The investigative and focusing work done during the Prepare and Launch Stage offers the Opioid Improvement Team a picture of current practices, resources, and possibilities. Now it is time to put that foundational work to good use and help practices design and implement new approaches to care for patients on long-term opioid therapy using the Six Building Blocks. During this stage, clinics work to achieve the following milestones with the support of the Practice Facilitator using the Design & Implement Workbook, Shared Learning Calls with other sites, and clinical education.

Design & Implement Stage Milestones Checklist

This is a starting list of milestones for this stage, which you can adapt to your needs.

Building Block Activities
Leadership & consensus

  • Protected time for improvement team to meet and work
  • Regularly emphasize project importance and solicit feedback during staff and clinician meetings
  • Clinical education opportunities offered to staff and clinicians, including on pain etiology
Policies, patient agreements, & workflows

  • Policies revised to align with evidence-based guidelines (e.g., CDC, AMDG)
  • Patient agreement revised to support the policy and educate patients about risks
  • Workflows written to support policies
  • Training conducted on policies, agreement, workflows, and supporting EHR templates
Tracking & monitoring patient care

  • Patients on long-term opioid therapy identified
  • All clinicians and delegates signed up for the prescription data monitoring program
  • Calculating MED as dose or medication changes is possible and easy for clinicians and staff
  • There is a dashboard of key measures for all patients on long-term opioid therapy
  • Data are used to monitor care gaps, high-risk patients, and clinical variation
Planned, patient-centered visits

Caring for patients with complex needs

  • Tools are selected and consistently in use to identify patients with complex needs (i.e., mental/behavioral health disorders, opioid use disorder, or other substance use disorders)
  • Educational opportunities are provided to clinicians on how to identify and treat patients with opioid use disorder
  • There is an approach to connecting patients to mental/behavioral health resources, either integrated in the primary care setting, in the community, or through telehealth
  • There is an approach to connecting patients with opioid use disorder to treatment, either internally through waivered providers or externally through an identified medication for opioid use disorder treatment facility
  • Confidentiality regulations and other information-sharing hurdles have been addressed so that patient information can be shared between medical, behavioral health, and substance use disorder clinicians
  • Training is provided to clinicians and staff on overcoming stigma about patients with mental/behavioral health needs, opioid use disorder, and other substance use disorders
Measuring success