=\"282\">Comagine Health<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Michael Von Korff, ScD<\/td>\n<td width=\"228\">Senior Investigator<\/td>\n<td width=\"282\">Kaiser Permanente Washington Research Institute<\/td>\n<\/tr>\n<tr>\n<td width=\"173\">Mia Wise, DO<\/td>\n<td width=\"228\">Medical Director, Collaborative Healthcare Solutions<\/td>\n<td width=\"282\">Premera Blue Cross<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Archived Meeting Materials&#8221; tab_id=&#8221;1740177161231-6020a53c-01ba&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table border=\"0\">\n<tbody>\n<tr>\n<td><strong>Date<\/strong><\/td>\n<td><strong>Materials<\/strong><\/td>\n<\/tr>\n<tr>\n<td>April 29<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/04\/Agenda-Opioid-Prescribing-20-0429.pdf\" rel=\"\">Agenda April 29<\/a><\/span><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/05\/Minutes-Opioid-Implementation-Workgroup-20-0226-revised.pdf\"><span class=\"doc\">Minutes February 26<\/span><\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/06\/Minutes-Opioid-Implementation-Workgroup-20-0429.pdf\"><span class=\"doc\">Minutes April 29<\/span><\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/04\/Bree-Long-Term-Opioid-Use-Recommendations-20-0427.pdf\"><span class=\"doc\">Draft\u00a0Recommendations<\/span><\/a><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/05\/LTOP-public-comments-updated.pdf\">Public Comments<\/a><\/span><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/05\/Bree-long-term-opioid-therapy-public-comments-summary-042720.pdf\"><span class=\"doc\">Public Comments Summary<\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td>February 26<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/02\/Agenda-Opioid-Prescribing-20-0226.pdf\">Agenda<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/03\/Minutes-Opioid-Implementation-Workgroup-20-0129.pdf\">Minutes\u00a0January 29<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/02\/Bree-Long-Term-Opioid-Use-Recommendations-20-0225.pdf\">Draft\u00a0Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>January 29<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/01\/Agenda-Opioid-Prescribing-20-0129.pdf\"><span class=\"doc\">Agenda\u00a0January 29<\/span><\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/01\/Minutes-Opioid-Implementation-Workgroup-19-1211.pdf\"><span class=\"doc\">Minutes\u00a0December 11<\/span><\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/01\/Bree-Long-Term-Opioid-Use-Recommendations-20-0129.pdf\"><span class=\"doc\">Draft\u00a0Recommendations<\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td>December 11<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/12\/Agenda-Opioid-Prescribing-19-1211.pdf\"><span class=\"doc\">Agenda\u00a0December 11<\/span><\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/12\/Minutes-Opioid-Implementation-Workgroup-19-1113.pdf\"><span class=\"doc\">Minutes\u00a0November 13<\/span><\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/12\/Bree-Long-Term-Opioid-Use-Recommendations-19-1125.pdf\"><span class=\"doc\">Draft\u00a0Recommendations<\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td>November 13<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/11\/Agenda-Opioid-Prescribing-19-1113.pdf\" rel=\"\">Agenda November 13<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/11\/Minutes-Opioid-Implementation-Workgroup-19-1016.pdf\" rel=\"\">Minutes September 16<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/11\/Bree-Opioid-Treatment-19-1107.pdf\" rel=\"\">Draft Guidelines<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>October 16<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/10\/Agenda-Opioid-Prescribing-19-1016.pdf\" rel=\"\">Agenda October 16<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/10\/Minutes-Opioid-Implementation-Workgroup-19-0925.pdf\" rel=\"\">Minutes September 25<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/10\/Bree-Opioid-Chronic-Assessment-19-1007.pdf\" rel=\"\">Chronic Opioid Therapy Assessment Draft<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>September 25<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/09\/Agenda-Opioid-Prescribing-19-0925-1.pdf\" rel=\"\">Agenda September 25<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/09\/Minutes-Opioid-Implementation-Workgroup-19-0828-1.pdf\" rel=\"\">Minutes August 28<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/09\/Bree-Opioid-Chronic-Engagement-19-0917.pdf\" rel=\"\">Draft Chronic Opioid Management Patient Engagement<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>\u00a0August 28<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/08\/Agenda-Opioid-Prescribing-19-0828.pdf\" rel=\"\">Agenda August 28<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/08\/Minutes-Opioid-Implementation-Workgroup-19-0626.pdf\" rel=\"\">Minutes June 26<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/08\/Opioid-prescribing-chronic-opioid-managemen-19-0822.pdf\" rel=\"\">Draft Opioid Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>June 26<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/06\/Agenda-Opioid-Prescribing-19-0626.pdf\" rel=\"\">Agenda June 26<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/06\/Minutes-Opioid-Implementation-Workgroup-19-0522.pdf\" rel=\"\">Minutes May 22<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/06\/Opioid-prescribing-chronic-opioid-managemen-19-0625.pdf\" rel=\"\">Draft Chronic Opioid Management Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>May 22<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Agenda-Opioid-Prescribing-19-0522.pdf\" rel=\"\">Agenda May 22<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Minutes-Opioid-Implementation-Workgroup-19-0424.pdf\" rel=\"\">Minutes April 24<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Murphy.2018.pdf\" rel=\"\">Murphy: Guidance on opioid tapering<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Berna.2015.pdf\" rel=\"\">Berna: Tapering long-term opioid therapy<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Opioid-prescribing-chronic-opioid-managemen-19-0514.pdf\" rel=\"\">Opioid Prescribing: Chronic Opioid Therapy Draft<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>April 24<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/04\/Agenda-Opioid-Prescribing-19-0424.pdf\" rel=\"\">Agenda April 24<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/07\/Minutes-Opioid-Implementation-Workgroup-19-0327-2.pdf\" rel=\"\">Minutes March 27<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/04\/Lembke.2016-risks-benefits-chronic-opioid-therapy.pdf\" rel=\"\">Weighing Risks Benefits Chronic Opioid Therapy Lembke<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/04\/FDA-Safety-Announcement_Harm-from-Sudden-Discontinuation-of-Opioid-Medicines_2019.04.09.pdf\" rel=\"\">FDA Safety Announcement<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>March 27<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Agenda-Opioid-Prescribing-19-0327.pdf\" rel=\"\">Agenda March 27<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Minutes-Opioid-Implementation-Workgroup-19-0227.pdf\" rel=\"\">Minutes February 27<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>February 27<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/02\/Agenda-Opioid-Prescribing-19-0227.pdf\" rel=\"\">Agenda February 27<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/02\/Minutes-Opioid-Implementation-Workgroup-18-1205.pdf\" rel=\"\">Minutes December 5<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Tapering-Guidance-Tools-1-3-19-final.pdf\" rel=\"\">Tapering Guidance Tools<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Oregon-Tapering-Update-Feb-27-2019.pdf\" rel=\"\">Presentation: Oregon Tapering Update<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>December 5<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/11\/Agenda-Opioid-Prescribing-18-1205.pdf\" rel=\"\">Agenda December 5<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/11\/Minutes-Opioid-Implementation-Workgroup-18-1010.pdf\" rel=\"\">Minutes October 10<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/12\/printing-slides.pdf\" rel=\"\">Presentation slides<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>October 10<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/10\/Agenda-Opioid-Prescribing-18-1010.pdf\" rel=\"\">Agenda October 10<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/12\/Minutes-Opioid-Implementation-Workgroup-18-0627.pdf\" rel=\"\">Minutes June 27<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/10\/2015-AMDG-tapering-OUD-guidance.pdf\" rel=\"\">AMDG Tapering<\/a><\/span><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/10\/2015-AMDG-tapering-OUD-guidance.pdf\" rel=\"\">\u00a0Guidance<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Awards&#8221; tab_id=&#8221;1739898902823-e25fb20c-0340&#8243;][\/vc_tta_section][\/vc_tta_tour][vc_separator color=&#8221;custom&#8221; border_width=&#8221;10&#8243; accent_color=&#8221;#145e61&#8243;][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; title=&#8221;Low Back Pain Management&#8221; el_id=&#8221;low-back-pain-tour&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1705963413140-bd62ff0c-a117&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<h4>Guideline title: Low Back Pain Management Report and Guidelines<\/h4>\n<p><strong>Publication Status:<\/strong> Needs minor revisions &#8211; to be scheduled<\/p>\n<p><strong>Date of publication<\/strong>: 2013<\/p>\n<p><strong>Date of last evidence search: <\/strong>2013<\/p>\n<p><strong>Scope: <\/strong>pain evaluation and management; identification of psychosocial risks; patient communication, public awareness, <strong><br \/>\n<\/strong><\/p>\n<p><strong>Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n<p><strong>Description: <\/strong>This report summarizes those best practices and presents guidelines for hospitals, clinics, individual providers, public health, purchasers\/employers and health plans. Significant variation exists in the diagnosis and treatment of patients with new onset or persistent acute LBP, with high utilization rates for many costly modalities that have not been shown to improve health outcomes Increased implementation of evidence-based guidelines and best practices, use of screening tools, patient education, and financial incentives are all necessary to improve the quality of LBP care and health outcomes while reducing inappropriate care and costs. Some of the guidelines have been identified as high priority to aid in implementation efforts.