Adaptive Decision Support for Addiction Treatment ADAPT

What this Trial Is About

Researchers are refining and optimizing the EMBED clinical decision support system to help emergency department ED physicians better follow guidelines for giving buprenorphine to patients with opioid use disorder OUD. This study uses a Multiphase Optimization Strategy MOST with preparation, optimization, and confirmation phases to improve how the system supports treatment initiation in emergency care. The goal is to increase the number of physicians using the standard of care for buprenorphine administration in appropriate patients. The study has multiple phases. In the first optimization stage, a 2x2x2 factorial trial tests adding sustainable strategies like nurse prompts for withdrawal assessment, targeted clinician prompts to use the decision support system, and patient resources to promote equity and readiness for treatment. The second stage involves rapid serial randomized testing to improve system usability and reduce errors by refining the interface and workflow. The evaluation phase compares the optimized system to the original in a randomized trial focused on rates of buprenorphine initiation in the ED. Participants are emergency department patients aged 18 or older with moderate to severe opioid use disorder. Researchers will monitor the proportion of patient encounters where buprenorphine is started and assess engagement with the clinical decision support system. The study tracks outcomes from the ED visit through the end of each trial phase, which may last up to 18 months. The system integrates diagnosis, withdrawal severity assessment, patient motivation techniques, and automates clinical workflow including documentation and referrals.

Adaptive Decision Support for Addiction Treatment Master