Impact of Universal Screening and Automated Clinical Decision Support for the Treatment of Opioid Use Disorder in Emergency Departments: A Difference-in-Differences Analysis - 19/07/23
, Jeanmarie Perrone, MD b, d, Rachel McFadden, RN b, d, Ruiying Aria Xiong, MS a, e, Zachary F. Meisel, MD, MPH b, Nicole O’Donnell, CRS b, d, Dina Abdel-Rahman, BA b, e, Jeffrey Moon, MD, MPH b, Nandita Mitra, PhD c, Mucio Kit Delgado, MD, MS b, eAbstract |
Study objective |
Emergency department (ED)–initiated buprenorphine improves outcomes in patients with opioid use disorder; however, adoption varies widely. To reduce variability, we implemented a nurse-driven triage screening question in the electronic health record to identify patients with opioid use disorder, followed by targeted electronic health record prompts to measure withdrawal and guide next steps in management, including initiation of treatment. Our objective was to assess the impact of screening implementation in 3 urban, academic EDs.
Methods |
We conducted a quasiexperimental study of opioid use disorder–related ED visits using electronic health record data from January 2020 to June 2022. The triage protocol was implemented in 3 EDs between March and July 2021, and 2 other EDs in the health system served as controls. We evaluated changes in treatment measures over time and used a difference-in-differences analysis to compare outcomes in the 3 intervention EDs with those in the 2 controls.
Results |
There were 2,462 visits in the intervention hospitals (1,258 in the preperiod and 1,204 in the postperiod) and 731 in the control hospitals (459 in the preperiod and 272 in the postperiod). Patient characteristics within the intervention and control EDs were similar across the time periods. Compared with the control hospitals, the triage protocol was associated with a 17% greater increase in withdrawal assessment, using the Clinical Opioid Withdrawal Scale (COWS) (95% CI 7 to 27). Buprenorphine prescriptions at discharge also increased by 5% (95% CI 0% to 10%), and naloxone prescriptions increased by 12% points (95% CI 1% to 22%) in the intervention EDs relative to controls.
Conclusion |
An ED triage screening and treatment protocol led to increased assessment and treatment of opioid use disorder. Protocols designed to make screening and treatment the default practice have promise in increasing the implementation of evidence-based treatment ED opioid use disorder care.
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| Please see page 132 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: ML and MKD were responsible for study concept and design, acquired the data, drafted the manuscript, and acquired funding. ML, RAX, NM, and MKD analyzed and interpreted the data. JP, RM, NO, ZFM, DAR, and JM participated in critical revision of the manuscript for important intellectual content. RAX and NM offered statistical expertise. ML takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria:(1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This work was supported by the Penn Injury Science Center (CDC 19R49CE003083). Dr. Lowenstein was also supported by the National Institute on Drug Abuse (grant K23DA055087), and Dr. Delgado was also supported by the National Institute of Child Health and Human Development (grant K23HD090272001) and by a philanthropic grant from the Abramson Family Foundation. |
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| This work was presented as an oral abstract at the Society of Academic Emergency Medicine Annual Meeting in New Orleans, LA, on May 12, 2022 and as a poster at the Society of General Internal Medicine Annual Meeting in Orlando, FL, on April 7, 2022. |
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Vol 82 - N° 2
P. 131-144 - août 2023 Retour au numéro
Article précédent
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