<span id=\"page15R_mcid2\" class=\"markedContent\"><\/span><strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><br \/>\n<\/span><\/span><\/strong><\/p>\n<h4>Supporting Materials<\/h4>\n<p><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2014\/05\/hca_letter_accepting_spine_tkrthr.pdf\">Letter from Health Care Authority Accepting TKR\/THR Bundle, Warranty, and Spine Report<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2014\/04\/public_comments_spine.pdf\">Public Comments Summary: Spine\/Low Back Pain Report and Recommendations<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2014\/04\/bree_bc_spine_scoap_rec.pdf\">Original Spine SCOAP Recommendation to HCA<\/a>\u00a0(Adopted January 2013)<\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2014\/04\/Spine-Charter.pdf\">Workgroup Charter<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2014\/05\/hca_letter_accepting_card.pdf\">Letter from Health Care Authority Accepting Spine SCOAP and Cardiology Recommendations<\/a><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Read On-line&#8221; tab_id=&#8221;1705963413791-f71c06e9-51bb&#8221;][vc_column_text]<\/p>\n<h3><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2014\/04\/spine_lbp.pdf\">Low Back Pain Report and Guidelines<\/a><\/h3>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Resources and Tools&#8221; tab_id=&#8221;1705963443633-1442d1c1-3902&#8243;][vc_toggle title=&#8221;Resources and Tools&#8221;]<a href=\"https:\/\/www.qualityhealth.org\/spinecoap\/\">Spine Care Outcomes and Assessment Program (COAP)<\/a><\/p>\n<p><a href=\"https:\/\/wahealthalliance.org\/initiatives\/low-back-pain-implementation-collaborative\/\">WHA Low Back Pain Implementation Collaborative<\/a><\/p>\n<p><a href=\"https:\/\/wahealthalliance.org\/wp-content\/uploads\/2023\/07\/Acute-LBP-Care-Pathway-Oct-2022-1.pdf\">WHA Acute Low Back Pain Care Pathway<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Metrics and Evaluation Tools&#8221; tab_id=&#8221;1705963480038-8d0242a7-3dca&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p>To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n<p>To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n<p>Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n<p>[\/vc_column_text][vc_toggle title=&#8221;Delivery Site and Health Systems&#8221;]Health System Evaluation Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-System-score-card-_-Low-back-pain.xlsx\">Health System score card _ Low back pain<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Plans&#8221;]Health Plan Evaluation Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-Plan-Score-Card_low-back-pain.xlsx\">Health Plan Score Card_low back pain<\/a>[\/vc_toggle][vc_toggle title=&#8221;Guideline Metrics&#8221;]The work group did not recommend specific metrics, however audience specific evaluation tools and other prescribing metrics developed by the Bree Collaborative can be useful. These measures can be found on the Washington State Common Measure Set. For all of these measure a decrease is improvement.<\/p>\n<ul>\n<li>New Opioid Patient Days Supply of First Opioid Prescription\n<ul>\n<li><span id=\"page10R_mcid41\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients with at least one opioid prescription in the current by days\u2019 supply (day <\/span><span dir=\"ltr\" role=\"presentation\">supply categories: &lt;3, 4-7, 8-13 and &gt;14).<\/span><\/span><span id=\"page10R_mcid42\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Patients with at least one opioid prescription in the current quarter who have no opioids <\/span><span dir=\"ltr\" role=\"presentation\">prescribed in the prior quarter; Age stratify and report results for two groups: children\/adolescents aged 17 <\/span><span dir=\"ltr\" role=\"presentation\">and younger, and adults aged 18 and older.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>New Opioid Patients Transitioning to Chronic Opioids\n<ul>\n<li><span id=\"page10R_mcid57\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients who are prescribed &gt;60 days\u2019 supply of opioids in the current calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter with at least one opioid prescription in the previous quarter and no opioid prescription in the prior <\/span><span dir=\"ltr\" role=\"presentation\">quarter.<\/span><\/span><span id=\"page10R_mcid58\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span><\/em> <span dir=\"ltr\" role=\"presentation\">Number of patients with at least one opioid prescription in the previous quarter who have no <\/span><span dir=\"ltr\" role=\"presentation\">opioids prescribed in the prior quarter. Report as incidences per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Patients Prescribed High-Dose Chronic Opioid Therapy\n<ul>\n<li><span id=\"page10R_mcid73\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids at &gt;50 mg\/day or <\/span><span dir=\"ltr\" role=\"presentation\">&gt;90 mg\/day MED.<\/span><\/span><span id=\"page10R_mcid74\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids in the calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter. <\/span><\/span><span id=\"page10R_mcid75\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">Report each result as prevalence per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Use of Opioids at High Dosage (HDO)\n<ul>\n<li><span id=\"page10R_mcid89\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">The proportion of members 18 years and older who received prescription opioids at a high dosage (average <\/span><span dir=\"ltr\" role=\"presentation\">morphine milligram equivalent dose [MME] \u226590) for \u226515 days during the measurement year.<\/span><\/span><span id=\"page10R_mcid90\" class=\"markedContent\"> <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Examples of Implementation &#8211; IN DEVELOPMENT&#8221; tab_id=&#8221;1705963538279-4e048305-ae87&#8243;][\/vc_tta_section][vc_tta_section title=&#8221;WorkGroup Members&#8221; tab_id=&#8221;1739898920833-bde878a0-3de7&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table>\n<tbody>\n<tr>\n<th width=\"35%\">Member<\/th>\n<th>Title<\/th>\n<th>Organization<\/th>\n<\/tr>\n<tr>\n<td>Dan Brzusek, DO<\/td>\n<td>Physiatrist<\/td>\n<td>Northwest Rehab Association<\/td>\n<\/tr>\n<tr>\n<td>Neil Chasan<\/td>\n<td>Physical Therapist<\/td>\n<td>Sport Reaction Center<\/td>\n<\/tr>\n<tr>\n<td>Andrew Friedman, MD<\/td>\n<td>Physiatrist<\/td>\n<td>Virginia Mason<\/td>\n<\/tr>\n<tr>\n<td>Leah Hole-Curry, JD<\/td>\n<td>Medical Administrator<\/td>\n<td>WA State Labor &amp; Industries<\/td>\n<\/tr>\n<tr>\n<td>Heather Kroll, MD<\/td>\n<td>Rehab Physician<\/td>\n<td>Rehab Institute of Washington<\/td>\n<\/tr>\n<tr>\n<td>Chong Lee, MD<\/td>\n<td>Spine Surgeon<\/td>\n<td>Group Health Cooperative<\/td>\n<\/tr>\n<tr>\n<td>Mary Kay O\u2019Neill, MD, MBA (Chair)<\/td>\n<td>Executive Medical Director<\/td>\n<td>Regence Blue Shield<\/td>\n<\/tr>\n<tr>\n<td>John Robinson, MD, SM<\/td>\n<td>Chief Medical Officer<\/td>\n<td>First Choice Health<\/td>\n<\/tr>\n<tr>\n<td>Michael Von Korff, ScD<\/td>\n<td>Psychologist &amp; Researcher<\/td>\n<td>Group Health Research Institute<\/td>\n<\/tr>\n<tr>\n<td>Kelly Weaver, MD<\/td>\n<td>Physiatrist<\/td>\n<td>The Everett Clinic<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Awards&#8221; tab_id=&#8221;1739898921684-db09fed2-09b2&#8243;][vc_column_text css=&#8221;&#8221;]Award winners for Best Practices in Low Back Pain Treatment<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-76835\" src=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2026\/01\/Copy-of-Trailblazer-award-web-OPIC-2025-1.gif\" alt=\"\" width=\"350\" height=\"350\" \/><\/p>\n<ul>\n<li><a href=\"https:\/\/www.uwmedicine.org\/\"><strong>UW Medicine &amp; UW Physicians <\/strong><\/a><strong><a href=\"https:\/\/www.healthpointchc.org\/\">(2023)<\/a><\/strong><\/li>\n<li><a href=\"https:\/\/www.chpw.org\/\"><strong>Community Health Plan of Washington <\/strong><\/a><strong><a href=\"https:\/\/www.healthpointchc.org\/\">(2023)<\/a><\/strong><\/li>\n<li><a href=\"https:\/\/www.multicare.org\/\"><strong>MultiCare <\/strong><\/a><strong><a href=\"https:\/\/www.healthpointchc.org\/\">(2023)<\/a><\/strong><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_separator color=&#8221;custom&#8221; border_width=&#8221;10&#8243; accent_color=&#8221;#145e61&#8243;][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; title=&#8221;Opioid Prescribing Metrics&#8221; el_id=&#8221;opioid-prescribing-metrics-tour&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1705963198496-bd2e4651-6925&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<h4>Guideline title: Opioid Prescribing Metrics Report and Guidelines<\/h4>\n<p><strong>Publication Status:<\/strong> Active<\/p>\n<p><strong>Date of publication<\/strong>: 2017<\/p>\n<p><strong>Date of last evidence search: <\/strong>2017<\/p>\n<p><strong>Scope: <\/strong>Definitions, metrics descriptions<strong><br \/>\n<\/strong><\/p>\n<p><strong>Methods:<\/strong> expert consensus<\/p>\n<p><strong>Description: <\/strong>The metrics were designed to be limited in number, have a strategic focus, and to be used for quality improvement. The first six metrics focus on guideline-concordant prescribing including chronic opioid use, opioid dose, concurrent chronic sedative use and transition from short-term to long-term opioid use. The last three metrics focus on mortality, overdose morbidity, and prevalence of opioid use disorder.