Lean Management for Improved Opioid Prescribing in Ambulatory Care

1. The Research Question Using Lean Management to Improve Opioid Prescribing for Pain in Ambulatory Care Connie van Eeghen DrPH, Amanda Kennedy PharmD, Mark Pasanen MD, Benjamin Littenberg MD, Charles MacLean MD University of Vermont • The Question: Is a structured, systems-based QI method, such as Lean, effective in helping practices implement a set of best practice strategies? • Why this is important: • Increased prescription pain relief drug diversion/addiction • Structured problem-solving approaches such as Lean have potential to improve many primary care processes

2. What the Researchers Did • Engaged 9 primary practices & 1 orthopaedic practice in Lean redesign of office work • Mixed methods, prospective, observational • Multiple case studies paired pre- and post-intervention surveys from providers and staff • 155 study participants; 77% response rate • 36 prescribers and 83 staff responded (n=119) • Primary outcome: provider satisfaction with opioid prescription management

3. What the Researchers Found

4. What This Means for Clinical Practice • The Lean approach embedded key strategies into office work successfully. Most common: • Use of state-sponsored prescription data base • Provider/staff team approach to managing Rx • Consistent approach across entire practice • Lean was effective and well-received regardless of the specific strategies selected • A toolkit to guide the use of Lean in primary care may have broad application