Next Steps
Step 1: Understand Improvement Opportunity
Using data to understand prescribing practices is a foundational step in any quality improvement effort. In addition to your Minnesota Department of Human Services (DHS) Opioid Prescribing Report and prescription data, consider other sources of prescribing data that might be available to you (for example, data from your EMR or the Minnesota Prescription Monitoring Program).
- Review the Sentinel opioid prescribing measures webpage to gain a better understanding of the data reflected in your DHS report.
- Submit a brief online OPIP Provider Confirmation form to provide basic information about your practice and confirm that you received and reviewed your DHS Opioid Prescribing Report. The contact information you provide will allow DHS to remain in communication with you throughout the course of your project.
Step 2: Review standards of practice; identify challenges, barriers, stressors; then choose a change
Root cause analysis and careful reflection are critical in identifying a meaningful tests of change. Clinicians should consider how their practice may or may not differ from colleagues and clinical peers.
- Study the Community Standards of Practice (PDF) for opioid prescribing and assess your alignment with the standards
- Complete a self-assessment exercise for the measures where you have exceeded the quality thresholds and email the completed Self Assessment Forms to dhs.opioid@state.mn.us (DHS can not accept hand-written responses).
Implementation science has shown that both individual and system barriers influence the success of an improvement plan. While lack of information is one barrier, lack of support and resources also hinder successful change. The self-assessment exercise should also help you identify existing barriers.
Step 3: Plan the change
Thoughtful planning is the next essential step for any successful change initiative. Understanding the problem, what is perpetuating the problem, identifying a meaningful improvement intervention, and whether the solution will actually solve the problem are key considerations. Gaps in clinical practice often persist because clinicians solve for the wrong problem. DHS offers a simple tool to help providers plan their test of change.
Complete an Opioid Prescribing Improvement Program: Quality improvement plan (DHS-8265) (PDF) for at least one measure where your opioid prescribing rate exceeds the quality improvement threshold and email it to dhs.opioid@state.mn.us.
Step 4: Do the change; study the outcomes; sustain the improvements
During the “Do the change” phase, clinicians should think about what supports and resources are available to them, and how they can evaluate their change effort. Clinicians will gain insight into what interventions work and do not work, as well as what may offer potential. Discovering that a given intervention does not result in improvement is valuable.
Clinicians who implemented a change and studied the outcomes should evaluate their improvement effort and email the completed Opioid Prescribing Improvement Program Quality Improvement Evaluation (DHS-8394) (PDF) to dhs.opioid@state.mn.us.
Chronic Pain Waiver
Chronic pain is a clinically complex phenomenon and individualized, patient-centered care is imperative, whether opioids are part of the treatment plan or not. DHS partnered with a panel of pain management experts to develop a tenable alternative to quality improvement requirements for those who treat chronic pain. The alternative, referred to as a waiver, emphasizes processes that uphold patient safety and clinical practice guidelines.
The waiver is available to clinics specializing in pain management and includes all licensed prescribers on staff, regardless of their engagement in OPIP. Any clinic that meets all the following criteria can apply for a waiver:
- Clinic or group must specialize in the treatment of chronic pain, and
- Clinic or group must have at least one board-certified pain specialist on staff, and
- Clinic or group must not have any open or pending investigations with DHS’ Office of the Inspector General, and
- Individual clinicians must not have any disciplinary actions related to opioids with the Board of Medical Practice or Board of Nursing within the previous two years (24 months).
Email dhs.opioid@state.mn.us if you have questions or need to request application materials to apply for a waiver.
Resources and Partners
Working with Minnesota’s medical community is a core component of the OPIP project. These partnerships allow DHS to develop and share an extensive set of practical, no-cost resources to support clinical improvement efforts across the state.
Project ECHO
Project ECHO is a guided-practice model that revolutionizes medical education and increases workforce capacity to provide best-practice specialty care and reduce health disparities. DHS currently supports the following three Project ECHO models:
Institute for Clinical Systems Improvement (ICSI)
ICSI existed to provide evidence-based, innovative solutions that addressed health care’s toughest challenges. While ICSI closed in 2022, their tremendous contributions to Minnesota’s opioid stewardship remains publicly available on the following ICSI webpages.
- The Opioid Initiatives webpage includes a number of resources designed to help individual prescribers and organizations build safer opioid prescribing habits.
- Chronic Pain and Long-term Opioid Medication: Building a New Culture
A collaboration between both patients and providers, this report highlights themes and necessary elements for building a better and safer opioid prescribing culture for individuals experiencing chronic pain.
- Opioid Prescribing Quality Improvement Webinars
ICSI hosted a webinar series specific to the DHS quality improvement program. Recordings of each of the following topics are free.
- Introduction to the OPIP quality improvement program
- Leading your organization through change
- Barriers, strategies and assets for improving opioid prescribing
- Improving post-operative and post-acute prescribing
- Tested strategies for improved opioid prescribing
- Sustaining improvement, reporting to DHS
Centers for Disease Control and Prevention (CDC)
The CDC offers numerous and up-to-date resources to support the health care community’s quality improvement efforts around opioid prescribing, including current updates to opioid prescribing guidelines.