<span id=\"page15R_mcid2\" class=\"markedContent\"><\/span><strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><br \/>\n<\/span><\/span><\/strong><\/p>\n<h4>Supporting Materials<\/h4>\n<p><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2023\/04\/Opioid-NDC-2017-include.xls\">Opioid NDC include<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2023\/04\/Opioid-NDC-2017-exclude.xls\">Opioid NDC exclude<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2017\/08\/HCA-Letter-Accepting-Metrics-2017.pdf\" rel=\"\">Letter from Health Care Authority Accepting Opioid Prescribing Metrics<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2016\/05\/Opioid-Implementation-Charter-2016.pdf\" rel=\"\">Opioid Guideline Implementation Charter<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2015\/06\/2015AMDGOpioidGuideline.pdf\">Agency Medical Directors Group Interagency Guideline on Prescribing Opioids for Pain<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"http:\/\/www.agencymeddirectors.wa.gov\/Files\/FY16-288SummaryAMDGOpioidGuideline_FINAL.pdf\">AMDG Guideline Summary<\/a><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Read On-line&#8221; tab_id=&#8221;1705963199208-2ad41f73-aa63&#8243;][vc_column_text]<\/p>\n<h3><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/06\/Bree-Opioid-Prescribing-Metrics-Final-2017.pdf\">Opioid Prescribing Metrics Report and Guidelines<\/a><\/h3>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Resources and Tools &#8211; IN DEVELOPMENT&#8221; tab_id=&#8221;1705963225651-5d8871a3-c9ef&#8221;][vc_toggle title=&#8221;Resources and Tools&#8221;]<a href=\"https:\/\/www.agencymeddirectors.wa.gov\/Files\/2015AMDGOpioidGuideline.pdf#page=26\">Interagency Guideline on Prescribing Opioids for Pain<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Metrics and Evaluation Tools&#8221; tab_id=&#8221;1705963263058-b06675e6-d8bf&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p>To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n<p>To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n<p>Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n<p>[\/vc_column_text][vc_toggle title=&#8221;Delivery Site and Health Systems&#8221;]Health System <a href=\"https:\/\/qualityhealth.sharepoint.com\/:x:\/g\/ETuDhWb4ztpKrFzHVH_8D1MBHmzJD1L_FzR0KYfrknng3g?e=YU1pDJ\">Evaluation Score Card<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Care Professionals&#8221;][\/vc_toggle][vc_toggle title=&#8221;Health Plans&#8221;]Health Plan <a href=\"https:\/\/qualityhealth.sharepoint.com\/:x:\/g\/ETJA_yobXbJIuyHCoIL_AhABEiexhqLnTY07UxTJXCNESw?e=Dyf8pp\">Evaluation Score Card<\/a>[\/vc_toggle][vc_toggle title=&#8221;Washington State Agencies&#8221;][\/vc_toggle][vc_toggle title=&#8221;Private and Public Purchasers&#8221;][\/vc_toggle][vc_toggle title=&#8221;Guideline Metrics&#8221;]The work group did not recommend specific metrics, however other prescribing metrics developed by the Bree Collaborative can be useful. These measures can be found on the Washington State Common Measure Set. For all of these measure a decrease is improvement.<\/p>\n<ul>\n<li>New Opioid Patient Days Supply of First Opioid Prescription\n<ul>\n<li><span id=\"page10R_mcid41\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients with at least one opioid prescription in the current by days\u2019 supply (day <\/span><span dir=\"ltr\" role=\"presentation\">supply categories: &lt;3, 4-7, 8-13 and &gt;14).<\/span><\/span><span id=\"page10R_mcid42\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Patients with at least one opioid prescription in the current quarter who have no opioids <\/span><span dir=\"ltr\" role=\"presentation\">prescribed in the prior quarter; Age stratify and report results for two groups: children\/adolescents aged 17 <\/span><span dir=\"ltr\" role=\"presentation\">and younger, and adults aged 18 and older.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>New Opioid Patients Transitioning to Chronic Opioids\n<ul>\n<li><span id=\"page10R_mcid57\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients who are prescribed &gt;60 days\u2019 supply of opioids in the current calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter with at least one opioid prescription in the previous quarter and no opioid prescription in the prior <\/span><span dir=\"ltr\" role=\"presentation\">quarter.<\/span><\/span><span id=\"page10R_mcid58\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span><\/em> <span dir=\"ltr\" role=\"presentation\">Number of patients with at least one opioid prescription in the previous quarter who have no <\/span><span dir=\"ltr\" role=\"presentation\">opioids prescribed in the prior quarter. Report as incidences per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Patients Prescribed High-Dose Chronic Opioid Therapy\n<ul>\n<li><span id=\"page10R_mcid73\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids at &gt;50 mg\/day or <\/span><span dir=\"ltr\" role=\"presentation\">&gt;90 mg\/day MED.<\/span><\/span><span id=\"page10R_mcid74\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids in the calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter. <\/span><\/span><span id=\"page10R_mcid75\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">Report each result as prevalence per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Use of Opioids at High Dosage (HDO)\n<ul>\n<li><span id=\"page10R_mcid89\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">The proportion of members 18 years and older who received prescription opioids at a high dosage (average <\/span><span dir=\"ltr\" role=\"presentation\">morphine milligram equivalent dose [MME] \u226590) for \u226515 days during the measurement year.<\/span><\/span><span id=\"page10R_mcid90\" class=\"markedContent\"> <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Examples of Implementation &#8211; IN DEVELOPMENT&#8221; tab_id=&#8221;1705963323258-0d73e135-32f6&#8243;][\/vc_tta_section][vc_tta_section title=&#8221;WorkGroup Members&#8221; tab_id=&#8221;1739898943804-dca20bdd-68da&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table width=\"0\">\n<tbody>\n<tr>\n<td width=\"174\"><strong>Name<\/strong><\/td>\n<td width=\"227\"><strong>Title<\/strong><\/td>\n<td width=\"282\"><strong>Organization<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Chris Baumgartner<\/td>\n<td width=\"227\">Director Prescription Monitoring Program<\/td>\n<td width=\"282\">Washington State Department of Health<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">David Buchholz, MD<\/td>\n<td width=\"227\">Medical Director<\/td>\n<td width=\"282\">Premera Blue Cross<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gary Franklin, MD, MPH (Chair)<\/td>\n<td width=\"227\">Medical Director<\/td>\n<td width=\"282\">Washington State Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Charissa Fontinos, MD<\/td>\n<td width=\"227\">Deputy Chief Medical Officer<\/td>\n<td width=\"282\">Washington State Health Care Authority<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Deb Fulton-Kehoe, PhD, MPH<\/td>\n<td width=\"227\">Epidemiologist<\/td>\n<td width=\"282\">University ofWashington<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Frances Gough, MD<\/td>\n<td width=\"227\">Chief Medical Officer<\/td>\n<td width=\"282\">Molina Healthcare<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Dan Kent, MD<\/td>\n<td width=\"227\">Chief Medical Officer<\/td>\n<td width=\"282\">UnitedHealthcare<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Kathy Lofy, MD<\/td>\n<td width=\"227\">Chief Science Officer<\/td>\n<td width=\"282\">Washington State Department of Health<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Jaymie Mai, PharmD<\/td>\n<td width=\"227\">Pharmacy Manager<\/td>\n<td width=\"282\">Washington State Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Mark Murphy, MD<\/td>\n<td width=\"227\">Family Medicine and Addiction Medicine<\/td>\n<td width=\"282\">MultiCare<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Shirley Reitz, PharmD<\/td>\n<td width=\"227\">\u200eClinical Pharmacist Client Manager<\/td>\n<td width=\"282\">OmedaRx, Cambia<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gregory Rudolph, MD<\/td>\n<td width=\"227\">Addiction Medicine<\/td>\n<td width=\"282\">Swedish Pain Services<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Mark Stephens<\/td>\n<td width=\"227\">President<\/td>\n<td width=\"282\">Change Management Consulting<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">David Tauben, MD<\/td>\n<td width=\"227\">Chief of Pain Medicine<\/td>\n<td width=\"282\">University of Washington Medical Center<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gregory Terman MD, PhD<\/td>\n<td width=\"227\">Professor<\/td>\n<td width=\"282\">Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Michael Von Korff, ScD<\/td>\n<td width=\"227\">Senior Investigator<\/td>\n<td width=\"282\">Kaiser Permanente Washington Research Institute<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Awards&#8221; tab_id=&#8221;1739898944831-19ca2572-adcc&#8221;][vc_column_text css=&#8221;&#8221;]Award winners for Best Practices in Opioid Prescribing Metrics:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-76835\" style=\"color: #000000;\" src=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2026\/01\/Copy-of-Trailblazer-award-web-OPIC-2025-1.gif\" alt=\"\" width=\"350\" height=\"350\" \/><\/p>\n<ul>\n<li><strong><a href=\"https:\/\/www.chpw.org\/\">Community Health Plan of Washington (2023)<\/a><\/strong><\/li>\n<li><a href=\"https:\/\/www.optum.com\/en\/about-us.html\" target=\"_blank\" rel=\"noopener\"><strong>Everett Clinic\/Optum Health (2024)<\/strong><\/a><\/li>\n<li><strong><a href=\"https:\/\/www.uhc.com\/lp\/find-affordable-health-plans?cid=ps:ifp-acquisition:5535e3aa&amp;WT.mc_id=8030435&amp;tfn=1-877-525-8849&amp;mrcid=ps:google:brand-uhc%7CUHC-Brand-GGL-UHC-BG-Generic-PM-8030435%7CUHC%7CBrandGeneric:2022:8030435&amp;leadsourcename=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;utm_term=unitedhealthcare+insurance&amp;utm_source=GOOGLE&amp;utm_medium=cpc&amp;utm_campaign=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;gclid=CjwKCAiArLyuBhA7EiwA-qo80KYe8CVPuTaG48HKK3mQEbgMN5mb8Ga15OvdUreaj87mrnwsFdeJmBoCY6oQAvD_BwE&amp;gclsrc=aw.ds\">UnitedHealthcare (2024)<\/a><\/strong><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_separator color=&#8221;custom&#8221; border_width=&#8221;10&#8243; accent_color=&#8221;#145e61&#8243;][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; el_id=&#8221;opioid-prescribing-older-adults-tour&#8221; title=&#8221;Opioid Prescribing in Older Adults&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1611185894835-3cc4334a-7b27&#8243;][vc_column_text]<\/p>\n<h4>Guideline title: Opioid Prescribing in Older Adults Report and Guidelines<\/h4>\n<p><strong>Publication Status:<\/strong> Active<\/p>\n<p><strong>Date of publication<\/strong>: July 2022<\/p>\n<p><strong>Date of last evidence search:<\/strong> 2022<\/p>\n<p><strong>Scope:<\/strong> a<span id=\"page15R_mcid11\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">cute prescribing<\/span><span dir=\"ltr\" role=\"presentation\">, i<span id=\"page15R_mcid14\" class=\"markedContent\">ntermittent opioid therapy<\/span>, c<span id=\"page15R_mcid18\" class=\"markedContent\">o-prescribing opioids with CNS-active medications<\/span>, n<span id=\"page15R_mcid21\" class=\"markedContent\">on-opioid pharmacologic pain management<\/span><span id=\"undefined\" class=\"markedContent\"><\/span><span id=\"page15R_mcid22\" class=\"markedContent\"><\/span><span id=\"page15R_mcid23\" class=\"markedContent\"><\/span>, n<span id=\"page15R_mcid25\" class=\"markedContent\">on-pharmacologic pain management<\/span>, t<span id=\"page15R_mcid28\" class=\"markedContent\">apering or deprescribing<\/span>.