title: Healthcare system-wide implementation of opioid-safety guideline recommendations: the case of urine drug screening and opioid-patient suicide- and overdose-related events in the Veterans Health Administration.
abstract: This study provides an example of how healthcare system-wide progress in implementation of opioid-therapy guideline recommendations can be longitudinally assessed and then related to subsequent opioid-prescribed patient health and safety outcomes. Using longitudinal linear mixed effects analyses, we determined that in the Department of Veterans Affairs (VA) healthcare system (n = 141 facilities), over the 4-year interval from 2010 to 2013, a key opioid therapy guideline recommendation, urine drug screening (UDS), increased from 29 to 42 %, with an average within-facility increase rate of 4.5 % per year. Higher levels of UDS implementation from 2010 to 2013 were associated with lower risk of suicide and drug overdose events among VA opioid-prescribed patients in 2013, even after adjusting for patients' 2012 demographic characteristics and medical and mental health comorbidities. Findings suggest that VA clinicians and healthcare policymakers have been responsive to the 2010 VA/Department of Defense (DOD) UDS treatment guideline recommendation, resulting in improved patient safety for VA opioid-prescribed patients.
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA, 94025, USA. penny.brennan@va.gov.
authors.forename: Penny L
authors.initials: PL
authors.lastname: Brennan
authors.affiliation: Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA, 94025, USA.
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Del Re
authors.affiliation: Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA, 94025, USA.
authors.forename: Patricia T
authors.initials: PT
authors.lastname: Henderson
authors.affiliation: Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA, 94025, USA.
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000506:poisoning / Q000627:therapeutic use / Q000652:urine; D004353:Drug Evaluation, Preclinical / Q000379:methods*; D062787:Drug Overdose / Q000150:complications / Q000517:prevention & control* / Q000652:urine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D063487:Prescription Drug Misuse / Q000009:adverse effects*; D013405:Suicide / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D000092864:Suicide Prevention
chemical_list: D000701:Analgesics, Opioid
keywords: Drug overdose; Opioid therapy safety; Suicide; Treatment guideline implementation; Urine drug screening