The overarching goal of this proposal is to integrate patient social risk information into an existing electronic health record (EHR)-based clinical decision support (CDS) tool (CDSv1) to facilitate emergency department (ED)-initiated, social risk-informed opioid use disorder (OUD) medication treatment and ultimately improve treatment adherence and follow up. The investigators will evaluate the feasibility and acceptability of the social care-enhanced CDS tool, CDSv2, (compared to CDSv1) at a single study site (UCSF) as an intervention to increase medication treatment adherence and follow up for adult ED patients experiencing opioid use disorder using a mixed-methods, before-after approach.
All University of California, San Francisco ED providers (residents, attendings, advanced practice providers) who have used either CDSv1 or CDSv2 will be eligible to participate in surveys and interviews regarding feasibility and acceptability.
English-speaking patients ≥18 years of age presenting to the UCSF ED with opioid use disorder who receive medication treatment (as a result of CDSv1 or CDSv2) will be eligible to participate.
they have a medical or psychiatric condition requiring hospitalization at the index ED visit,
are actively suicidal, are cognitively impaired,
present from an extended care facility, or
require opioids for a pain condition.
Sequential
ED-Based Clinical Decision Support for Opioid Use Disorder
Other interventionThe original clinical decision support (CDS) tool, EMergency department initiated BuprenorphinE for opioid use Disorder or EMBED, was designed by researchers at Yale to support emergency department (ED) clinicians with varying levels of experience prescribing buprenorphine for patients with opioid use disorder (OUD). The tool alerts ED providers of a patient who is potentially eligible for MOUD using Epic's storyboard. The provider must then click on the notification to open the OUD evaluation tool, which has multiple components: OUD assessment, OUD diagnosis, withdrawal assessment, and readiness for treatment. These components are then paired with an orderset, "ED Opioid Use Disorder Treatment" that includes nursing orders, prescriptions for buprenorphine and ancillary medications, and substance use disorder discharge resources.
Social Care-Enhanced Clinical Decision Support for Opioid Use Disorder
Other interventionThe investigators will use human-centered design to adapt the basic CDS tool to incorporate patient social needs, involving patients, staff, and end-user ED clinicians in the iterative design process. This tool is being actively developed.
CDSv1 clinician launch
Percentage of ED clinicians who launch CDSv1 for patients with OUD
CDSv1 encounter launch
Percentage of eligible encounters (i.e., encounters including patients with OUD as defined by the EHR-derived phenotype) where CDSv1 was launched by clinician
CDSv2 clinician launch
Percentage of ED clinicians who launch CDSv2 for patients with OUD
CDSv2 encounter launch
Percentage of eligible encounters (i.e., encounters including patients with OUD as defined by the EHR-derived phenotype) where CDSv2 was launched by clinician
CDSv1 treatment adherence
Proportion of participants adherent to the same OUD medication prescribed using CDSv1 at 30 days post-ED visit
CDSv1 follow up
Proportion of participants receiving formal inpatient, outpatient, or ED-based addiction treatment services at 30 days post-ED visit for CDSv1
CDSv2 treatment adherence
Proportion of participants adherent to the same OUD medication prescribed using CDSv2 at 30 days post-ED visit
CDSv2 follow up
Proportion of participants receiving formal inpatient, outpatient, or ED-based addiction treatment services at 30 days post-ED visit for CDSv2
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University of California, San Francisco
Lead sponsor
National Institute on Drug Abuse (NIDA)
Collaborator
