Berkshire Medical Center Inc

CAROL M. WHITE PHYSICAL EDUCATION PROGRAM

BERKSHIRE HEALTH SYSTEMS ALTERNATIVES FOR EMERGENCY TREATMENT (ALERT) FOR PAIN - THE ALERT PROJECT IS DESIGNED TO DECREASE OPIOID PRESCRIBING AND INCREASE THE USE OF OPIOID-SPARING MEDICATIONS AND INTERVENTIONAL PROCEDURES FOR PAIN PATIENTS SEEN IN THREE SAFETY NET EMERGENCY DEPARTMENTS (EDS) IN RURAL BERKSHIRE COUNTY, MA. TO THIS END, ALERT WILL IMPLEMENT COMPUTERIZED, OPIOID-SPARING ORDER SETS FOR PATIENTS PRESENTING MUSCULOSKELETAL PAIN, DENTAL PAIN, HEADACHE, KIDNEY STONES, AND ABDOMINAL PAIN. IN ADDITION, BECAUSE PAIN IS A BIOPSYCHOSOCIAL PHENOMENON, THE MOST COMPLEX PATIENTS WILL RECEIVE A MULTIDISCIPLINARY ASSESSMENT, A COMPREHENSIVE CARE PLAN, AND NAVIGATION SERVICES TO HELP THEM ACCESS HOSPITAL- AND COMMUNITY-BASED SERVICES, INCLUDING MEDICAL AND BEHAVIORAL HEALTH CARE, ADDICTION TREATMENT, RESTORATIVE THERAPIES, COMPLEMENTARY AND INTEGRATIVE THERAPIES, AND SERVICES TO ADDRESS UNMET BASIC NEEDS. THE POPULATION OF FOCUS IS MEN AND WOMEN (AGE 18 AND OLDER) WHO FREQUENTLY SEEK PAIN CARE IN THE THREE EDS OPERATED BY BERKSHIRE HEALTH SYSTEMS (BHS). IN CY2022, 16,185 UNDUPLICATED PAIN PATIENTS WERE SEEN IN THE BHS EDS, 13.8% OF WHOM IDENTIFIED AS RACIAL MINORITIES AND 4.5% AS HISPANIC/LATINO. THE GEOGRAPHIC CATCHMENT AREA IS BERKSHIRE COUNTY. ALTHOUGH THE POPULATION IDENTIFIES PREDOMINANTLY AS WHITE (86.2%), THE COUNTY IS INCREASINGLY DIVERSE, WITH A 54% INCREASE IN THE HISPANIC/LATINO POPULATION IN THE PAST 10 YEARS. A CENTER OF ARTS, CULTURE AND RECREATION, BERKSHIRE COUNTY IS A POPULAR RETIREMENT DESTINATION AND TOURIST AREA. THE COUNTY’S MEDIAN HOUSEHOLD INCOME ($63,169) IS LOWER THAN THE STATE ($89,026) AND THE US ($70,784). THE BEAUTY OF THE BERKSHIRES AND THE STATE’S PROGRESSIVE APPROACH TO THE RIGHTS OF SEXUAL AND GENDER MINORITIES HAVE ATTRACTED MANY LGBTQ+ PEOPLE TO THE AREA. OVER THREE YEARS, ALERT WILL IMPLEMENT OPIOID-SPARING ORDER SETS FOR 10,500 PAIN PATIENTS (1,500 IN YEAR 1 AND 4500 IN YEARS 2 AND 3). CARE PLANS WILL BE DEVELOPED FOR 330 PATIENTS (90, 120 AND 120 IN YEARS 1, 2, AND 3), AND 660 PATIENTS WILL RECEIVE NAVIGATION SERVICES (180, 240, AND 240). NEED: THE NEED FOR THE PROPOSED PROJECT STEMS FROM THE HIGH RATE OF OPIOID-RELATED MORTALITY IN BERKSHIRE COUNTY (48/100,000 POPULATION IN 2021), THE HIGH OPIOID-PRESCRIBING RATE (501/1000 COMPARED TO 333/1000 NATIONWIDE), AND THE LACK OF A SYSTEM OF CARE FOR PAIN PATIENTS WHO RELY ON THE ED. GOAL 1 IS TO IMPLEMENT A SET OF EVIDENCE-BASED, ORDER SETS TO INCREASE THE USE OF OPIOID-SPARING APPROACHES TO TREAT THE HIGH-PRIORITY PAIN CONDITIONS SEEN IN THE BHS EDS, ALONG WITH A RIGOROUS SYSTEM OF CONTINUOUS PERFORMANCE IMPROVEMENT. GOAL 1 OBJECTIVES INCLUDE CONDUCTING A PROGRESSIVE SERIES OF HEALTH STREAM AND 1:1 TRAINING SESSIONS SUCH THAT, BY JUNE 30, 2024, 80% OF ED PROVIDERS ARE PREPARED TO IMPLEMENT ALL FIVE NON-OPIOID ORDER SETS AND DELIVER INTERVENTIONAL PROCEDURES FOR PAIN (INTRAARTICULAR INJECTIONS, TRIGGER POINT INJECTIONS, AND SYMPATHETIC NERVE BLOCKS), THEREBY SIGNIFICANTLY DECREASING OPIOID PRESCRIBING, AND MONITORING ED PROVIDER PERFORMANCE USING THE ALERT DASHBOARD. GOAL 2 IS TO CONDUCT COMPREHENSIVE, MULTIDISCIPLINARY, MULTIMODAL ASSESSMENTS OF PATIENTS WITH HIGH UTILIZATION OF ED SERVICES AND CREATE PLANS FOR TAPERING OR AVOIDING OPIOIDS FOR PAIN MANAGEMENT ACROSS THE CONTINUUM OF CARE. GOAL 2 OBJECTIVES INCLUDE DESIGNING AND IMPLEMENTING NEW CLINICAL PROTOCOLS AND INITIATING INTERDISCIPLINARY TEAM ASSESSMENTS AND CARE PLANNING FOR 10 PATIENTS PER MONTH BEGINNING JANUARY 1, 2024. GOAL 3 IS TO PROVIDE PATIENT NAVIGATION SERVICES TO ENGAGE PATIENTS IN COMPREHENSIVE CARE PLANS FOR PAIN MANAGEMENT OUTSIDE THE ED. GOAL 3 OBJECTIVES ARE TO INITIATE NAVIGATION BEGINNING MARCH 1, 2024; TO MONITOR ITS EFFECTIVENESS, AND, BY THE END OF THE PROJECT, TO CONNECT 80% OF PATIENTS TO AT LEAST ONE SERVICE AND 50% TO TWO SERVICES. EVIDENCE-BASED PRACTICES INCORPORATED INTO ALERT INCLUDE A PROVIDER LEARNING COMMUNITY; CONTINUOUS, DATA-BASED PERFORMANCE IMPROVEMENT; COMMUNITY-BASED RESTORATIVE THERAPIES, AND PATIENT NAVIGATION.