Table 2.

Six Building Blocks

Building Block	Description	Examples of Action Steps
1. Provide Leadership     Support	Leadership can build organization-   wide consensus to prioritize safe,   more selective, and more cautious   opioid prescribing	Identify clinical champions to spearhead COT practice   change initiatives. Provide protected time and space for providers and   staff to discuss and agree upon short and long-term   goals for COT practice change initiatives
2. Revise Policies,     Patient Agreements     and Workflows	Revise and implement clinic policies   and define standard work for   health care team members to   achieve safer opioid prescribing   and COT management in each   clinical contact with COT   patients.	Convene a team from each area of the clinic to revise   existing policies or write new ones Review patient agreement and revise to ensure   alignment with clinic policies. Discuss with all staff and clinicians and modify roles,   responsibilities and workflows accordingly
3. Implement a Registry     for Population     Management	Implement pro-active population   management before, during, and   between clinic visits of all COT   patients to ensure that care is safe   and appropriate and provide   measure to track COT   improvement activities.	Enter all existing COT patients and their relevant   enrollment data into a COT registry. Assign each COT patient to a single provider   responsible for managing their opioid use and. Assign a team member in each clinic with responsibility   and protected time for managing and updating the   registry. Use the registry to track data for prescription   management (e.g., COT dose, PEG scores to   monitor function and pain, date of state prescription   database checks)
4. Conduct Planned     Patient-Centered     Visits	Conduct pre-visit planning and   support patient-centered,   empathic communication for   COT patient care.	Review COT registry reports prior to the visit to   identify care gaps Monitor and adjust management based on function and   quality of life rather than pain scores (the PEG scale) Offer organizational support for clinic staff and   providers to preview charts and do team huddles   about COT patients Support staff training, to encourage the use of   empathic communication techniques that
5. Identify Resources     for Complex Patients	Develop resources to ensure that   patients who develop complex   opioid dependence, are identified   and provided with appropriate   care	Identify addiction referral resources and other mental/   behavioral health resources, and ensure they are   readily available, setting-up referral protocols or   agreements as necessary.
6. Measure Progress	Continuously monitor progress and   improve with experience.	Identify key process and outcome measures to monitor   practice change implementation. Monitor agreed upon COT patient care data, providing   and discussing data with clinic staff and medical   providers at monthly meetings.