| 作者单位 |
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT 06519, USA ;
Yale University School of Medicine, New Haven, CT 06510, USA ;
Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, CT 06511, USA ;
Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT 06520, USA ;
Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA ;
Department of Emergency Medicine, University of Colorado, Aurora, CO 80045, USA ;
Department of Emergency Medicine, Mayo Clinic, Rochester, MN 55905, USA ;
The Patient Revolution, New Haven, CT 06511, USA ;
Information Technology Services, Yale New-Haven Health, New Haven, CT 06519, USA ;
Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA ;
Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Baystate, MA 01199, USA ;
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| 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 (EMergency department-initiated BuprenorphinE 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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