Combatting the opioid epidemic with analytics and AI

Brooks Rehabilitation uses SAS Visual Analytics to help reduce opioid prescription rates by 50%–70%

Nearly half a million people died from opioid misuse between 1999 and 2019, according to the Centers for Disease Control and Prevention. Concern over this crisis has mounted over the years. In 2013, the U.S. Department of Health and Human Services declared opioid overdose and misuse an epidemic. Then, in 2017, it was declared a public health emergency.

Among physicians and health care providers, advancing pain care and reducing prescriptions of opioids is a major goal in combatting this crisis. The opioid epidemic is influenced by many complex factors, and the wide range of opioid types and strengths makes it challenging to consistently measure prescribing patterns. But Brooks Rehabilitation, a leading physical rehabilitation system of care, is working to change this.

Headquartered in Jacksonville, Florida, Brooks Rehabilitation is ranked as the No. 1 rehabilitation hospital in Florida by U.S. News & World Report and among the top 20 in the country. The organization specializes in treating patients who’ve experienced strokes, brain or spinal cord injuries, amputations and other complex orthopedic or neurologic injuries or illnesses. In addition to three inpatient rehabilitation hospitals for complicated injuries, Brooks Rehabilitation offers outpatient rehabilitation, skilled nursing facilities, assisted living facilities, home health care and community programs for continued rehabilitation.

As an organization specializing in complicated and life-altering injuries, Brooks Rehabilitation takes responsible and effective pain management seriously. Its care teams wanted to find ways to reduce the likelihood of opioid abuse and addiction for its patients. To achieve this, the medical team needed a standard measurement system to track opioid prescription rates.

Creating a shared language with data and analytics

The first step on this journey was to create a cohesive data system that would allow the Brooks Rehabilitation team to access all the necessary data in one place. “Before SAS, our analytics were primarily done on spreadsheets. We lacked automation, and everything was very siloed,” says Mindi Manes, PhD and Director of the Center for Outcomes Analytics and Research at Brooks Rehabilitation. “We wanted to centralize our data into a single analytics platform.”

In 2015, the team began creating a unified and accessible analytics ecosystem. They partnered with SAS Consulting Services to guide them through the initial implementation and ongoing updates.

“Now,” Manes says, “we have several SAS dashboards that our physicians and therapists are using today. A great example is our therapy outcomes dashboard. This dashboard allows our therapy teams to evaluate in near real-time the functional mobility of our patients on admission and as they move through the hospital system. This allows them to improve their clinical documentation related to therapy outcomes and to ensure we are improving patient mobility before patients are discharged home.”

Reducing opioid prescriptions in patient care

Once the team established a unified and central source of analytics, they were able to analyze patient care more effectively, including the prescription rate of opioids at Brooks’ facilities. “One of the things I am most proud of,” says Manes, “is that through data and analytics, we can support our clinical teams in providing the best patient care. A great example of this is our partnership with the multimodal pain team in reducing the use of opioid medications among our patients in the hospitals.”

The multimodal pain team at Brooks Rehabilitation specializes in providing effective and safe pain management to patients, including offering non-opioid pain management options like massage, heat treatments, physical therapy, local injections and more. But, in addition to offering effective non-opioid pain management options, the group also wanted to track opioid prescription rates. However, not all opioids are created equally – each has different potency, uses, and effects. So, the team needed a standard baseline to assess reduction effectively.

Parag Shah, MD, MBA, FACHE, Medical Director of Brooks Rehabilitation Hospital – Bartram Campus and Medical Director of Data Solutions of Brooks Rehabilitation explains, “For example, oxycodone, hydrocodone, fentanyl, codeine, tramadol. These are all opioids. So how do we compare apples to apples?”

So, using its data and SAS, the team developed a solution. “We used SAS to convert all medications to morphine milligram equivalents,” explains Dr. Shah. With this method, opioid medication dosages are converted to morphine milligram equivalents to standardize dosages among opioids with differing strengths. “Then, we started benchmarking patient data from before we built the program versus afterward. Next, we created a dashboard to create awareness around this program with our providers. We also started sending out a daily email to providers to help them visualize their patient’s Morphine Milligram Equivalent,” says Dr. Shah.

50%–70% reduction in opioid use

Now, the morphine milligram equivalent tool is an integral part of regular team meetings where patient pain management and satisfaction are discussed among physicians, nursing and therapy staff.

“Using these different techniques to drive that change with data, we saw on average a 50% to 75% reduction in opioid use after implementing SAS,” reports Dr. Shah.

Following the resounding success of this program, the Brooks Rehabilitation team has found a variety of ways to use their centralized data ecosystem to further improve patient care. “I think throughout the organization, we are seeing a big uptick in the use of data,” says Dr. Shah. “The requests for data projects continue to increase as we continue to maximize our programs. Overall, I would say the culture within our team has shifted in a very positive way towards more data-driven decisions.”

Looking ahead to continued innovation

Since adopting SAS, data has become a crucial component of patient care decisions. Dr. Shah says, “SAS has been critical to how our team now analyzes, visualizes and presents data. It helps drive conversations and questions, and now I would say throughout our organization, I don’t think you’ll find leaders who don’t understand the benefits of data.”

The Brooks Rehabilitation team is continuing to find new and innovative ways to use data, analytics and artificial intelligence to improve the lives of its patients. “Currently, we use AI for therapeutic purposes, with things like virtual reality and robotic exoskeletons,” says Manes. “We have a data scientist who is helping us develop machine learning models to predict different patient outcomes related to identifying sub-populations of patients who do best with specific therapies. So, we are looking to expand those efforts.”

“Our patients are benefiting greatly from the use of data,” says Dr. Shah. “I’m thankful to the SAS team for helping Brooks drive change and build a data-driven culture, which really does impact patient care. It helps us give patients the highest quality outcomes. Ultimately, those improved outcomes and increased independence bring joy back into their lives.”