\u00a0<\/span><\/span><\/p>\n<p><strong>Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n<p><strong>Description: <\/strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">This guideline focuses on <\/span><\/span><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">specific concerns regarding opioid use in older adults, but does not encompass <\/span><\/span><span id=\"page15R_mcid2\" class=\"markedContent\"><\/span><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">all aspects of opioid prescribing<\/span><\/span><strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">. <\/span><\/span><\/strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">For additional guidance on opioid prescribing, refer to <\/span><\/span><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">previous <span id=\"page15R_mcid3\" class=\"markedContent\">Bree <span dir=\"ltr\">Collaborative <\/span><\/span><\/span><\/span><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><span id=\"page15R_mcid3\" class=\"markedContent\">opioid <\/span><\/span><\/span><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><span id=\"page15R_mcid3\" class=\"markedContent\"><span dir=\"ltr\">guidelines.<\/span><\/span><\/span><\/span><strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><br \/>\n<\/span><\/span><\/strong>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Read On-line&#8221; tab_id=&#8221;1611186008290-d545d42a-5304&#8243;][vc_column_text]<\/p>\n<h3><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/07\/Bree-Opioid-Older-Adults-Final.pdf\">Opioid Prescribing in Older Adults Report and Guidelines <\/a><\/h3>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Resources and Tools&#8221; tab_id=&#8221;1614355732535-38241aa0-0972&#8243;][vc_toggle title=&#8221;Resources and Tools&#8221;]<a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/rr\/rr7103a1.htm\">CDC Clinical Practice Guideline for Prescribing Opioids for Pain \u2014 United States, 2022<\/a><\/p>\n<p><a href=\"https:\/\/doh.wa.gov\/public-health-healthcare-providers\/healthcare-professions-and-facilities\/opioid-prescribing\/healthcare-providers\">WA DOH Opioid Prescribing Toolkits<\/a><\/p>\n<p><a href=\"https:\/\/doh.wa.gov\/you-and-your-family\/safe-medication-return\">WA DOH Safe Medication Return<\/a><\/p>\n<p><a href=\"https:\/\/www.takebackyourmeds.org\/\">Take Back Your Meds<\/a><\/p>\n<p><a href=\"https:\/\/www.pbm.va.gov\/PBM\/AcademicDetailingService\/Documents\/Pain_Opioid_Taper_Tool_IB_10_939_P96820.pdf\">VA Opioid Taper Decision Tool<\/a>[\/vc_toggle][vc_video link=&#8221;https:\/\/youtu.be\/20iq-w-eTEg&#8221; title=&#8221;Related Bree Webinars Link&#8221;][\/vc_tta_section][vc_tta_section title=&#8221;Metrics and Evaluation Tools&#8221; tab_id=&#8221;1670435629340-513499d3-03e0&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p>To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n<p>To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n<p>Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n<p>[\/vc_column_text][vc_toggle title=&#8221;Delivery Site and Health Systems&#8221;]Health System Score Cards <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-System-Score-Card_Opioid-OA-1.xlsx\">Health System Score Card_Opioid OA<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Care Professionals&#8221;]Provider Evaluation Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Provider-score-card_Rx-OA.xlsx\">Provider score card_Rx OA<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Plans&#8221;]Health Plan Evaluation Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-Plan-Score-Card_Opioid-Rx.xlsx\">Health Plan Score Card_Opioid Rx<\/a>[\/vc_toggle][vc_toggle title=&#8221;Guideline Metrics&#8221;]The work group did not recommend specific metrics, however other prescribing metrics developed by the Bree Collaborative can be useful. These measures can be found on the Washington State Common Measure Set. For all of these measure a decrease is improvement.<\/p>\n<ul>\n<li>New Opioid Patient Days Supply of First Opioid Prescription\n<ul>\n<li><span id=\"page10R_mcid41\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients with at least one opioid prescription in the current by days\u2019 supply (day <\/span><span dir=\"ltr\" role=\"presentation\">supply categories: &lt;3, 4-7, 8-13 and &gt;14).<\/span><\/span><span id=\"page10R_mcid42\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Patients with at least one opioid prescription in the current quarter who have no opioids <\/span><span dir=\"ltr\" role=\"presentation\">prescribed in the prior quarter; Age stratify and report results for two groups: children\/adolescents aged 17 <\/span><span dir=\"ltr\" role=\"presentation\">and younger, and adults aged 18 and older.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>New Opioid Patients Transitioning to Chronic Opioids\n<ul>\n<li><span id=\"page10R_mcid57\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients who are prescribed &gt;60 days\u2019 supply of opioids in the current calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter with at least one opioid prescription in the previous quarter and no opioid prescription in the prior <\/span><span dir=\"ltr\" role=\"presentation\">quarter.<\/span><\/span><span id=\"page10R_mcid58\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span><\/em> <span dir=\"ltr\" role=\"presentation\">Number of patients with at least one opioid prescription in the previous quarter who have no <\/span><span dir=\"ltr\" role=\"presentation\">opioids prescribed in the prior quarter. Report as incidences per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Patients Prescribed High-Dose Chronic Opioid Therapy\n<ul>\n<li><span id=\"page10R_mcid73\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids at &gt;50 mg\/day or <\/span><span dir=\"ltr\" role=\"presentation\">&gt;90 mg\/day MED.<\/span><\/span><span id=\"page10R_mcid74\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids in the calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter. <\/span><\/span><span id=\"page10R_mcid75\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">Report each result as prevalence per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Use of Opioids at High Dosage (HDO)\n<ul>\n<li><span id=\"page10R_mcid89\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">The proportion of members 18 years and older who received prescription opioids at a high dosage (average <\/span><span dir=\"ltr\" role=\"presentation\">morphine milligram equivalent dose [MME] \u226590) for \u226515 days during the measurement year.<\/span><\/span><span id=\"page10R_mcid90\" class=\"markedContent\"> <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Examples of Implementation &#8211; IN DEVELOPMENT&#8221; tab_id=&#8221;1680641218362-119ac635-8068&#8243;][\/vc_tta_section][vc_tta_section title=&#8221;Workgroup Members&#8221; tab_id=&#8221;1739898964938-a433690d-0db4&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table class=\"wp-block-table\">\n<tbody>\n<tr>\n<td><strong>Name<\/strong><\/td>\n<td><strong>Title<\/strong><\/td>\n<td><strong>Organization<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Gary Franklin, MD, MPH (Co-chair)<br \/>\nJason Fodeman, MD<br \/>\nJaymie Mai, PharmD<\/td>\n<td>Medical Director<br \/>\nAssistant Medical Director<br \/>\nPharmacy Manager<\/td>\n<td>WA Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td>Darcy Jaffe, MN, ARNP, NE-BC, FACHE (Co-chair)<\/td>\n<td>Senior Vice President, Safety &amp; Quality<\/td>\n<td>WA Hospital Association<\/td>\n<\/tr>\n<tr>\n<td>Mark Sullivan, MD, PhD (Co-chair)<\/td>\n<td>Professor of Psychiatry and Behavioral Sciences<\/td>\n<td>University of Washington<\/td>\n<\/tr>\n<tr>\n<td>Judy Zerzan-Thul, MD, MPH (Co-chair)<\/td>\n<td>Chief Medical Officer<\/td>\n<td>WA Health Care Authority<\/td>\n<\/tr>\n<tr>\n<td>Carla Ainsworth, MD, MPH<\/td>\n<td>Provider<\/td>\n<td>Iora Primary Care \u2013 Central District<\/td>\n<\/tr>\n<tr>\n<td>Rose Bigham<\/td>\n<td>Patient Advocate<\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Denise Boudreau, PhD, RPh, MS<\/td>\n<td>Senior Scientific Investigator<\/td>\n<td>Kaiser Permanente Washington Health Research Institute<\/td>\n<\/tr>\n<tr>\n<td>Siobhan Brown, MPH, CPH, CHES<br \/>\nYusuf Rashid, RPh<\/td>\n<td>Senior Analyst, Health Systems Innovation<br \/>\nVP of Pharmacy and Vendor Relationship Management<\/td>\n<td>Community Health Plan of Washington<\/td>\n<\/tr>\n<tr>\n<td>Pamela Stitzlein Davies, MS, ARNP, FAANP<\/td>\n<td>Adult\/Geriatric Nurse Practitioner<\/td>\n<td>University of Washington \/ Seattle Pacific University<\/td>\n<\/tr>\n<tr>\n<td>Elizabeth Eckstrom, MD<\/td>\n<td>Division of General Internal Medicine and Geriatrics<\/td>\n<td>Oregon Health Sciences University<\/td>\n<\/tr>\n<tr>\n<td>James Floyd, MD<\/td>\n<td>Internal