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Medical centers were randomized to raise that cutoff from the top 1% to the top 5% of risk in February or August 2019. VA researchers analyzed 44,042 patients in all 140 medical centers and published the results on 2 May 2022. Patients under the mandate were five times more likely to receive a case review. They had 22% lower odds of death within four months (odds ratio 0.78, 95% confidence interval 0.65 to 0.94). The authors detected no effect on the nine serious adverse events that were the primary outcomes. Mortality was an exploratory outcome added after the trial began. Unadjusted death rates were 6.7% without the mandate and 6.9% with it. 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Patients of similar predicted risk were thus compared with and without the flag and the review that it triggered. The trial does not compare STORM with another way to pick patients. The paper calls STORM predictive analytics and says that its algorithm was previously validated, but it does not say how the model was built or whether it learned from data."},"evidence":[{"kind":"peer-reviewed study","citation":"Strombotne KL, Legler A, Minegishi T, Trafton JA, Oliva EM, Lewis ET, Sohoni P, Garrido MM, Pizer SD, Frakt AB. Effect of a Predictive Analytics-Targeted Program in Patients on Opioids: a Stepped-Wedge Cluster Randomized Controlled Trial. Journal of General Internal Medicine 38(2):375-381, published online 2 May 2022 (PMC9060407). The authors work at VA's Partnered Evidence-based Policy Resource Center and at the Program Evaluation and Resource Center of VHA's Office of Mental Health and Suicide Prevention, and VHA funded the work.","title":"Effect of a Predictive Analytics-Targeted Program in Patients on Opioids: a Stepped-Wedge Cluster Randomized Controlled Trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9060407/","date":"2022-05-02","written_by":"deployer","quote":"Mandated review inclusion was associated with a significant decrease in all-cause mortality within 4 months of inclusion (OR: 0.78; 95% CI: 0.65-0.94)."}],"replication":{"produced_by":["STORM computed each patient's risk of an overdose- or suicide-related event in the next year from VHA records.","VHA Notice 2018-08 required interdisciplinary teams to review every patient whom STORM rated very high risk.","Each review covered the patient's risks, prescriptions and risk mitigation strategies and was documented in the medical record."],"must_hold":["The patient is prescribed opioid analgesics and has a predicted risk between the top 1% and 5% nationally.","Clinicians have the time to complete case reviews for an expanded high-risk cohort.","The risk scores keep their performance over time and across populations."],"echoes":[]},"paired_incident":null,"headline":"Veterans flagged by *STORM* for case review die less often in a VA trial","metric":"22% lower odds of death within four months","comparator":{"against":"Patients with similar STORM risk at medical centers that had not yet raised the very high risk cutoff, so that no review was mandated","before":null,"after":"22% lower odds of all-cause mortality (OR 0.78, 95% CI 0.65-0.94)","basis":"measured","quote":"We found that being identified as a \"very high\" risk (treatment) patient was associated with 22% lower odds of all-cause mortality relative to control patients.","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9060407/"},"later":null,"value":null,"developer_country":"United States","deployer_country":"United States","unrated_because":null,"brief_notes":null,"brief":null,"revisions":[{"date":"2026-11-01","change":"Added the record from the report of VA's Partnered Evidence-based Policy Resource Center and VHA's Program Evaluation and Resource Center.","source":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9060407/","editor":"AIBD"}],"confidence":"claimed","shade":"low","claim_status":"The deployer's account","claim_basis":"Sources: the deployer's peer-reviewed study. 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The authors work at VA's Partnered Evidence-based Policy Resource Center and at the Program Evaluation and Resource Center of VHA's Office of Mental Health and Suicide Prevention, and VHA funded the work.","title":"Effect of a Predictive Analytics-Targeted Program in Patients on Opioids: a Stepped-Wedge Cluster Randomized Controlled Trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9060407/","date":"2022-05-02","written_by":"deployer","quote":"Mandated review inclusion was associated with a significant decrease in all-cause mortality within 4 months of inclusion (OR: 0.78; 95% CI: 0.65-0.94)."}]}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["evidence"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"sources[].id":{"state":"value_present","value":{"kind":"identifiers","identifiers":["AIBD-1008-source-0001"],"role":"Existing evidence items, in their original order"},"provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"review_state":"record_mapped","coverage":"complete"},"sources[].language":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"sources[].relationship":{"state":"value_present","value":{"kind":"record_fields","fields":{"evidence":[{"kind":"peer-reviewed study","citation":"Strombotne KL, Legler A, Minegishi T, Trafton JA, Oliva EM, Lewis ET, Sohoni P, Garrido MM, Pizer SD, Frakt AB. Effect of a Predictive Analytics-Targeted Program in Patients on Opioids: a Stepped-Wedge Cluster Randomized Controlled Trial. Journal of General Internal Medicine 38(2):375-381, published online 2 May 2022 (PMC9060407). 