Identifying High-Risk Patients for Harm Reduction, Risk Mitigation, and Treatment Outreach: Leveraging the Veterans Health Administration's Transformative Approach to Improving Opioid Safety and Decreasing All-Cause Mortality

This session will first describe the Veterans Health Administration’s (VHA) rigorously evaluated, transformative approach to implementing targeted prevention interventions among patients prescribed opioids using VHA’s Stratification Tool for Opioid Risk Mitigation (STORM; Oliva et al., 2017). STORM uses predictive analytics to identify patients at risk for overdose and suicide among patients prescribed opioids, presents risk factors, and recommends evidence-based risk mitigation strategies and non-pharmacologic treatment options. A key finding from VHA’s 3-year Randomized Program Evaluation of STORM (Minegishi et al., 2018, 2019, 2022; Strombotne et al., 2022, Chinman et al., 2019; Rogal et al., 2020) was mortality effects for an interdisciplinary risk review mandate of STORM predictive model-identified high-risk patients, specifically, a 22% reduction in all-cause mortality within a 4-month time frame (~180 lives saved; Strombotne et al., 2022).

Presenters will then describe how VHA is applying lessons from these efforts, as well as its award-winning opioid overdose education and naloxone distribution (OEND) efforts (https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=5679), to support national implementation of additional harm reduction interventions, including syringe services programs (SSPs). For SSP outreach efforts, one of the biggest challenges is identifying patients with injection drug use (IDU) since there are no specific ICD-10-CM codes. VHA is taking a multipronged approach to addressing this gap, including advocating for a new ICD-10-CM code for IDU, applying a natural language processing (NLP; text-mining of clinical notes) approach to help identify patients with IDU, and creating a national standardized note that includes data elements that can be stored in VHA’s Corporate Data Warehouse. These approaches will inform dashboards to help identify high-risk patients who may benefit from harm reduction, risk mitigation, and treatment outreach, including SSPs, fentanyl test strips, and substance use and infectious disease services (e.g., medications for opioid use disorder, Pre-exposure Prophylaxis; hepatitis B-C testing/treatment).