AHA Opioid Case Study Form Submission

Thank you for your interest in sharing a case study for inclusion in AHA’s Opioid Toolkit. The purpose of the collection of case studies is to include examples that hospitals and health systems can reference as they plan similar initiatives. As we review the content, we will follow-up with any additional questions and next steps.

Question Title

* 1. Full Name:

Question Title

* 2. Email address:

Question Title

* 3. Hospital or Organization:

Question Title

* 4. Position:

Question Title

* 5. Phone Number

Question Title

* 6. City

Question Title

* 7. Zip Code

Question Title

* 8. State

Question Title

* 9. Topic

Ensuring clinician education about and oversight of appropriate prescribing practices

Nonopioid pain management

Addressing stigma

Options to identify and address opioid use disorders

Ensuring patient, family and caregiver education about the risks of opioids

Safeguarding prescription opioids against diversion

Working in collaboration with communities

Other – fill in the blank

Question Title

* 10. About the Initiative:
Overview - Name and description of program/initiative; process; involvement of other organizations

Question Title

* 11. Process - What was the process? Were other organizations involved and if yes, how? How are you sustaining effort/keeping it current?

Question Title

* 12. Impact - Measurable results/improvements. Describe the quantitative results of this program.

Question Title

* 13. Lessons Learned - Problems and solutions, e.g., did you have to make a business case to start the initiative? What were the winning elements? What was the biggest challenge? What would you do differently? What alternatives did you consider and why did you choose this approach?

Question Title

* 14. Future Goals - Next steps/objectives for sustaining or expanding; have you shared this work elsewhere, for example, presentations, articles, journal submissions? Is the program replicable by other organizations?

Question Title

* 15. Operating Expenses/Funding - What financial support did the organization and/or partners provide to the effort? How will funding be provided going forward?

Question Title

* 16. Resources (i.e. Resources you created? Resources cited?) - Would you be willing to answer questions or talk with colleagues in more depth about your program? Please attach or link to any resources that you created or references used, if applicable.

Question Title

* 1. Full Name:

Question Title

* 2. Email address:

Question Title

* 3. Hospital or Organization:

Question Title

* 4. Position:

Question Title

* 5. Phone Number

Question Title

* 6. City

Question Title

* 7. Zip Code

Question Title

* 8. State

Question Title

* 9. Topic

Question Title

* 10. About the Initiative: Overview - Name and description of program/initiative; process; involvement of other organizations

Question Title

* 11. Process - What was the process? Were other organizations involved and if yes, how? How are you sustaining effort/keeping it current?

Question Title

* 12. Impact - Measurable results/improvements. Describe the quantitative results of this program.

Question Title

* 13. Lessons Learned - Problems and solutions, e.g., did you have to make a business case to start the initiative? What were the winning elements? What was the biggest challenge? What would you do differently? What alternatives did you consider and why did you choose this approach?

Question Title

* 14. Future Goals - Next steps/objectives for sustaining or expanding; have you shared this work elsewhere, for example, presentations, articles, journal submissions? Is the program replicable by other organizations?

Question Title

* 15. Operating Expenses/Funding - What financial support did the organization and/or partners provide to the effort? How will funding be provided going forward?

Question Title

* 16. Resources (i.e. Resources you created? Resources cited?) - Would you be willing to answer questions or talk with colleagues in more depth about your program? Please attach or link to any resources that you created or references used, if applicable.

* 10. About the Initiative:
Overview - Name and description of program/initiative; process; involvement of other organizations