Academic Journal
User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial
| العنوان: | User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial |
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| المؤلفون: | Melnick, Edward R, Nath, Bidisha, Dziura, James D, Casey, Martin F, Jeffery, Molly M, Paek, Hyung, Soares, William E, Hoppe, Jason A, Rajeevan, Haseena, Li, Fangyong, Skains, Rachel M, Walter, Lauren A, Patel, Mehul D, Chari, Srihari V, Platts-Mills, Timothy F, Hess, Erik P, D’Onofrio, Gail |
| المساهمون: | National Institute on Drug Abuse |
| المصدر: | BMJ ; page e069271 ; ISSN 1756-1833 |
| بيانات النشر: | BMJ |
| سنة النشر: | 2022 |
| الوصف: | Objective To determine the effect of a user centered clinical decision support tool versus usual care on rates of initiation of buprenorphine in the routine emergency care of individuals with opioid use disorder. Design Pragmatic cluster randomized controlled trial (EMBED). Setting 18 emergency department clusters across five healthcare systems in five states representing the north east, south east, and western regions of the US, ranging from community hospitals to tertiary care centers, using either the Epic or Cerner electronic health record platform. Participants 599 attending emergency physicians caring for 5047 adult patients presenting with opioid use disorder. Intervention A user centered, physician facing clinical decision support system seamlessly integrated into user workflows in the electronic health record to support initiating buprenorphine in the emergency department by helping clinicians to diagnose opioid use disorder, assess the severity of withdrawal, motivate patients to accept treatment, and complete electronic health record tasks by automating clinical and after visit documentation, order entry, prescribing, and referral. Main outcome measures Rate of initiation of buprenorphine (administration or prescription of buprenorphine) in the emergency department among patients with opioid use disorder. Secondary implementation outcomes were measured with the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Results 1 413 693 visits to the emergency department (775 873 in the intervention arm and 637 820 in the usual care arm) from November 2019 to May 2021 were assessed for eligibility, resulting in 5047 patients with opioid use disorder (2787 intervention arm, 2260 usual care arm) under the care of 599 attending physicians (340 intervention arm, 259 usual care arm) for analysis. Buprenorphine was initiated in 347 (12.5%) patients in the intervention arm and in 271 (12.0%) patients in the usual care arm (adjusted generalized estimating equations odds ratio ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1136/bmj-2021-069271 |
| الاتاحة: | http://dx.doi.org/10.1136/bmj-2021-069271 http://data.bmj.org/tdm/10.1136/bmj-2021-069271 https://syndication.highwire.org/content/doi/10.1136/bmj-2021-069271 |
| Rights: | http://creativecommons.org/licenses/by-nc/4.0/ |
| رقم الانضمام: | edsbas.75E2B4C6 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1136/bmj-2021-069271 |
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