IMPROVE: Improving Management of Pain Relief and Opioid (Rx) Verification


Chronic non-terminal pain is common in the United States, and improvements are needed in primary care where most chronic pain is managed. Among the problems associated with chronic pain is the epidemic of prescription opioid misuse and overdose deaths. In 2009, a national panel of experts published consensus guidelines for opioid therapy of chronic pain. Consequently, the Mallinckrodt C.A.R.E.S. AllianceSM  has developed a set of tools for clinicians to improve the effectiveness and safety of opioid prescribing that align with the 2009 guidelines. Research to date suggests that many primary care clinicians have not integrated the 2009 guidelines into their work; this Quality Improvement project seeks to address this issue.

Specific Aims and Objectives

The two-phase demonstration project is designed to refine and test implementation of opioid management tools currently used in primary care practice settings, with the broad goal of improving the safety and effectiveness of opioid prescribing for chronic non-terminal pain.

The specific aims are:

  1. Review and refine opioid management tools, leading to the development of a practice-adaptable toolkit and an implementation guide
  2. Assess perspectives of patients and primary care clinicians regarding implementation of toolkit
  3. Evaluate the feasibility of primary care clinicians to collect and track patient-reported function during routine clinical visits

Phase 1 (complete) - Expert Panels: We recruited primary care clinicians, administrative staff and specialist consultants to provide guidance in the refinement of a subset of opioid management tools and in the development of an implementation guide. Panel outcomes will be a practice-adaptable toolkit and implementation guide.

Phase 2 (near completion) - Practice Implementation: We recruited practices that identified a need to improve their current opioid prescribing and patient management, but hade not yet implemented a process for doing so, or implemented one that is not working as planned. Practices that have implemented a successful opioid prescribing and management protocol were not a good fit for this study. Practice were requested to implement the management program that is being tested in this project.

We invited 10 practices to participate in the eight-month implementation phase. During months one and two, practices continued with usual care, while documenting any concerns and/or frustrations with current opioid management procedures. Patient-reported functional assessment data was collected during this time to guide subsequent treatment and track opioid prescribing tool implementation. Over the next three months, practices were asked to utilize the practice-adaptable toolkit and implementation guide with new and current patients. During the final three months, providers and patients will be asked to complete de-identified questionnaires in a traditional practice-based research card study. Practices will also be asked for guidance on improving the tools and implementation guide.

Participation Benefits: Participation Benefits: Expert Panel members will receive $300 for approximately three hours of time reviewing and refining a subset of tools and developing an associated implementation plan. All practices will receive $3,500 for their participation during the eight-month implementation phase.


This project is being conducted from March 1, 2013 through April 2015.


Active intervention is currently in progress.

Key Findings and Publications

Check back later for key findings and publications.

Contact Information

For additional information about this study, please contact: 

Robin Liston, MPH
Research Project Manager
AAFP National Research Network
1-800-274-2237, x3175

Emily Bullard, MPH, CHES
Senior Research Project Coordinator
AAFP National Research Network
1-800-274-2237, x3174

This project was supported by a grant from Mallinckrodt C.A.R.E.S. AllianceSM.