Medicine<\/td>\n<td>University of Washington School of Medicine<\/td>\n<\/tr>\n<tr>\n<td>Nancy Fisher, MD<\/td>\n<td>Ex Officio Member<\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Debra Gordon, RN, DNP, FAAN<\/td>\n<td>Department of Anesthesiology and Pain Medicine<\/td>\n<td>University of Washington School of Medicine<\/td>\n<\/tr>\n<tr>\n<td>Shelly Gray, PharmD<\/td>\n<td>School of Pharmacy<\/td>\n<td>University of Washington<\/td>\n<\/tr>\n<tr>\n<td>Blake Maresh, MPA, CMBE<\/td>\n<td>Deputy Director, Office of Health Professions<\/td>\n<td>Washington State Department of Health<\/td>\n<\/tr>\n<tr>\n<td>Wayne McCormick, MD<\/td>\n<td>Division of Gerontology and Geriatric Medicine<\/td>\n<td>University of Washington<\/td>\n<\/tr>\n<tr>\n<td>Kushang Patel, MD<\/td>\n<td>Anesthesiology and Pain Medicine<\/td>\n<td>University of Washington<\/td>\n<\/tr>\n<tr>\n<td>Elizabeth Phelan, MD<\/td>\n<td>Department of Geriatrics<\/td>\n<td>University of Washington<\/td>\n<\/tr>\n<tr>\n<td>Dawn Shuford-Pavlich<\/td>\n<td>Home and Community Services Division<\/td>\n<td>Department of Social and Health Services<\/td>\n<\/tr>\n<tr>\n<td>Angela Sparks, MD<\/td>\n<td>Medical Director Clinical Knowledge Development &amp; Support<\/td>\n<td>Kaiser Permanente Washington<\/td>\n<\/tr>\n<tr>\n<td>Gina Wolf, DC<\/td>\n<td>Chiropractor<\/td>\n<td>Wolf Chiropractic Clinic<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Archived Meeting Materials&#8221; tab_id=&#8221;1740177378700-fc561326-8e1e&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table class=\"wp-block-table\">\n<tbody>\n<tr>\n<td><strong>Date<\/strong><\/td>\n<td><strong>Materials<\/strong><\/td>\n<\/tr>\n<tr>\n<td>December 16<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Agenda-Opioid-Older-Adults-20-1216.pdf\">Agenda December 16<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Charter-Roster-older-adults-opioids-2020-12.pdf\">Draft Charter and Roster<\/a><\/td>\n<\/tr>\n<tr>\n<td>January 13<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Agenda-Opioid-Older-Adults-21-0113.pdf\">Agenda January 13<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Minutes-Opioids-Older-Adults-Workgroup-20-1216.pdf\">Minutes December 16<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Bree-priorities-opioids-older-adults-21-0115.pdf\">Bree priorities opioids older adults-21-0115<\/a><\/td>\n<\/tr>\n<tr>\n<td>March 10<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Agenda-Opioid-Older-Adults-21-0310.pdf\">Agenda March 10<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Minutes-Opioids-Older-Adults-Workgroup-21-0113.pdf\">Minutes January 13<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/ROL-opioid-and-older-adult-and-acute-postop_March_3.pdf\">ROL opioid and older adult and acute postop<\/a><\/td>\n<\/tr>\n<tr>\n<td>April 14<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Agenda-Opioid-Older-Adults-21-0414.pdf\">Agenda April 14<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Minutes-Opioids-Workgroup-21-0310.pdf\">Minutes March 10<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Bree-Acute-Opioid-21-0412.pdf\">Acute Opioid Prescribing Draft<\/a><\/td>\n<\/tr>\n<tr>\n<td>May 12<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Agenda-Opioid-Older-Adults-21-0512.pdf\">Agenda May 12<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Minutes-Opioids-Older-Adults-Workgroup-21-0414.pdf\">Minutes April 14<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/04\/Bree-Acute-Opioid-21-0424.pdf\">Draft Opioid Prescribing Guidelines<\/a><\/td>\n<\/tr>\n<tr>\n<td>June 9<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Agenda-Opioid-Older-Adults-21-0609-FHCQ-LT21-01.pdf\" target=\"_blank\" rel=\"noopener\">Agenda June 9<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Minutes-Opioids-Older-Adults-Workgroup-21-0512.pdf\" target=\"_blank\" rel=\"noopener\">Minutes May 12<\/a><\/td>\n<\/tr>\n<tr>\n<td>July 14<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Agenda-Opioid-Older-Adults-21-0714.pdf\" target=\"_blank\" rel=\"noopener\">Agenda July 14<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Minutes-Opioids-Older-Adults-Workgroup-21-0609.pdf\" target=\"_blank\" rel=\"noopener\">Minutes June 9<\/a><\/td>\n<\/tr>\n<tr>\n<td>August 11<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Agenda-Opioid-Older-Adults-21-0811.pdf\" target=\"_blank\" rel=\"noopener\">Agenda August 11<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Minutes-Opioids-Older-Adults-Workgroup-21-0714.pdf\" target=\"_blank\" rel=\"noopener\">Minutes July 14<\/a><\/td>\n<\/tr>\n<tr>\n<td>September 8<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Agenda-Opioid-Older-Adults-21-0908.pdf\" target=\"_blank\" rel=\"noopener\">Agenda September 8<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Minutes-Opioids-Older-Adults-Workgroup-21-0811.pdf\" target=\"_blank\" rel=\"noopener\">Minutes August 11<\/a><\/td>\n<\/tr>\n<tr>\n<td>October 13<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Agenda-Opioid-Older-Adults-21-1013.pdf\" target=\"_blank\" rel=\"noopener\">Agenda October 13<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Minutes-Opioids-Older-Adults-Workgroup-21-0908.pdf\" target=\"_blank\" rel=\"noopener\">Minutes September 8<\/a><\/td>\n<\/tr>\n<tr>\n<td>December 8<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Agenda-Opioid-Older-Adults-21-1208.pdf\" target=\"_blank\" rel=\"noopener\">Agenda December 8<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2021\/12\/Minutes-Opioids-Older-Adults-Workgroup-21-1013.pdf\" target=\"_blank\" rel=\"noopener\">Minutes October 13<\/a><\/td>\n<\/tr>\n<tr>\n<td>January 12<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/01\/Agenda-Opioid-Older-Adults-22-0112.pdf\" target=\"_blank\" rel=\"noopener\">Agenda January 12<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/01\/Minutes-Opioids-Older-Adults-Workgroup-21-1208.pdf\" target=\"_blank\" rel=\"noopener\">Minutes December 8<\/a><\/td>\n<\/tr>\n<tr>\n<td>February 9<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/06\/Agenda-Opioid-Older-Adults-22-0209.pdf\" target=\"_blank\" rel=\"noopener\">Agenda February 9<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/06\/Minutes-Opioids-Older-Adults-Workgroup-22-0112.pdf\" target=\"_blank\" rel=\"noopener\">Minutes January 12<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/06\/Bree-Older-Adults-Opioid-Guidelines_Feb_2022_Summary.pdf\" target=\"_blank\" rel=\"noopener\">Opioid Draft Summary Presentation Slides<\/a><\/td>\n<\/tr>\n<tr>\n<td>April 13<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/06\/Agenda-Opioid-Older-Adults-22-0413.pdf\" target=\"_blank\" rel=\"noopener\">Agenda April 13<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/06\/Minutes-Opioids-Older-Adults-Workgroup-22-0209.pdf\" target=\"_blank\" rel=\"noopener\">Minutes February 9<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/06\/Bree-Opioid-Older-Adults-Draft-Recommendations-Workgroup.pdf\" target=\"_blank\" rel=\"noopener\">Opioid Draft Recommendations 4\/13<\/a><\/td>\n<\/tr>\n<tr>\n<td>July 20<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/08\/Agenda-Opioid-Older-Adults-22-0720.pdf\" target=\"_blank\" rel=\"noopener\">Agenda July 20<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/08\/Minutes-Opioids-Older-Adults-Workgroup-22-0413.pdf\" target=\"_blank\" rel=\"noopener\">Minutes April 13<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/wp-content\/uploads\/2022\/05\/Bree-Opioid-Older-Adults-Draft-22-0513.pdf\" target=\"_blank\" rel=\"noopener\">Opioid Draft Recommendations for Public Comment<\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2022\/08\/Public-Commentes_Opioids-Prescribing-in-Older-Adults-071322.pdf\" target=\"_blank\" rel=\"noopener\">Public Comment Review Chart<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Awards&#8221; tab_id=&#8221;1739898966034-6f619a57-9a7e&#8221;][vc_column_text css=&#8221;&#8221;]Award winners for Best Practices in Opioid Prescribing in Older Adults:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-76835\" src=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2026\/01\/Copy-of-Trailblazer-award-web-OPIC-2025-1.gif\" alt=\"\" width=\"350\" height=\"350\" \/><\/p>\n<ul>\n<li><a href=\"https:\/\/www.uwmedicine.org\/\"><strong>UW Medicine &amp; UW Physicians<\/strong><\/a><\/li>\n<li><strong><a href=\"https:\/\/www.chpw.org\/\">\u00a0Community Health Plan of Washington<\/a><\/strong><\/li>\n<li><strong><a href=\"https:\/\/www.uhc.com\/lp\/find-affordable-health-plans?cid=ps:ifp-acquisition:5535e3aa&amp;WT.mc_id=8030435&amp;tfn=1-877-525-8849&amp;mrcid=ps:google:brand-uhc%7CUHC-Brand-GGL-UHC-BG-Generic-PM-8030435%7CUHC%7CBrandGeneric:2022:8030435&amp;leadsourcename=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;utm_term=unitedhealthcare+insurance&amp;utm_source=GOOGLE&amp;utm_medium=cpc&amp;utm_campaign=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;gclid=CjwKCAiArLyuBhA7EiwA-qo80KYe8CVPuTaG48HKK3mQEbgMN5mb8Ga15OvdUreaj87mrnwsFdeJmBoCY6oQAvD_BwE&amp;gclsrc=aw.ds\">UnitedHealthcare<\/a><\/strong><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_separator color=&#8221;custom&#8221; border_width=&#8221;10&#8243; accent_color=&#8221;#145e61&#8243;][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; title=&#8221;Palliative Care&#8221; el_id=&#8221;palliative-care-tour&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1705962278224-23243125-2903&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<h4>Guideline title: Palliative Care Report and Guidelines<\/h4>\n<p><strong>Publication Status:<\/strong> Active<\/p>\n<p><strong>Date of publication<\/strong>: 2019<\/p>\n<p><strong>Date of last evidence search: <\/strong>2019<\/p>\n<p><strong>Scope: <\/strong>Definitions; spreading awareness of palliative care; clinical best practice; revision of benefit structure.