Community Care of North Carolina (CCNC), supported by a $2.6 million grant from The Trust (KBR) and matching funds from the ORH, is expanding the Project Lazarus approach statewide through 3 interrelated initiatives:

 1.     Community-based Coalitions aim to broaden awareness of the extent and seriousness of unintentional poisonings and chronic pain issues, and to support community involvement in prevention and early intervention.  Attendees include a broad range of  community partners including law enforcement, public health, schools, hospitals and faith based organizations.

2.     The Clinical Process focuses on the medical assessment and treatment of chronic pain. Toolkits have been developed to guide decisions by treating providers in Emergency Room, primary care and care management settings. The kits provide decision support and other tools for providers identifying and addressing each patient’s specific care needs. These toolkits can be accessed online at https://www.communitycarenc.org/population-management/chronic-pain-project/. Additional training will be rolled out in 40 sites across the state for all opioid prescribers including primary care physicians, emergency room doctors, hospitalists, dentists, and local pharmacists. The focus of the education is on assessment criteria for pain, safe opioid prescribing, use of CCNC’s Provider Portal, and registration and use of the Controlled Substance Reporting System (CSRS). Information tailored to specific clinicians includes:

• Care managers.  Data tools have been developed to help care managers identify patients most at-risk of developing issues with opioids, (>12 narcotic scripts and >=10 ED admissions in a 12 month period of time).  Tools tailored to the needs of these high-risk patients such as pain agreements are available through the CCNC Provider Portal and the CCNC website.
• Primary care physicians.  The PCP tool kit provides information on assessing and managing chronic pain in the primary care setting, encourages the use of pain treatment agreements and offers guidance for accessing and using the Provider Portal and the CSRS.
• Emergency Department physicians.  The ED toolkit describes policy issues that must be addressed at the administrative level; provides clinical tools for the assessment of acute vs. chronic pain; discusses the value of the Provider Portal and CSRS in the ED setting; shares strategies to decrease unnecessary imaging; and lists appropriate pain treatment pathways.

3.    Program outcome goals (as measured through the UNC Injury Prevention Research Center) aim to decrease mortality due to unintentional poisonings; decrease inappropriate utilization of ED for pain management; decrease inappropriate ED utilization of imaging with diagnosis of chronic pain; and increase use of Provider Portal and CSRS.

Project Lazarus Resources: Infrastructure of Community Care of North Carolina (14 CCNC Networks, 14 local Chronic Pain Coordinators, 600 care coordinators statewide, 5,000 primary care physicians participating with CCNC).