2023
Adoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder
Gao E, Melnick E, Paek H, Nath B, Taylor R, Loza A. Adoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder. JAMA Network Open 2023, 6: e2342786. PMID: 37948075, PMCID: PMC10638655, DOI: 10.1001/jamanetworkopen.2023.42786.Peer-Reviewed Original ResearchConceptsHealth care systemED initiationOpioid use disorderBuprenorphine initiationCare systemUse disordersEmergency Department-Initiated BuprenorphineSecondary analysisClinician's roleEmergency department initiationClinical decision support interventionClinical decision support toolProportional hazard modelingCare of patientsNetwork of cliniciansDecision support interventionsAdvanced practice practitionersDose-dependent mannerUnique cliniciansTime-dependent covariatesTrial interventionNonintervention groupED clustersMore effective interventionsNumber of exposuresImplementation strategies to address the determinants of adoption, implementation, and maintenance of a clinical decision support tool for emergency department buprenorphine initiation: a qualitative study
Simpson M, Ritger C, Hoppe J, Holland W, Morris M, Nath B, Melnick E, Tietbohl C. Implementation strategies to address the determinants of adoption, implementation, and maintenance of a clinical decision support tool for emergency department buprenorphine initiation: a qualitative study. Implementation Science Communications 2023, 4: 41. PMID: 37081581, PMCID: PMC10117277, DOI: 10.1186/s43058-023-00421-7.Peer-Reviewed Original ResearchOpioid use disorderBuprenorphine initiationClinical decision support toolEmergency departmentED cliniciansSignificant public health problemCDS interventionsIntervention EDsUsual care armPragmatic clinical trialsPublic health problemEvidence-based treatmentsCare armED initiationBuprenorphine treatmentED settingIntervention armOngoing treatmentClinical trialsClinician experienceClinician trainingUse disordersBuprenorphineHealth problemsSecondary aimRacial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems
Holland W, Li F, Nath B, Jeffery M, Stevens M, Melnick E, Dziura J, Khidir H, Skains R, D'Onofrio G, Soares W. Racial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems. Academic Emergency Medicine 2023, 30: 709-720. PMID: 36660800, PMCID: PMC10467357, DOI: 10.1111/acem.14668.Peer-Reviewed Original ResearchConceptsOpioid use disorderCommunity emergency departmentsEmergency departmentDischarge diagnosisHealth care systemHispanic patientsBlack patientsHospital typeCare systemNon-Hispanic patientsOpioid overdose deathsClinical decision support systemOpioid withdrawalPrimary outcomeMedication treatmentBuprenorphine accessED treatmentTreatment accessOverdose deathsX-waiverBuprenorphinePatientsUse disordersEthnic disparitiesSecondary analysis
2022
User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial
Melnick ER, Nath B, Dziura JD, Casey MF, Jeffery MM, Paek H, Soares WE, Hoppe JA, Rajeevan H, Li F, Skains RM, Walter LA, Patel MD, Chari SV, Platts-Mills TF, Hess EP, D'Onofrio G. User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial. The BMJ 2022, 377: e069271. PMID: 35760423, PMCID: PMC9231533, DOI: 10.1136/bmj-2021-069271.Peer-Reviewed Original ResearchConceptsOpioid use disorderUsual care armEmergency departmentUse disordersCare armPragmatic clusterClinical decision supportIntervention armRoutine emergency careSecondary implementation outcomesSeverity of withdrawalTertiary care centerClinical decision support toolInitiation of buprenorphineElectronic health record tasksElectronic health record workflowsRE-AIM frameworkElectronic health record platformsHealth record platformsClinical decision support systemElectronic health recordsVisit documentationTreatment of addictionUsual careAdult patients
2021
57 EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder
Melnick E, Casey M, Dziura J, Jeffery M, Soares W, Hoppe R. 57 EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder. Annals Of Emergency Medicine 2021, 78: s23. DOI: 10.1016/j.annemergmed.2021.09.066.Peer-Reviewed Original ResearchEmergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems
Soares WE, Melnick ER, Nath B, D'Onofrio G, Paek H, Skains RM, Walter LA, Casey MF, Napoli A, Hoppe JA, Jeffery MM. Emergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems. Annals Of Emergency Medicine 2021, 79: 158-167. PMID: 34119326, PMCID: PMC8449788, DOI: 10.1016/j.annemergmed.2021.03.013.Peer-Reviewed Original ResearchConceptsHealth care systemCause ED visitsNonfatal opioid overdoseED visitsOpioid use disorderCare systemOpioid overdoseUse disordersCOVID-19 pandemicOpioid-related complicationsEmergency department visitsHospital-based interventionsED visit ratesEmergency department utilizationVisit countsUS health care systemOpioid overdose ratesDepartment visitsHistorical controlsAdult visitsOpioid overdosesOverdose ratesMedical emergencyVisit ratesMore weeks
2019
Identifying Opioid Use Disorder in the Emergency Department: Multi-System Electronic Health Record–Based Computable Phenotype Derivation and Validation Study
Chartash D, Paek H, Dziura JD, Ross BK, Nogee DP, Boccio E, Hines C, Schott AM, Jeffery MM, Patel MD, Platts-Mills TF, Ahmed O, Brandt C, Couturier K, Melnick E. Identifying Opioid Use Disorder in the Emergency Department: Multi-System Electronic Health Record–Based Computable Phenotype Derivation and Validation Study. JMIR Medical Informatics 2019, 7: e15794. PMID: 31674913, PMCID: PMC6913746, DOI: 10.2196/15794.Peer-Reviewed Original ResearchOpioid use disorderNegative predictive valuePositive predictive valueEmergency department patientsEmergency departmentUse disordersHealth care systemPredictive valueComputable phenotypeExternal validation phasesDepartment patientsCare systemPhysician chart reviewLarge health care systemExternal validation cohortEmergency medicine physiciansHigh predictive valueElectronic health recordsChart reviewChief complaintValidation cohortPragmatic trialClinical dataBilling codesMedicine physiciansUser-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial
Melnick ER, Jeffery MM, Dziura JD, Mao JA, Hess EP, Platts-Mills TF, Solad Y, Paek H, Martel S, Patel MD, Bankowski L, Lu C, Brandt C, D’Onofrio G. User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial. BMJ Open 2019, 9: e028488. PMID: 31152039, PMCID: PMC6550013, DOI: 10.1136/bmjopen-2018-028488.Peer-Reviewed Original ResearchMeSH KeywordsAdultBuprenorphineCluster AnalysisDecision Support Systems, ClinicalEmergency Service, HospitalFemaleHumansMaleMiddle AgedMulticenter Studies as TopicNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPragmatic Clinical Trials as TopicRandomized Controlled Trials as TopicUnited StatesYoung AdultConceptsOpioid use disorderEmergency departmentSecondary outcomesUse disordersEmergency department-initiated buprenorphineWestern Institutional Review BoardData Safety Monitoring BoardIndependent study monitorsRates of cliniciansRoutine emergency careSafety monitoring boardInstitutional review boardClinical decision support systemClinician prescribingPragmatic clusterPatient characteristicsPeer-reviewed journalsClinical decision supportPrimary outcomeED cliniciansWithdrawal symptomsOngoing treatmentPatients' willingnessMonitoring boardBuprenorphine