<\/p>\n<p><strong>Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n<p><strong>Description: <\/strong>These guidelines present steps for adoption for individual stakeholder groups including patients and family members, specialty palliative care, health care systems, health plans, and the Washington State Health Care Authority on pages 5-11. Palliative care is further defined, including information on best practices for spreading awareness, clinical components of high-quality palliative care, differences between primary and specialty palliative care, and when to refer to specialty palliative care. Goals of care conversations are discussed and reimbursement strategies are outlined. Finally, quality metrics are outlined.<span id=\"page15R_mcid2\" class=\"markedContent\"><\/span><strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><br \/>\n<\/span><\/span><\/strong><\/p>\n<h4>Supporting Materials<\/h4>\n<p><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/03\/HCA-Letter-Accepting-Palliative-Care.pdf\" rel=\"\">Letter from the HCA Accepting the Palliative Care Recommendations<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Palliative-Care-Charter-Roster-Final-2019.pdf\" rel=\"\">Palliative<\/a><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Palliative-Care-Charter-Roster-Final-2019.pdf\" rel=\"\">\u00a0Care Charter and Roster<\/a><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Read On-line&#8221; tab_id=&#8221;1705962278709-5b1fe9fd-71dc&#8221;][vc_column_text]<\/p>\n<h3><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/11\/Palliative-Care-recommendations-FINAL-2019.pdf\">Palliative Care Report and Guidelines<\/a><\/h3>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Resources and Tools&#8221; tab_id=&#8221;1705962297913-94a61f1a-a053&#8243;][vc_toggle title=&#8221;Resources and Tools&#8221;]<a href=\"https:\/\/doh.wa.gov\/sites\/default\/files\/legacy\/Documents\/Pubs\/609013.pdf\">WA DOH Palliative Care Road Map\u00a0<\/a><\/p>\n<p><a href=\"https:\/\/waportal.org\/partners\/washington-rural-palliative-care-initiative\">Washington State Rural Palliative Care Initiative\u00a0<\/a><\/p>\n<p><a href=\"https:\/\/www.hca.wa.gov\/about-hca\/programs-and-initiatives\/making-informed-health-care-decisions\/palliative-care\">HCA Palliative Care<\/a><\/p>\n<p><a href=\"https:\/\/wshpco.org\/\">WA State Hospice &amp; Palliative Care Organization\u00a0<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Metrics and Evaluation Tools&#8221; tab_id=&#8221;1705962325226-7a8758f6-35f2&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p>To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n<p>To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n<p>Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n<p>[\/vc_column_text][vc_toggle title=&#8221;Delivery Site and Health Systems&#8221;]Health System Evaluation Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-System-Score-Card-_-Palliative-Care.xlsx\">Health System Score Card _ Palliative Care<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Care Professionals&#8221;]Primary Care Providers and sub-speciality providers <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/PC-Score-Card-_-Pallative-Care.xlsx\">PC Score Card _ Pallative Care<\/a><\/p>\n<p>Specialty care providers <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Sepcialty-care-Score-Card-_-Palliative.xlsx\">Specialty care Score Card _ Palliative<\/a>[\/vc_toggle][vc_toggle title=&#8221;Health Plans&#8221;]Health Plan Evaluation Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Health-Plan-Score-Card-_-Pallative-Care.xlsx\">Health Plan Score Card _ Pallative Care<\/a>[\/vc_toggle][vc_toggle title=&#8221;Washington State Health Care Authority&#8221;]Washington State HCA Score Card <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/WA-HCA-Score-Card-_-Pallative.xlsx\">WA HCA Score Card _ Palliative<\/a>[\/vc_toggle][vc_toggle title=&#8221;Private and Public Purchasers&#8221;]Employer and purchaser score cards <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2024\/06\/Purchasers-Score-Card-_-Pallative-Care.xlsx\">Purchasers Score Card _ Pallative Care<\/a>[\/vc_toggle][vc_toggle title=&#8221;Guideline Metrics&#8221;]The work group did not recommend specific metrics, however other prescribing metrics developed by the Bree Collaborative can be useful. These measures can be found on the Washington State Common Measure Set. For all of these measure a decrease is improvement.<\/p>\n<ul>\n<li>New Opioid Patient Days Supply of First Opioid Prescription\n<ul>\n<li><span id=\"page10R_mcid41\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients with at least one opioid prescription in the current by days\u2019 supply (day <\/span><span dir=\"ltr\" role=\"presentation\">supply categories: &lt;3, 4-7, 8-13 and &gt;14).<\/span><\/span><span id=\"page10R_mcid42\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Patients with at least one opioid prescription in the current quarter who have no opioids <\/span><span dir=\"ltr\" role=\"presentation\">prescribed in the prior quarter; Age stratify and report results for two groups: children\/adolescents aged 17 <\/span><span dir=\"ltr\" role=\"presentation\">and younger, and adults aged 18 and older.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>New Opioid Patients Transitioning to Chronic Opioids\n<ul>\n<li><span id=\"page10R_mcid57\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients who are prescribed &gt;60 days\u2019 supply of opioids in the current calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter with at least one opioid prescription in the previous quarter and no opioid prescription in the prior <\/span><span dir=\"ltr\" role=\"presentation\">quarter.<\/span><\/span><span id=\"page10R_mcid58\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span><\/em> <span dir=\"ltr\" role=\"presentation\">Number of patients with at least one opioid prescription in the previous quarter who have no <\/span><span dir=\"ltr\" role=\"presentation\">opioids prescribed in the prior quarter. Report as incidences per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Patients Prescribed High-Dose Chronic Opioid Therapy\n<ul>\n<li><span id=\"page10R_mcid73\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids at &gt;50 mg\/day or <\/span><span dir=\"ltr\" role=\"presentation\">&gt;90 mg\/day MED.<\/span><\/span><span id=\"page10R_mcid74\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids in the calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter. <\/span><\/span><span id=\"page10R_mcid75\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">Report each result as prevalence per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Use of Opioids at High Dosage (HDO)\n<ul>\n<li><span id=\"page10R_mcid89\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">The proportion of members 18 years and older who received prescription opioids at a high dosage (average <\/span><span dir=\"ltr\" role=\"presentation\">morphine milligram equivalent dose [MME] \u226590) for \u226515 days during the measurement year.<\/span><\/span><span id=\"page10R_mcid90\" class=\"markedContent\"> <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Examples of Implementation &#8211; IN DEVELOPMENT&#8221; tab_id=&#8221;1705962372742-ebe7b2bd-d297&#8243;][\/vc_tta_section][vc_tta_section title=&#8221;Workgroup Members&#8221; tab_id=&#8221;1739898985789-96b612f7-996e&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table>\n<tbody>\n<tr>\n<th width=\"35%\"><strong>Member<\/strong><\/th>\n<th><strong>Title<\/strong><\/th>\n<th><strong>Organization<\/strong><\/th>\n<\/tr>\n<tr>\n<td>John Robinson, MD, SM (Chair)<\/td>\n<td>Chief Medical Officer<\/td>\n<td>First Choice Health<\/td>\n<\/tr>\n<tr>\n<td>Lydia Bartholomew, MD<\/td>\n<td>Senior Medical Director, Pacific Northwest<\/td>\n<td>Aetna<\/td>\n<\/tr>\n<tr>\n<td>George Birchfield, MD<\/td>\n<td>Inpatient Hospice<\/td>\n<td>EvergreenHealth<\/td>\n<\/tr>\n<tr>\n<td>Raleigh Bowden, MD<\/td>\n<td>Director<\/td>\n<td>Okanogan Palliative Care Team<\/td>\n<\/tr>\n<tr>\n<td>Mary Catlin, MPH<\/td>\n<td>Senior Director<\/td>\n<td>Honoring Choices, Washington State Hospital Association<\/td>\n<\/tr>\n<tr>\n<td>Randy Curtis, MD, MPH<\/td>\n<td>Director, Cambia Palliative Care Center of Excellence<\/td>\n<td>University of Washington Medicine<\/td>\n<\/tr>\n<tr>\n<td>Leslie Emerick<\/td>\n<td>Director of Public Policy<\/td>\n<td>Washington State Hospice and Palliative Care Organization<\/td>\n<\/tr>\n<tr>\n<td>Ross M Hays, MD<\/td>\n<td>Director, Palliative Care Program<\/td>\n<td>Seattle Children\u2019s<\/td>\n<\/tr>\n<tr>\n<td>Greg Malone, MA, Mdiv, BCC<\/td>\n<td>Mgr Palliative Care Services, &amp; Spiritual Care Provider<\/td>\n<td>Swedish Medical Center<\/td>\n<\/tr>\n<tr>\n<td>Kerry Schaefer, MS<\/td>\n<td>Strategic Planner for Employee Health<\/td>\n<td>King County<\/td>\n<\/tr>\n<tr>\n<td>Bruce Smith, MD<\/td>\n<td>Medical Director of Providence Hospice of Seattle<\/td>\n<td>Providence Health and Services<\/td>\n<\/tr>\n<tr>\n<td>Richard Stuart, DSW<\/td>\n<td>Psychologist<\/td>\n<td>Swedish Medical Center \u2013 Edmonds Campus<\/td>\n<\/tr>\n<tr>\n<td>Stephen Thielke, MD<\/td>\n<td>Geriatric Psychiatry<\/td>\n<td>University of Washington<\/td>\n<\/tr>\n<tr>\n<td>Cynthia Tomik, LICSW<\/td>\n<td>Manager, Palliative Care<\/td>\n<td>EvergreenHealth<\/td>\n<\/tr>\n<tr>\n<td>Gregg Vandekieft, MD, MA<\/td>\n<td>Medical Director for Palliative Care<\/td>\n<td>Providence St. Peter Hospital<\/td>\n<\/tr>\n<tr>\n<td>Hope Wechkin, MD<\/td>\n<td>Medical Director, Hospice and Palliative Care<\/td>\n<td>EvergreenHealth<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Archived Meeting Materials&#8221; tab_id=&#8221;1740177472620-a74b5265-8b77&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table border=\"0\">\n<tbody>\n<tr>\n<td><strong>Date<\/strong><\/td>\n<td><strong>Materials<\/strong><\/td>\n<\/tr>\n<tr>\n<td>November 8<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/11\/Agenda-Palliative-Care-19-1108.pdf\"><span class=\"doc\">Agenda\u00a0November 8<\/span><\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/11\/Minutes-Palliative-Care-Workgroup-19-0906.pdf\"><span class=\"doc\">Minutes\u00a0September 6<\/span><\/a><br \/>\n<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/02\/Minutes-Palliative-Care-Workgroup-20-1108.pdf\"><span class=\"doc\">Minutes\u00a0November 8<\/span><\/a><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2020\/01\/Palliative-Care-draft-recommendations-DRAFT-19-0919-1.pdf\" rel=\"\">Palliative