Opioid Pain Management Quality Metrics

The following are examples of non- validated quality metrics that could be used by individual providers, health care systems, or multi-center quality improvement collaboratives to support implementation of the American Academy of Pediatrics guideline for Opioid Prescribing. These metrics reflect several key aspects of care for common clinical issues. A subset of these metrics or entirely different metrics could also be selected.

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Studies have reported inequities in opioid prescribing and related outcomes. The following examples illustrate possible clinical populations for each measure.

*Stratify by health equity measures such as, but not limited to, race and ethnicity, preferred language, sex and gender, and insurance type.

^In calculating the denominator for these measures, reference the literature available for specific clinical populations. Compare to other institutions’ prescribing practices for specific clinical populations.

Opioid prescribing (KAS 1)

Type of Measure: Outcome

Definition*: % of patients prescribed opioids in a clinical scenario identified to need or potentially need opioids^{^}

Calculation:

N: Patients prescribed opioids
D: Patients identified to need or potentially need opioids^{^}

(i.e. Patients discharged with sickle cell disease pain crisis)

Type of Measure: Outcome

Definition*: Patients prescribed opioids in a clinical scenario identified to not need opioids^{^}

Calculation: Count (rare event) metric^{^}(i.e. Patients discharged after orthopedic injury)

Type of Measure: Balancing

Definition*: Phone calls, ED returns, re-admissions, reports of poor pain control, satisfaction with pain control at home (whichever applies clinically and feasibly to the setting)

Calculation: Count (rare event) metric

Opioid monotherapy (KAS 2)

Opioid formulation (KAS 3)

Opioid dose weight-based (for <40 kg) (KAS 3)

Opioid dose age-based (for >40 kg) (KAS 3)

Opioid supply (KAS 3)

Type of Measure: Process

Definition*: % of opioid prescriptions with a 5-day supply or less (unless expected duration of pain >5 days)

Calculation:

N: Opioid prescriptions with a 5-day supply or less (can measure as total doses and/or days dispensed)
D: Opioid prescriptions

Type of Measure: Process

Definition*: Average number of days and/or doses per opioid prescription

Calculation: Continuous metric

PDMP (in KAS 3)

Tramadol/Codeine (KAS 4.1)

Tramadol/Codeine (KAS 4.2)

Tramadol (KAS 4.3)

Tramadol/Codeine (KAS 4.4)

Co-Prescribing Benzodiazepines (KAS 5)

Naloxone (KAS 6)

Caregiver Education - Safe Storage and Administration (KAS 7)

Type of Metric: Outcome

Definition*: % of patients prescribed opioids that receive education about safe storage and directly observed administration during the same encounter

Calculation:

N: Patients prescribed opioids that receive education about safe storage and directly observed administration during the same encounter
D: Patients prescribed opioids

Caregiver Education – Safe Disposal (KAS 8)

Chronic Pain (KAS 9)

Type of Measure: Outcome

Definition*: % of patients prescribed opioids with pre-existing chronic pain

Calculation:

N: Patients prescribed opioids with pre-existing chronic pain
D: Patients prescribed opioids

Type of Measure: Balancing

Definition*: Patients with chronic pain with opioids discontinued

Calculation: Count (rare event) metric

Last Updated

08/23/2024

Source

American Academy of Pediatrics