Form 1 Request for Opioid Project Information

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Organization (PSO) Summit to Address the Opioid Crisis Request for Opioid Project Information

Form Approved

OMB No. 0935-0179

Exp. Date 11/30/2020

Introduction: If you have worked on, or are interested in learning about, opioid-related projects and how you may be able to adapt them to a specific care setting, AHRQ would appreciate your completing this form. This information will help us in planning the November 30^th Opioid Summit. For example, we may find a theme worth highlighting at the summit or a setting of care that could use help developing tools for improvement related to opioids. Your participation is voluntary, but very much appreciated.

PSO Information

PSO Name:

Contact Name:

Contact Email:

Public reporting burden for this collection of information is estimated to average 10 minutes per response, the estimated time required to complete the survey. An agency many not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0179) AHRQ, 5600 Fishers Lane, Mail Stop 07W41A, Rockville, MD 20857.

Our PSO has done an opioid-related project that involves one or more of the following components		We can contribute tools or materials
	Yes or No	Yes or No
Collaboration Component
Our PSO collaborates with other PSOs or partner organizations (in addition to your provider members)	☐ Yes ☐ No	☐ Yes ☐ No
Training Component
Our project includes Opioid-related training or education for clinicians	☐ Yes ☐ No	☐ Yes ☐ No
Our project includes Opioid-related training or education for patients	☐ Yes ☐ No	☐ Yes ☐ No
Organizational Support
Our project increases organizational support and/or resources available to clinicians to address the needs of their patients who are using opioids	☐ Yes ☐ No	☐ Yes ☐ No
Our project encourages organizational changes to improve opioid prescribing methods	☐ Yes ☐ No	☐ Yes ☐ No
Our project includes measurements of the impacts of organizational changes and or progress	☐ Yes ☐ No	☐ Yes ☐ No
Tools Component
Our project includes electronic or printed educational materials (toolkits, wall charts, publications)	☐ Yes ☐ No	☐ Yes ☐ No
Our project includes clinical guidelines or decision support tools	☐ Yes ☐ No	☐ Yes ☐ No
Our project includes surveillance or monitoring tools to track opioid use or prescribing patterns	☐ Yes ☐ No	☐ Yes ☐ No
Analysis Component
Our project includes analysis of opioid-related PSWP to identify patterns and trends	☐ Yes ☐ No	☐ Yes ☐ No

1. If your project involved additional components not listed above, please describe them below.

2. If you have suggestions about how PSOs could contribute to addressing the opioid crisis please describe them below.

3. Please provide suggestions for research projects related to opioids.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Cheri Sweigard
File Modified	0000-00-00
File Created	2021-01-20