Care Draft Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>September 6<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/09\/Agenda-Palliative-Care-19-0906.pdf\" rel=\"\">Agenda September 6<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/09\/Minutes-Palliative-Care-Workgroup-19-0816.pdf\" rel=\"\">Minutes August 8<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/09\/Palliative-Care-draft-recommendations-19-0903.pdf\" rel=\"\">Palliative Care Draft Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>August 16<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/08\/Agenda-Palliative-Care-19-0816.pdf\" rel=\"\">Agenda August 16<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/08\/Minutes-Palliative-Care-Workgroup-19-0712.pdf\" rel=\"\">Minutes July 12<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/08\/Palliative-Care-draft-recommendations-19-0812.pdf\" rel=\"\">Draft Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>July 12<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/07\/Agenda-Palliative-Care-19-0712.pdf\" rel=\"\">Agenda July 12<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/07\/Minutes-Palliative-Care-Workgroup-19-0614.pdf\" rel=\"\">Minutes June 14<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/07\/Palliative-Care-draft-recommendations-19-0701.pdf\" rel=\"\">Draft Palliative Care Recommendations<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>June 14<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/06\/Agenda-Palliative-Care-19-0614.pdf\" rel=\"\">Agenda June 14<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/06\/Minutes-Palliative-Care-Workgroup-19-0510.pdf\" rel=\"\">Minutes May 10<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/06\/Palliative-Care-draft-recommendations-19-0529.pdf\" rel=\"\">Draft Recommendations Palliative Care<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>May 10<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Agenda-Palliative-Care-19-0510.pdf\" rel=\"\">Agenda May 10<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Minutes-Palliative-Care-Workgroup-19-0412.pdf\" rel=\"\">Minutes April 12<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Palliative-Care-draft-recommendations-19-0510.pdf\" rel=\"\">Palliative Care Draft Recommendations<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/05\/Appendix-C-palliative-care-1.pdf\" rel=\"\">Appendix: Guideline and Systematic Review Search Results<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>April 12<\/td>\n<td><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Agenda-Palliative-Care-19-0412.pdf\" rel=\"\"><span class=\"doc\">Agenda April 12<\/span><br \/>\n<\/a><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Minutes-Palliative-Care-Workgroup-19-0308.pdf\" rel=\"\">Draft Minutes March 8<\/a><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Agenda-Palliative-Care-19-0412.pdf\" rel=\"\"><br \/>\n<\/a><\/span><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Appendix-C-palliative-care.pdf\" rel=\"\"><span class=\"doc\">Appendix C Palliative Care<\/span><br \/>\n<\/a><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Bree-defining-serious-illness-19-0328.pdf\" rel=\"\"><span class=\"doc\">Defining Serious Illness\/Palliative Care Triggers<\/span><br \/>\n<\/a><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/04\/Bree_justis4-12-19-2.pdf\" rel=\"\">Justis Slides<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>March 8<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Agenda-Palliative-Care-19-0308.pdf\" rel=\"\">Agenda March 8<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Minutes-Palliative-Care-Workgroup-19-0208.pdf\" rel=\"\">Minutes February 8<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Joint-commission-palliative-care-metrics.pdf\" rel=\"\">Joint Commission Palliative Care Metrics<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/CAPC-CPARC-National-Palliative-Care-Registry-WA-state-snapshot.pdf\" rel=\"\">CAPC-CPARC National Palliative Care Registry WA State Snapshot<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/NCP-Guidelines-8-domains.pdf\" rel=\"\">NCP Guidelines 8 Domains<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>February 8<\/td>\n<td><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/01\/Agenda-Palliative-Care-19-0104.docx\" rel=\"\">Agenda February 8<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Minutes-Palliative-Care-Workgroup-19-0104-1.pdf\" rel=\"\">Minutes January 4<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/NCHPC-NCPGuidelines_4thED_web_FINAL-1.pdf\" rel=\"\">NCHPC-NCP Gudielines<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/03\/Palliative-Care-Charter-Roster-2018-3.pdf\" rel=\"\">Draft Charter Roster<\/a><\/span><\/td>\n<\/tr>\n<tr>\n<td>January 4<\/td>\n<td><span class=\"doc\">\u00a0<a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/01\/Agenda-Palliative-Care-19-0104.docx\" rel=\"\">Agenda January 4<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/01\/Health-Affairs-guideline-summary-18-1130.pdf\" rel=\"\">Health Affairs Guideline Summary<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/01\/Bree-Palliative-Care-Slides-190104-2.pdf\" rel=\"\">Bree Palliative Care Slides<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/01\/Conflict-of-Interest-Form-1.pdf\" rel=\"\">Conflict of Interest Form<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2019\/01\/OPMA-Roster.pdf\" rel=\"\">OPMA Training Roster<\/a><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Awards&#8221; tab_id=&#8221;1739898986546-46b5813b-da8c&#8221;][vc_column_text css=&#8221;&#8221;]Award winners for Best Practices in Palliative Care:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-76835\" src=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2026\/01\/Copy-of-Trailblazer-award-web-OPIC-2025-1.gif\" alt=\"\" width=\"350\" height=\"350\" \/><\/p>\n<ul>\n<li><a href=\"https:\/\/www.uwmedicine.org\/\"><strong>UW Medicine &amp; UW Physicians <\/strong><\/a><a href=\"https:\/\/www.healthpointchc.org\/\"><strong>(2023)<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/wa.kaiserpermanente.org\/html\/public\/about\"><strong>Kaiser Permanente <\/strong><\/a><a href=\"https:\/\/www.healthpointchc.org\/\"><strong>(2023)<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/www.uhc.com\/lp\/find-affordable-health-plans?cid=ps:ifp-acquisition:5535e3aa&amp;WT.mc_id=8030435&amp;tfn=1-877-525-8849&amp;mrcid=ps:google:brand-uhc%7CUHC-Brand-GGL-UHC-BG-Generic-PM-8030435%7CUHC%7CBrandGeneric:2022:8030435&amp;leadsourcename=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;utm_term=unitedhealthcare+insurance&amp;utm_source=GOOGLE&amp;utm_medium=cpc&amp;utm_campaign=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;gclid=CjwKCAiArLyuBhA7EiwA-qo80KYe8CVPuTaG48HKK3mQEbgMN5mb8Ga15OvdUreaj87mrnwsFdeJmBoCY6oQAvD_BwE&amp;gclsrc=aw.ds\"><strong>UnitedHealthcare <\/strong><\/a><a href=\"https:\/\/www.healthpointchc.org\/\"><strong>(2024)<\/strong><\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_separator color=&#8221;custom&#8221; border_width=&#8221;10&#8243; accent_color=&#8221;#145e61&#8243;][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; title=&#8221;Prescribing for Perioperative Pain&#8221; el_id=&#8221;prescribing-postoperative-pain&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1705962893951-70348fdf-1f52&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<h4>Guideline title: <strong>Prescribing for Post-operative Pain Report and Guidelines<\/strong><\/h4>\n<p><strong>Publication Status:<\/strong> Active<\/p>\n<p><strong>Date of publication<\/strong>: 2018<\/p>\n<p><strong>Date of last evidence search: <\/strong>2018<\/p>\n<p><strong>Scope: <\/strong>Clinical guidelines based on time of recovery; additional considerations for children and adolescents.<strong><br \/>\n<\/strong><\/p>\n<p><strong>Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n<p><strong>Description: <\/strong>In addition to prescribing the appropriate amount of opioids for a given procedure, it is important that the surgeon provide education for the patient and caregivers about realistic expectations for postoperative pain management, functional recovery activities, and timely reduction in opioid use as well as providing instruction for safe storage and disposal of opioids as specified in the 2015 AMDG Guideline<span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">.<\/span><\/span><strong><span id=\"page15R_mcid2\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><br \/>\n<\/span><\/span><\/strong><\/p>\n<h4>Supporting Materials<\/h4>\n<p><span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/10\/Letter-from-HCA-accepting-perscribing-guidelines.pdf\" rel=\"\">Letter from the Health Care Authority Accepting the Postoperative Prescribing Guidelines<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2016\/05\/Opioid-Implementation-Charter-2016.pdf\" rel=\"\">Opioid Guideline Implementation Charter<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2015\/06\/2015AMDGOpioidGuideline.pdf\">Agency Medical Directors Group Interagency Guideline on Prescribing Opioids for Pain<\/a><\/span><br \/>\n<span class=\"doc\"><a href=\"http:\/\/www.agencymeddirectors.wa.gov\/Files\/FY16-288SummaryAMDGOpioidGuideline_FINAL.pdf\">AMDG Guideline Summary<\/a><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Read On-line&#8221; tab_id=&#8221;1705962894505-5ed91917-3a80&#8243;][vc_column_text]<\/p>\n<h3><a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2018\/09\/Final-Supplemental-Bree-AMDG-Postop-pain-091318-wcover.pdf\">Prescribing Opioids for Postoperative Pain Report and Guidelines<\/a><\/h3>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Resources and Tools&#8221; tab_id=&#8221;1705962918703-ee308952-08c9&#8243;][vc_toggle title=&#8221;Resources and Tools&#8221;]<a href=\"https:\/\/www.agencymeddirectors.wa.gov\/Files\/2015AMDGOpioidGuideline.pdf#page=26\">Interagency Guideline on Prescribing Opioids for Pain<\/a><\/p>\n<p><a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/rr\/rr7103a1.htm\">CDC Clinical Practice Guideline for Prescribing Opioids for Pain \u2014 United States, 2022<\/a>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Metrics and Evaluation Tools&#8221; tab_id=&#8221;1705962953686-897e6126-3200&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p>To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n<p>To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n<p>Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n<p>[\/vc_column_text][vc_toggle title=&#8221;Delivery Site and Health Systems&#8221; css=&#8221;&#8221;]Acute Prescribing <a href=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2025\/03\/Health-System-Score-Card-Rx-Acute.xlsx\">Health System Score Card<\/a>[\/vc_toggle][vc_toggle title=&#8221;Guideline Metrics&#8221;]The work group did not recommend specific metrics, however audience specific evaluation tools and other prescribing metrics developed by the Bree Collaborative can be useful. These measures can be found on the Washington State Common Measure Set. For all of these measure a decrease is improvement.