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Serious adverse events did not change.","account":"The Veterans Health Administration (VHA) built STORM, the Stratification Tool for Opioid Risk Mitigation. Its dashboard uses predictive analytics to stratify patients prescribed opioids by risk of an overdose- or suicide-related event. In March 2018, VHA required interdisciplinary case reviews for patients whom STORM rated very high risk. Medical centers were randomized to raise that cutoff from the top 1% to the top 5% of risk in February or August 2019. VA researchers analyzed 44,042 patients in all 140 medical centers and published the results on 2 May 2022. Patients under the mandate were five times more likely to receive a case review. They had 22% lower odds of death within four months (odds ratio 0.78, 95% confidence interval 0.65 to 0.94). The authors detected no effect on the nine serious adverse events that were the primary outcomes. Mortality was an exploratory outcome added after the trial began. Unadjusted death rates were 6.7% without the mandate and 6.9% with it. The 22% figure comes from a model that adjusts for month, facility and patient characteristics."}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["summary","account"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"systems[].autonomy_permissions":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].component_role":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].deployment_configuration":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].inputs_outputs":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].model_name":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].model_version":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].product_name":{"state":"value_present","value":{"kind":"record_fields","fields":{"system":"STORM (Stratification Tool for Opioid Risk Mitigation)"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["system"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"systems[].provider":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"taxonomy_crosswalks[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"title":{"state":"value_present","value":{"kind":"record_fields","fields":{"title":"VA evaluators find that patients whose STORM opioid risk scores triggered a mandated case review had 22% lower odds of death within four months","headline":"Veterans flagged by *STORM* for case review die less often in a VA trial"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["title","headline"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"version":{"state":"value_present","value":{"kind":"identifiers","identifiers":["bd7d75e229201461a03194a32499c12fccfd2cf180512a4ecf7976395fd6a819"],"role":"SHA-256 of the complete public record and its assessments"},"provenance":{"kind":"curatorial","basis":"SHA-256 of the public record, its assessments, and its displayed answers and notes, excluding its own identifier and the derived coverage summary.","record_fields":[],"source_refs":[]},"review_state":"record_mapped","coverage":"complete"},"workflow":{"state":"value_present","value":{"kind":"record_fields","fields":{"account":"The Veterans Health Administration (VHA) built STORM, the Stratification Tool for Opioid Risk Mitigation. Its dashboard uses predictive analytics to stratify patients prescribed opioids by risk of an overdose- or suicide-related event. In March 2018, VHA required interdisciplinary case reviews for patients whom STORM rated very high risk. Medical centers were randomized to raise that cutoff from the top 1% to the top 5% of risk in February or August 2019. VA researchers analyzed 44,042 patients in all 140 medical centers and published the results on 2 May 2022. Patients under the mandate were five times more likely to receive a case review. They had 22% lower odds of death within four months (odds ratio 0.78, 95% confidence interval 0.65 to 0.94). The authors detected no effect on the nine serious adverse events that were the primary outcomes. Mortality was an exploratory outcome added after the trial began. Unadjusted death rates were 6.7% without the mandate and 6.9% with it. The 22% figure comes from a model that adjusts for month, facility and patient characteristics.","replication":{"produced_by":["STORM computed each patient's risk of an overdose- or suicide-related event in the next year from VHA records.","VHA Notice 2018-08 required interdisciplinary teams to review every patient whom STORM rated very high risk.","Each review covered the patient's risks, prescriptions and risk mitigation strategies and was documented in the medical record."],"must_hold":["The patient is prescribed opioid analgesics and has a predicted risk between the top 1% and 5% nationally.","Clinicians have the time to complete case reviews for an expanded high-risk cohort.","The risk scores keep their performance over time and across populations."],"echoes":[]}}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["account","replication"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"}},"summary":{"total":91,"addressed":91,"known":30,"reviewed":2,"reviewed_complete":2,"reviewed_partial":0,"record_mapped":28,"review_not_assessed":61,"not_assessed":0,"complete":false,"by_state":{"value_present":30,"not_reported":0,"unresolved":61,"not_assessed":0,"not_applicable":0,"withheld":0,"source_unavailable":0}}},"presentation_version":"4c7bbb3bb9b634252e7d7157293a92cb6549396e2c3cfac18f697495769475f1"}