Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions
Abstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outco...
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-07477-6 |
| _version_ | 1819006716635774976 |
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| author | Daniel M. Hartung Jonah Geddes Sara E. Hallvik P. Todd Korthuis Luke Middleton Gillian Leichtling Christi Hildebran Hyunjee Kim |
| author_facet | Daniel M. Hartung Jonah Geddes Sara E. Hallvik P. Todd Korthuis Luke Middleton Gillian Leichtling Christi Hildebran Hyunjee Kim |
| author_sort | Daniel M. Hartung |
| collection | DOAJ |
| description | Abstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis. |
| first_indexed | 2024-12-21T00:13:07Z |
| format | Article |
| id | doaj.art-0b91c7ad7f274398903eec36decc4481 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T00:13:07Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-0b91c7ad7f274398903eec36decc44812022-12-21T19:22:18ZengBMCBMC Health Services Research1472-69632022-01-012211910.1186/s12913-022-07477-6Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptionsDaniel M. Hartung0Jonah Geddes1Sara E. Hallvik2P. Todd Korthuis3Luke Middleton4Gillian Leichtling5Christi Hildebran6Hyunjee Kim7Oregon State University, College of PharmacyOregon Health & Science UniversityComagine HealthOregon Health & Science UniversityOregon State University, College of PharmacyComagine HealthComagine HealthOregon Health & Science UniversityAbstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.https://doi.org/10.1186/s12913-022-07477-6OpioidsMedicaidOverdose |
| spellingShingle | Daniel M. Hartung Jonah Geddes Sara E. Hallvik P. Todd Korthuis Luke Middleton Gillian Leichtling Christi Hildebran Hyunjee Kim Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions BMC Health Services Research Opioids Medicaid Overdose |
| title | Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions |
| title_full | Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions |
| title_fullStr | Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions |
| title_full_unstemmed | Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions |
| title_short | Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions |
| title_sort | evaluation of a medicaid performance improvement project to reduce high dose opioid prescriptions |
| topic | Opioids Medicaid Overdose |
| url | https://doi.org/10.1186/s12913-022-07477-6 |
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