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Progress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder

Authors
  • Melnick, Edward R.1
  • Nath, Bidisha1
  • Ahmed, Osama M.2
  • Brandt, Cynthia1, 2
  • Chartash, David3
  • Dziura, James D.4
  • Hess, Erik P.5
  • Holland, Wesley C.2
  • Hoppe, Jason A.6
  • Jeffery, Molly M.7
  • Katsovich, Liliya4
  • Li, Fangyong4
  • Lu, Charles C.4
  • Maciejewski, Kaitlin4
  • Maleska, Matthew8
  • Mao, Jodi A.2
  • Martel, Shara1
  • Michael, Sean6
  • Paek, Hyung9
  • Patel, Mehul D.10
  • And 8 more
  • 1 Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT 06519, USA
  • 2 Yale University School of Medicine, New Haven, CT 06510, USA
  • 3 Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, CT 06511, USA
  • 4 Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT 06520, USA
  • 5 Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA
  • 6 Department of Emergency Medicine, University of Colorado, Aurora, CO 80045, USA
  • 7 Department of Emergency Medicine, Mayo Clinic, Rochester, MN 55905, USA
  • 8 The Patient Revolution, New Haven, CT 06511, USA
  • 9 Information Technology Services, Yale New-Haven Health, New Haven, CT 06519, USA
  • 10 Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
  • 11 Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Baystate, MA 01199, USA
Type
Published Article
Journal
Journal of psychiatry and brain science
Publication Date
Feb 21, 2020
Volume
5
Identifiers
DOI: 10.20900/jpbs.20200003
PMID: 32309637
PMCID: PMC7164817
Source
PubMed Central
Keywords
License
Green
External links

Abstract

Buprenorphine (BUP) can safely and effectively reduce craving, overdose, and mortality rates in people with opioid use disorder (OUD). However, adoption of ED-initiation of BUP has been slow partly due to physician perception this practice is too complex and disruptive. We report progress of the ongoing EMBED ( EM ergency department-initiated B uprenorphin E for opioid use Disorder) project. This project is a five-year collaboration across five healthcare systems with the goal to develop, integrate, study, and disseminate user-centered Clinical Decision Support (CDS) to promote the adoption of Emergency Department (ED)-initiation of buprenorphine/naloxone (BUP) into routine emergency care. Soon to enter its third year, the project has already completed multiple milestones to achieve its goals including (1) user-centered design of the CDS prototype, (2) integration of the CDS into an automated electronic health record (EHR) workflow, (3) data coordination including derivation and validation of an EHR-based computable phenotype, (4) meeting all ethical and regulatory requirements to achieve a waiver of informed consent, (5) pilot testing of the intervention at a single site, and (6) launching a parallel group-randomized 18-month pragmatic trial in 20 EDs across 5 healthcare systems. Pilot testing of the intervention in a single ED was associated with increased rates of ED-initiated BUP and naloxone prescribing and a doubling of the number of unique physicians adopting the practice. The ongoing multi-center pragmatic trial will assess the intervention’s effectiveness, scalability, and generalizability with a goal to shift the emergency care paradigm for OUD towards early identification and treatment. Trial Registration: Clinicaltrials.gov # NCT03658642 .

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