<\/p>\n<ul>\n<li>New Opioid Patient Days Supply of First Opioid Prescription\n<ul>\n<li><span id=\"page10R_mcid41\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients with at least one opioid prescription in the current by days\u2019 supply (day <\/span><span dir=\"ltr\" role=\"presentation\">supply categories: &lt;3, 4-7, 8-13 and &gt;14).<\/span><\/span><span id=\"page10R_mcid42\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Patients with at least one opioid prescription in the current quarter who have no opioids <\/span><span dir=\"ltr\" role=\"presentation\">prescribed in the prior quarter; Age stratify and report results for two groups: children\/adolescents aged 17 <\/span><span dir=\"ltr\" role=\"presentation\">and younger, and adults aged 18 and older.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>New Opioid Patients Transitioning to Chronic Opioids\n<ul>\n<li><span id=\"page10R_mcid57\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients who are prescribed &gt;60 days\u2019 supply of opioids in the current calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter with at least one opioid prescription in the previous quarter and no opioid prescription in the prior <\/span><span dir=\"ltr\" role=\"presentation\">quarter.<\/span><\/span><span id=\"page10R_mcid58\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span><\/em> <span dir=\"ltr\" role=\"presentation\">Number of patients with at least one opioid prescription in the previous quarter who have no <\/span><span dir=\"ltr\" role=\"presentation\">opioids prescribed in the prior quarter. Report as incidences per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Patients Prescribed High-Dose Chronic Opioid Therapy\n<ul>\n<li><span id=\"page10R_mcid73\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\"><em>Numerator:<\/em> Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids at &gt;50 mg\/day or <\/span><span dir=\"ltr\" role=\"presentation\">&gt;90 mg\/day MED.<\/span><\/span><span id=\"page10R_mcid74\" class=\"markedContent\"><br role=\"presentation\" \/><em><span dir=\"ltr\" role=\"presentation\">Denominator:<\/span> <\/em><span dir=\"ltr\" role=\"presentation\">Number of patients in the population prescribed &gt;60 days\u2019 supply of opioids in the calendar <\/span><span dir=\"ltr\" role=\"presentation\">quarter. <\/span><\/span><span id=\"page10R_mcid75\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">Report each result as prevalence per 1,000 population, age and sex adjusted.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li>Use of Opioids at High Dosage (HDO)\n<ul>\n<li><span id=\"page10R_mcid89\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">The proportion of members 18 years and older who received prescription opioids at a high dosage (average <\/span><span dir=\"ltr\" role=\"presentation\">morphine milligram equivalent dose [MME] \u226590) for \u226515 days during the measurement year.<\/span><\/span><span id=\"page10R_mcid90\" class=\"markedContent\"> <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_toggle][\/vc_tta_section][vc_tta_section title=&#8221;Examples of Implementation &#8211; IN DEVELOPMENT&#8221; tab_id=&#8221;1705962997945-6be8737f-ae71&#8243;][\/vc_tta_section][vc_tta_section title=&#8221;Workgroup Members&#8221; tab_id=&#8221;1739899005827-6eef80e6-d69f&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table width=\"0\">\n<tbody>\n<tr>\n<td width=\"174\"><strong>Name<\/strong><\/td>\n<td width=\"227\"><strong>Title<\/strong><\/td>\n<td width=\"282\"><strong>Organization<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Chris Baumgartner<\/td>\n<td width=\"227\">Director Prescription Monitoring Program<\/td>\n<td width=\"282\">Washington State Department of Health<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gary Franklin, MD, MPH (Chair)<\/td>\n<td width=\"227\">Medical Director<\/td>\n<td width=\"282\">Washington State Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Charissa Fontinos, MD<\/td>\n<td width=\"227\">Deputy Chief Medical Officer<\/td>\n<td width=\"282\">Washington State Health Care Authority<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Deb Gordon, DNP, RN, FAAN<\/td>\n<td width=\"227\">Teaching Associate, Co-director, Pain Service, Anesthesiology &amp; Pain Medicine<\/td>\n<td width=\"282\">Harborview Medical Center<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Frances Gough, MD<\/td>\n<td width=\"227\">Chief Medical Officer<\/td>\n<td width=\"282\">Molina Healthcare<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Dan Kent, MD<\/td>\n<td width=\"227\">Chief Medical Officer<\/td>\n<td width=\"282\">UnitedHealthcare<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Kathy Lofy, MD<\/td>\n<td width=\"227\">Chief Science Officer<\/td>\n<td width=\"282\">Washington State Department of Health<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Jaymie Mai, PharmD<\/td>\n<td width=\"227\">Pharmacy Manager<\/td>\n<td width=\"282\">Washington State Department of Labor and Industries<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Shirley Reitz, PharmD<\/td>\n<td width=\"227\">\u200eClinical Pharmacist Client Manager<\/td>\n<td width=\"282\">OmedaRx, Cambia<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gregory Rudolph, MD<\/td>\n<td width=\"227\">Addiction Medicine<\/td>\n<td width=\"282\">Swedish Pain Services<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Mark Stephens<\/td>\n<td width=\"227\">President<\/td>\n<td width=\"282\">Change Management Consulting<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">David Tauben, MD<\/td>\n<td width=\"227\">Chief of Pain Medicine<\/td>\n<td width=\"282\">University of Washington Medical Center<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Gregory Terman MD, PhD<\/td>\n<td width=\"227\">Professor<\/td>\n<td width=\"282\">Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Michael Von Korff, ScD<\/td>\n<td width=\"227\">Senior Investigator<\/td>\n<td width=\"282\">Kaiser Permanente Washington Research Institute<\/td>\n<\/tr>\n<tr>\n<td width=\"174\">Mia Wise, DO<\/td>\n<td width=\"227\">Medical Director, Collaborative Healthcare Solutions<\/td>\n<td width=\"282\">Premera Blue Cross<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Awards&#8221; tab_id=&#8221;1739899006697-2d6c568f-9b7f&#8221;][vc_column_text css=&#8221;&#8221;]Award winners for Best Practices in Opioid Prescribing for Post-operative Pain:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-76835\" src=\"https:\/\/www.qualityhealth.org\/bree\/wp-content\/uploads\/sites\/8\/2026\/01\/Copy-of-Trailblazer-award-web-OPIC-2025-1.gif\" alt=\"\" width=\"350\" height=\"350\" \/><\/p>\n<ul>\n<li><strong><a href=\"https:\/\/www.uwmedicine.org\/\">UW Medicine &amp; UW Physicians<\/a><\/strong><\/li>\n<li><strong><a href=\"https:\/\/www.chpw.org\/\">Community Health Plan of Washington<\/a><\/strong><\/li>\n<li><strong><a href=\"https:\/\/www.uhc.com\/lp\/find-affordable-health-plans?cid=ps:ifp-acquisition:5535e3aa&amp;WT.mc_id=8030435&amp;tfn=1-877-525-8849&amp;mrcid=ps:google:brand-uhc%7CUHC-Brand-GGL-UHC-BG-Generic-PM-8030435%7CUHC%7CBrandGeneric:2022:8030435&amp;leadsourcename=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;utm_term=unitedhealthcare+insurance&amp;utm_source=GOOGLE&amp;utm_medium=cpc&amp;utm_campaign=UHC-Brand-GGL-UHC-BG-Generic-PM-8030435&amp;gclid=CjwKCAiArLyuBhA7EiwA-qo80KYe8CVPuTaG48HKK3mQEbgMN5mb8Ga15OvdUreaj87mrnwsFdeJmBoCY6oQAvD_BwE&amp;gclsrc=aw.ds\">UnitedHealthcare<\/a><\/strong><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_separator color=&#8221;custom&#8221; border_width=&#8221;10&#8243; accent_color=&#8221;#145e61&#8243;][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"[vc_row overlay_dotted=&#8221;&#8221; el_id=&#8221;managing-pain-guidelines-row&#8221;][vc_column][vc_tta_tour style=&#8221;outline&#8221; shape=&#8221;square&#8221; color=&#8221;black&#8221; spacing=&#8221;20&#8243; active_section=&#8221;1&#8243; no_fill_content_area=&#8221;true&#8221; title=&#8221;Collaborative Care for Chronic Pain&#8221; el_id=&#8221;collaborative-care-tour&#8221;][vc_tta_section title=&#8221;Guideline Information&#8221; tab_id=&#8221;1705962508610-b3bf3d0d-0034&#8243;][vc_column_text css=&#8221;&#8221;] Guideline title: Collaborative Care for Chronic Pain Report and Guidelines Publication&#8230;","protected":false},"author":134,"featured_media":0,"parent":70686,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"class_list":["post-75437","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/pages\/75437","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/users\/134"}],"replies":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/comments?post=75437"}],"version-history":[{"count":34,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/pages\/75437\/revisions"}],"predecessor-version":[{"id":76892,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/pages\/75437\/revisions\/76892"}],"up":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/pages\/70686"}],"wp:attachment":[{"href":"https:\/\/www.qualityhealth.org\/bree\/wp-json\/wp\/v2\/media?parent=75437"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}