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Clinical Decision Support for Emergency Department-Initiated Buprenorphine for Opioid Use Disorder.
Clinical Decision Support for Emergency Department-Initiated Buprenorphine for Opioid Use Disorder.
상세정보
- 자료유형
- 학위논문
- Control Number
- 0017160639
- International Standard Book Number
- 9798382329895
- Dewey Decimal Classification Number
- 610
- Main Entry-Personal Name
- Holland, Wesley C.
- Publication, Distribution, etc. (Imprint
- [S.l.] : Yale University., 2024
- Publication, Distribution, etc. (Imprint
- Ann Arbor : ProQuest Dissertations & Theses, 2024
- Physical Description
- 48 p.
- General Note
- Source: Dissertations Abstracts International, Volume: 85-11, Section: B.
- General Note
- Advisor: Melnick, Edward R.
- Dissertation Note
- Thesis (M.D.)--Yale University, 2024.
- Summary, Etc.
- 요약Adoption of emergency department (ED) initiation of buprenorphine (BUP) for opioid use disorder (OUD) into routine emergency care has been slow, partly due to clinicians' unfamiliarity with this practice and perceptions that it is complicated and time-consuming. To address these barriers and guide emergency clinicians through the process of BUP initiation, we implemented a user-centered computerized clinical decision support system (CDS). This study was conducted to assess the feasibility of implementation and to evaluate the preliminary efficacy of the intervention to increase the rate of ED-initiated BUP.An interrupted time series study was conducted in an urban, academic ED from April 2018 to February 2019 (preimplementation phase), March 2019 to August 2019 (implementation phase), and September 2019 to December 2019 (maintenance phase) to study the effect of the intervention on adult ED patients identified by a validated electronic health record (EHR)-based computable phenotype consisting of structured data consistent with potential cases of OUD who would benefit from BUP treatment. The intervention offers flexible CDS for identification of OUD, assessment of opioid withdrawal, and motivation of readiness to start treatment and automates EHR activities related to ED initiation of BUP (including documentation, orders, prescribing, and referral). The primary outcome was the rate of ED-initiated BUP. Secondary outcomes were launch of the intervention, prescription for naloxone at ED discharge, and referral for ongoing addiction treatment.Of the 141,041 unique patients presenting to the ED over the preimplementation and implementation phases (i.e., the phases used in primary analysis), 906 (574 preimplementation and 332 implementation) met OUD phenotype and inclusion criteria. The rate of BUP initiation increased from 3.5% (20/574) in the preimplementation phase to 6.6% (22/332) in the implementation phase (p = 0.03). After the temporal trend of the number of physicians with X-waiver training and other covariates were adjusted for, the relative risk of BUP initiation rate was 2.73 (95% confidence interval [CI] = 0.62 to 12.0, p = 0.18). Similarly, the number of unique attendings who initiated BUP increased modestly 7/53 (13.0%) to 13/57 (22.8%, p = 0.10) after offering just-in-time training during the implementation period. The rate of naloxone prescribed at discharge also increased (6.5% preimplementation and 11.5% implementation; p 0.01). The intervention received a system usability scale score of 82.0 (95% CI = 76.7 to 87.2).Implementation of user-centered CDS at a single ED was feasible, acceptable, and associated with increased rates of ED-initiated BUP and naloxone prescribing in patients with OUD and a doubling of the number of unique physicians adopting the practice. We then implemented this intervention across several health systems in a trial to assess its effectiveness, scalability, and generalizability.
- Subject Added Entry-Topical Term
- Medicine.
- Subject Added Entry-Topical Term
- Health sciences.
- Index Term-Uncontrolled
- Addiction
- Index Term-Uncontrolled
- Buprenorphine
- Index Term-Uncontrolled
- Clinical decision support
- Index Term-Uncontrolled
- Emergency department
- Index Term-Uncontrolled
- Opioid
- Added Entry-Corporate Name
- Yale University Yale School of Medicine
- Host Item Entry
- Dissertations Abstracts International. 85-11B.
