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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

  • 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
Published Article
Journal of psychiatry and brain science
Publication Date
Feb 21, 2020
DOI: 10.20900/jpbs.20200003
PMID: 32309637
PMCID: PMC7164817
PubMed Central
External links


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: # NCT03658642 .

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