Clinical Decision Support for Opioid Use Disorders in Medical Settings: Usability Testing in an EMR

Study Overview
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Brief Summary
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The primary objective of this pilot study is to program an opioid use disorder (OUD) clinical decision support (CDS) tool for use in an electronic medical record (EMR) and obtain high primary care physician (PCP) usability and acceptability. The OUD-CDS is based on the NIDA-Blending Initiative white paper, Clinical Decision Support for Opioid Use Disorders: Working Group Report, which itself is based on national evidence-based guidelines (American Society of Addiction Medicine (ASAM 2015), VA (VA 2015). As such, this pilot study aims to help PCPs achieve accepted standards of care in OUD treatment. The secondary objectives of this pilot study are to evaluate the usefulness of the tool by comparing OUD case-finding, medication-assisted therapy (MAT) and referral patterns pre- and post-CDS deployment for PCPs with and without CDS access.

Official Title
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Clinical Decision Support for Opioid Use Disorders in Medical Settings: Pilot Usability Testing in an EMR

Conditions
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Opioid-use Disorder

Intervention / Treatment
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* Other: Opioid Wizard


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be an MD, Doctor of Osteopathy, Nurse Practitioner or Physician's Assistant engaged in independent primary care of adults at HealthPartners or Park Nicollet Have at least schedule 3 DEA prescribing privileges Voluntarily provide written informed consent to participate in this study Exclusion Criteria: Less than half-time clinical primary care responsibilities
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Waivered Providers Receive the Opioid Wizard<br>All providers who have a buprenorphine waiver will receive the OUD clinical decision support tool (Opioid Wizard). | Other: Opioid Wizard<br>* The Opioid Wizard is an OUD clinical decision support tool for primary care providers.<br>|
| No Intervention: Does not Receive the Opioid Wizard<br>All non-buprenorphine waivered providers will be randomized to receive or not receive the Opioid Wizard. This arm of providers will continue to treat their patients as usual. | |
| Experimental: Non-Waivered Providers who receive Opioid Wizard<br>All non-buprenorphine waivered providers will be randomized to receive or not receive the Opioid. This arm of providers will receive the OUD clinical decision support tool (Opioid Wizard). | Other: Opioid Wizard<br>* The Opioid Wizard is an OUD clinical decision support tool for primary care providers.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intervention PCP Confidence in Assessing and Treating OUD | # of intervention PCPs who report feeling moderately or very confident in assessing and treating OUD. | This outcome measure was calculated at approximately month 10 of the pilot study | 
| Intervention PCP Likeliness to Recommend Use of the OUD-CDS | # of PCPs with CDS access who rate the OUD-CDS >4 on a 5-point Likert scale of likeliness to recommend use of the tool to their colleagues. The scale ranges from 1-not at all likely to 5-very likely, with higher values representing a higher likelihood of recommending the OUD-CDS to other colleagues. | This was calculated after PCP surveys were completed, approximately month 10 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare Pre- and Post-intervention Rates of OUD Diagnosis in High-risk Patients. | Calculate and compare the number of patients diagnosed with OUD pre- and post-intervention. This will be presented as rate of OUD diagnoses per patient year. | This was calculated at the end of the pilot study (month 8). | 
| Compare Pre- and Post-intervention Rates of Medication-assisted Therapy (MAT) Use. | Calculate and compare the rate of MAT use among patients with OUD pre- and post-intervention. This is presented as a pre/post ratio of MAT rx per patient year. | This was calculated at the end of the pilot study (month 8). | 
| Compare Post-intervention Referral Patterns Between Intervention and Control Groups | Calculate and compare how often patients diagnosed with OUD are referred to specialty care or inpatient treatment post-intervention. Compare these rates between intervention and control groups. | This was calculated at the end of the pilot study (month 8). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CDS, Medication Assisted Therapy