How One QIN-QIO Reduced Opioid Use in Nursing Homes

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An analysis of Medicare Part D data by the U.S. Department of Health & Human Services’ Office of the Inspector General revealed that more than 460,000 Medicare Part D beneficiaries received high amounts of opioids in 2017, and according to a report by the Substance Abuse and Mental Health Services Administration, those numbers are expected to rise. 

To address this growing concern, atom Alliance — the Quality Innovation Network-Quality Improvement Organization serving Alabama, Indiana, Kentucky, Mississippi and Tennessee — initiated a two-phase pilot project to tailor pain management treatment for nursing home residents. 

atom Alliance conducted a performance improvement project to reduce opioid use in nursing homes while improving quality measures. The nursing homes were recruited to join trainings by a pharmacist on evidence-based opioid resources, including guidelines from the Centers for Disease Control and Prevention (CDC) and the use of comfort menus designed to offer non-pharmacologic pain management to residents. Twenty nursing homes (with a total of 725 long-stay residents) participated in the project between January and May 2018.

The goals of the project were to achieve a 10 percent reduction in residents with opioid orders and a 10 percent increase in specific opioid indications. 

The initial challenge for atom Alliance was providing nursing homes with a unique way to improve their Nursing Home Quality Composite Measure Score. The composite score consists of 13 long-stay quality measures and reflects the cumulative effect of systems improvement in long-term care settings. Opioids can negatively affect several quality measures, such as falls and pressure ulcers. Indications for opioid use were not specific, making it difficult to target pain treatment to residents’ individual needs. 

To meet these goals, atom Alliance trained the recruited nursing homes on the CDC Guidelines for Prescribing Opioids for Chronic Pain, alternatives for pain management and ways to taper opioids when appropriate. The QIN-QIO also shared best practices and data from various nursing homes so they could learn from peers. 

After the nursing home staff members were trained, they put that knowledge to work ensuring residents had specific indications for opioid use. They reviewed each chart carefully, noting each resident who might be a candidate for tapering, and consulted with residents and their providers to identify their sources of pain. Once their sources of pain were identified, nursing home staff and providers were able to address the residents’ comfort with appropriate solutions.


Targeted use of opioids, combined with non-opioid pain treatments, proved to be successful for several of the nursing homes. During both pilot phases, the proportion of specific opioid indications increased from 42 to 58 percent, allowing the skilled nursing facilities to target pain treatment to residents’ individual needs. The relative rate of opioid use decreased by 7.5 percent.

Additionally, the number of non-opioid treatments offered per facility more than tripled through the use of comfort menus and other interventions. 

The aggregate CMS nursing home composite score for six homes participating in the initial phase one pilot improved from 7.89 to 6.63, indicating improved overall quality of care. Of the 13 measures, the three related to opioids that improved the most were weight loss (10 fewer patients with weight loss), moderate to severe pain (eight fewer patients reporting), high-risk pressure ulcers (eight fewer patients with pressure ulcers), and falls with a major injury (eight fewer patient falls).

To learn more about this program, visit the atom Alliance blog.