Optimizing Emergency Department Clinical Decision Support to Improve Buprenorphine Use in Opioid Use Disorder A Study Comparing Original and Enhanced EMBED Systems

What this Trial Is About

Researchers are evaluating the EMBED clinical decision support system to improve emergency department ED physicians adherence to standard care for administering buprenorphine to patients with opioid use disorder OUD. This study uses a Multiphase Optimization Strategy MOST framework, including preparation, optimization, and confirmatory phases, to refine and optimize EMBED for better usability and implementation. The goal is to enhance treatment initiation rates during emergency care for individuals with OUD. The optimization phase has two stages Stage 1 involves a 2x2x2 factorial trial testing sustainable implementation strategies such as nurse prompts for withdrawal assessment, targeted clinician prompts to use the CDS, and patient-facing materials to promote equity and motivate readiness for treatment. Stage 2 focuses on improving CDS usability through serial randomized testing to minimize user errors, workflow disruption, and abandonment by refining the interface and workflow. In the evaluation phase, a randomized trial compares the effectiveness of the optimized package with the original EMBED system on rates of buprenorphine initiation in the ED. Participants engage with the clinical decision support integrated into the electronic health record workflow, which assists in diagnosing OUD, assessing withdrawal severity, motivating patients through brief negotiation interviews, and automating documentation, order entry, prescribing, and referral for ongoing care. Researchers measure outcomes including the proportion of ED encounters with buprenorphine initiation and CDS engagement. The study spans multiple phases with continuous assessment to refine and confirm improvements in treatment initiation over time.

Adaptive Decision Support for Addiction Treatment Master