Six Building Blocks

The Six Building Blocks is an evidence-based program to help primary care clinics improve how they manager long-term opioid therapy for patients with persistent pain.

Six Building Blocks

A team-based approach to improving opioid management in primary care

The challenge

Most opioid prescriptions for chronic pain are provided in primary care — which means that primary care teams need an evidence-based quality improvement roadmap to help implement effective, guideline-driven care for patients with persistent pain. Although large health systems may be able implement initiatives to reduce opioid prescribing at scale, smaller primary care practices often lack the necessary resources and workforce.

The Six Building Blocks is an evidence-based program to help primary care clinics improve how they manage long-term opioid therapy for patients with persistent pain. The program was developed by the ACT Center in partnership with the University of Washington Department of Family Medicine and supported by funding from the Agency for Healthcare Research and Quality. It provides a quality improvement roadmap to help primary care teams implement effective, compassionate, patient-centered, and guideline-driven opioid therapy for patients with persistent pain.

The tools and resources we developed in the Six Building Blocks program include a model, an assessment, and a set of implementation guides. These tools are in the public domain, and you can find links to them in our resource library. Our longtime partners at Comagine Health are using and adapting these resources in their ongoing work to advance the Six Building Blocks model. Learn more on their website.

In a study of the effectiveness of the program we:

  • Identified best practices from 20 exemplar primary care clinics across the United States that were selected for their use of team-based clinical innovations. These 6 best practice "building blocks" formed the basis of the program:
    • Provide supportive leadership and build consensus; 
    • Revise, align, and implement clinic policies, patient agreements, and workflows; 
    • Track and monitor patient care; 
    • Prepare for planned, patient-centered visits; 
    • Develop resources for “complex” patients with more needs; and 
    • Measure and celebrate success 
  • Designed an implementation blueprint (the Six Building Blocks) to facilitate evidence-based quality improvement, including a program overview, self-assessment, and implementation guide. These resources describe team-based, systems-level clinical changes to help patients with persistent pain maximize their functional status and quality of life with a treatment plan that minimizes risk to patients and clinicians alike.
  • Supported implementation of the Six Building Blocks in 6 rural-serving organizations, including 20 clinics, in eastern Washington and central Idaho. They are part of the UW’s Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region Practice and Research Network.
  • Evaluated the effectiveness by comparing patient and clinic outcomes in participating sites to those of clinics in the same geographic areas that did not receive the program. Our evaluation found improvements in high-dose opioid prescribing as well as reduced work stress for clinicians and staff in clinics that implemented Six Building Blocks.


Six Building Blocks resources can be useful for anyone who is interested in improving the care of patients using long-term opioid therapy, such as practice facilitators, quality improvement advisors, clinicians and staff, and clinic administrators. 

The program has been adapted or recommended by a variety of organizations, including the Washington State Department of Health, Washington State's Bree Collaborative, the Oregon Health Authority, the Substance Abuse and Mental Health Administration (SAMHSA), and the Centers for Disease Control and Prevention (CDC). The ACT Center has also used the Six Building Blocks resources in designing the Integrated Pain Management Program at Kaiser Permanente Washington.

Featured publications

Shoemaker-Hunt SJ, Evans L, Swan H, Bacon O, Ike B, Baldwin LM, Parchman ML. Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices. Implement Sci Commun. 2020 Feb 26;1:16. doi: 10.1186/s43058-020-00008-6. Full text

Parchman ML, Ike B, Osterhage KP, Baldwin LM. Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics. J Clin Transl Sci. 2020 Jan 10;4(5):425-430. doi: 10.1017/cts.2019.448. PubMed

Ike B, Baldwin LM, Sutton S, Van Borkulo N, Packer C, Parchman ML. Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management. J Am Board Fam Med. 2019 Sep-Oct;32(5):715-723. doi: 10.3122/jabfm.2019.05.190027. PubMed

Parchman ML, Penfold RB, Ike B, Tauben D, Von Korff M, Stephens M, Stephens KA, Baldwin LM. Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing. Ann Fam Med. 2019 Jul;17(4):319-325. doi: 10.1370/afm.2390. PubMed

Parchman ML, Von Korff M, Baldwin LM, Stephens M, Ike B, Cromp D, Hsu C, Wagner EH. Primary care clinic re-design for prescription opioid management. J Am Board Fam Med. 2017 Jan 2;30(1):44-51. doi: 10.3122/jabfm.2017.01.160183. PubMed


Agency for Healthcare Research and Quality


WWAMI region Practice and Research Network
University of Washington


Environmental scanning
Stakeholder engagement
Model development
Assessment tool


Michael Parchman


Featured resource

A how-to implementation guide for primary care clinics improving pain care and opioid management

Featured news

Michael Parchman
A research team led by Dr. Michael Parchman uses new ways to support small clinics in reducing opioid use in the rural Pacific Northwest