Health Policy and Health Services Research
Background: Emergency departments (EDs) frequently encounter patients with opioid use disorder (OUD) who are not engaged in addiction treatment, but significant system and patient barriers challenge optimal linkage to care. Decision support in the electronic medical records (EMR) is a demonstrated method for influencing provider behavior. We sought to evaluate the impact of integrating a decision support tool within the EMR to identify patients with OUD and prompt providers to refer them to subsequent addiction care via an electronic order.
Methods: This pre-post study in an urban, academic emergency department compared ED patient referral and follow-up at the hospital’s affiliated addiction treatment center for a period of three months before and after implementation of the decision support tool on August 8, 2018. Patients with a potential diagnosis of OUD were flagged based on predetermined criteria in the following EMR categories: chief complaint, past medical history, home medications, urine drug screen, and clinical impression. Providers were asked to counsel their patients on OUD and sign an electronic order for addiction treatment referral on flagged patients. The primary outcome was the number of patients receiving an electronic referral to the addiction treatment center. The secondary outcome was the number of referred patients who attended a first appointment.
Results: In the three months before the tool’s implementation, there were 14,780 ED patients, of which 64 (0.3%, 95%CI 0.3%-0.4%%) received an electronic referral to addiction treatment, and one referred patient (1.6%) attended an addiction treatment clinic visit. In the three months after, there were 14,725 ED patients, of which 164 (0.9%, 95%CI 0.7%-1.0%) patients received an electronic referral to addiction treatment, and four referred patients (2.4%) attended an addiction treatment clinic visit.
Conclusions: Decision support can improve ED provider referral of patients with suspected opioid use disorder for addiction evaluation and treatment without significant investment of resources. However, referral alone is a minimally impactful method for engaging ED patients in addiction treatment. This demonstrates the need for more resource intensive measures wherever they are deemed effective and feasible.