Expanding access to MOUD for patients in the emergency department: research and coordination

Project Summary/Abstract Despite being associated with increased survival and decreased drug use, emergency department (ED) initiation and prescription of medications for opioid use disorder (MOUD), including buprenorphine, for opioid overdose and untreated opioid use disorder (OUD), is not yet commonplace in the United States, most likely due to provider/healthcare system factors (e.g., lack of training, uncodified guidelines, and regulatory barriers) and patient/family factors (e.g., stigma). Thus, our highly experienced, multidisciplinary research team proposes a mixed-method quality improvement study, based on the California (CA) Bridge model, in a high volume ED (where we estimate that buprenorphine was initiated with only 20% of likely patients with OUD in 2024) to increase such care, along with establishing a national coordinating center (CC) that will produce an evidence- based guideline and provide training, technical assistance, and resources to all collaborating centers. The University of Arizona’s Prevention Research Center will partner with Banner Health and the Comprehensive Center for Pain and Addiction to complete our specific aims. Aim 1. (Research Project) Implement a SUN (substance use navigator) to increase ED OUD screening, MOUD initiation/prescribing, and linkages to care. Using electronic health data, we will examine percentage change over time in (a) screening/diagnosis (ICD-10 codes), (b) MOUD initiation and prescribing, and (c) linkage to post-discharge treatment within 7 days to increase ED provider knowledge for identifying and treating patients with OUD as measured by increases in rates over time. Aim 2. (Research Project) Investigate various structural factors that influence implementation, scalability, and sustainability (e.g., precise documentation of the ED champion’s types and categories of activities, an annual survey with ED personnel regarding the utility of the ED champion’s activities, and an examination of reimbursement data and support for appropriate documentation) to produce an effective, sustainable and replicable protocol. Aim 3. (CC) Evaluate the ability of the respective healthcare systems of the network-affiliated collaborators to provide MOUD administration directly to patients until their outpatient intake appointment or for 7 days (e.g., conduct a focus group with all collaborating centers to identify barriers, create actionable strategies to overcome those barriers, invite the collaborating centers to implement one strategy, and evaluate their progress in making changes) to create an evidence-based guideline for healthcare systems to provide patients with MOUD at discharge. Aim 4. (CC) Among network-affiliated collaborating centers, evaluate the provider-focused implementation strategies (e.g., SUNs, ED Champion, or other similar strategies) that facilitate ED clinician prescribing and linkage to care within 7-days. Through measures such as the documentation of each collaborating center’s implementation plans, quarterly updates of the types and number of implementation strategies, and network-wide feedback, we expect to increase the number of ED clinicians who initiate medication.