- Electronic Location and Access
- 로그인을 한후 보실 수 있는 자료입니다.
- Control Number
- joongbu:658068
MARC
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■006m o d
■007cr#unu||||||||
■020 ▼a9798382329895
■035 ▼a(MiAaPQ)AAI31141837
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a610
■1001 ▼aHolland, Wesley C.
■24510▼aClinical Decision Support for Emergency Department-Initiated Buprenorphine for Opioid Use Disorder.
■260 ▼a[S.l.]▼bYale University. ▼c2024
■260 1▼aAnn Arbor▼bProQuest Dissertations & Theses▼c2024
■300 ▼a48 p.
■500 ▼aSource: Dissertations Abstracts International, Volume: 85-11, Section: B.
■500 ▼aAdvisor: Melnick, Edward R.
■5021 ▼aThesis (M.D.)--Yale University, 2024.
■520 ▼aAdoption of emergency department (ED) initiation of buprenorphine (BUP) for opioid use disorder (OUD) into routine emergency care has been slow, partly due to clinicians' unfamiliarity with this practice and perceptions that it is complicated and time-consuming. To address these barriers and guide emergency clinicians through the process of BUP initiation, we implemented a user-centered computerized clinical decision support system (CDS). This study was conducted to assess the feasibility of implementation and to evaluate the preliminary efficacy of the intervention to increase the rate of ED-initiated BUP.An interrupted time series study was conducted in an urban, academic ED from April 2018 to February 2019 (preimplementation phase), March 2019 to August 2019 (implementation phase), and September 2019 to December 2019 (maintenance phase) to study the effect of the intervention on adult ED patients identified by a validated electronic health record (EHR)-based computable phenotype consisting of structured data consistent with potential cases of OUD who would benefit from BUP treatment. The intervention offers flexible CDS for identification of OUD, assessment of opioid withdrawal, and motivation of readiness to start treatment and automates EHR activities related to ED initiation of BUP (including documentation, orders, prescribing, and referral). The primary outcome was the rate of ED-initiated BUP. Secondary outcomes were launch of the intervention, prescription for naloxone at ED discharge, and referral for ongoing addiction treatment.Of the 141,041 unique patients presenting to the ED over the preimplementation and implementation phases (i.e., the phases used in primary analysis), 906 (574 preimplementation and 332 implementation) met OUD phenotype and inclusion criteria. The rate of BUP initiation increased from 3.5% (20/574) in the preimplementation phase to 6.6% (22/332) in the implementation phase (p = 0.03). After the temporal trend of the number of physicians with X-waiver training and other covariates were adjusted for, the relative risk of BUP initiation rate was 2.73 (95% confidence interval [CI] = 0.62 to 12.0, p = 0.18). Similarly, the number of unique attendings who initiated BUP increased modestly 7/53 (13.0%) to 13/57 (22.8%, p = 0.10) after offering just-in-time training during the implementation period. The rate of naloxone prescribed at discharge also increased (6.5% preimplementation and 11.5% implementation; p 0.01). The intervention received a system usability scale score of 82.0 (95% CI = 76.7 to 87.2).Implementation of user-centered CDS at a single ED was feasible, acceptable, and associated with increased rates of ED-initiated BUP and naloxone prescribing in patients with OUD and a doubling of the number of unique physicians adopting the practice. We then implemented this intervention across several health systems in a trial to assess its effectiveness, scalability, and generalizability.
■590 ▼aSchool code: 0265.
■650 4▼aMedicine.
■650 4▼aHealth sciences.
■653 ▼aAddiction
■653 ▼aBuprenorphine
■653 ▼aClinical decision support
■653 ▼aEmergency department
■653 ▼aOpioid
■690 ▼a0564
■690 ▼a0566
■690 ▼a0769
■71020▼aYale University▼bYale School of Medicine.
■7730 ▼tDissertations Abstracts International▼g85-11B.
■790 ▼a0265
■791 ▼aM.D.
■792 ▼a2024
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T17160639▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
