CTN-0091: Preventing and Identifying Opioid Use Disorder Using the Six Building Blocks (6BBs) for Improving Opioid Prescription Management

Laura-Mae Baldwin, MD, MPH
Lead investigator
University of Washington

This project seeks to develop and test a “train the trainer” curriculum and training experience that will facilitate the spread and use of the Six Building Blocks (6BBs) by adapting the 6BBs framework and toolkit for health systems and other organizations, training personnel to facilitate its implementation, and monitoring results of this implementation.

The Six Building Blocks is a team-based intervention for improving opioid prescribing and management. The Six Building Blocks include:

  1. Providing leadership support
  2. Revising and aligning policies, patient agreements, and workflows
  3. Tracking the patient population
  4. Offering planned, patient-centered visits
  5. Identifying resources for complex patients
  6. Measuring success

Find Six Building Blocks Resources for Practitioners here.

Funded by the NIH HEAL InitiativeSM.

Primary Findings

This project included creating Six BBs practice facilitator (PF) training program, implementing the program with up to five health system organizations, evaluating the program’s implementation, then revising the program, and developing a dissemination strategy for the program. The study recruited trainees with quality improvement experience to the six-month training program with a one-day, in-person knowledge and skill-building training, followed by six months of applied and shared learning experiences. Mixed methods assessed the in-person training, trainee confidence in their practice facilitation skills after in-person training and six months later, clinic initiation and completion of Six BBs milestones, and barriers and facilitators to engaging in PF work. The one-day training received high ratings (average 3.5/4). Average skills confidence scores were high (>75/100) after the one-day training and six months later. Initiation of expected Six BBs milestones was high, but many were not completed within six months. Barriers included lack of organizational support for protected Six BBs work time, lack of a clinical advisor, and trainee lack of experience with chronic pain management and the Six BBs. Investigators conclude that quality improvement personnel can be trained to scale up a complex PF intervention, though new PFs may take more time than experienced teams. Training must support new PFs throughout implementation of the intervention, and provide resources and skills to tailor interventions to clinics with varied levels of readiness.

Primary Outcomes Article: Parchman ML, et al. Training Needs of Practice Facilitators When Implementing An Opioid Improvement Initiative in Primary Care. Research Square 2021 (pre-print server; article has not been peer-reviewed). [get article]

    Node Involvement

    Lead Node(s):

  • Pacific Northwest Node

  • All Participating Nodes:

  • Pacific Northwest Node