Implementation Facilitation to Promote Emergency Department–Initiated Buprenorphine for Opioid Use Disorder

作者：Gail D’Onofrio, Eva Jennifer Edelman, Kathryn F. Hawk, Marek Cezary Chawarski, Michael V. Pantalon, Patricia H. Owens, Shara H. Martel, Richard Eric Rothman, Mustapha O. Saheed, Robert P. Schwartz, Ethan A. Cowan, Lynne D. Richardson, Edwin A. Salsitz, Michael S. Lyons, Caroline E. Freiermuth, Christine M. Wilder, Lauren Whiteside, Judith I. Tsui, Jared Wilson Klein, Edouard Coupet, Patrick G. O’Connor, Abigail G. Matthews, Sean M. Murphy, Kristen Huntley, David A. Fiellin · 发表于：JAMA Network Open · 年份：2023 · DOI：10.1001/jamanetworkopen.2023.5439 · 被引用次数：49 · 研究领域：Opioid Use Disorder Treatment、Health Policy Implementation Science、Substance Abuse Treatment and Outcomes

Importance: Emergency department (ED)-initiated buprenorphine for the treatment of opioid use disorder (OUD) is underused. Objective: To evaluate whether provision of ED-initiated buprenorphine with referral for OUD increased after implementation facilitation (IF), an educational and implementation strategy. Design, Setting, and Participants: This multisite hybrid type 3 effectiveness-implementation nonrandomized trial compared grand rounds with IF, with pre-post 12-month baseline and IF evaluation periods, at 4 academic EDs. The study was conducted from April 1, 2017, to November 30, 2020. Participants were ED and community clinicians treating patients with OUD and observational cohorts of ED patients with untreated OUD. Data were analyzed from July 16, 2021, to July 14, 2022. Exposure: A 60-minute in-person grand rounds was compared with IF, a multicomponent facilitation strategy that engaged local champions, developed protocols, and provided learning collaboratives and performance feedback. Main Outcomes and Measures: The primary outcomes were the rate of patients in the observational cohorts who received ED-initiated buprenorphine with referral for OUD treatment (primary implementation outcome) and the rate of patients engaged in OUD treatment at 30 days after enrollment (effectiveness outcome). Additional implementation outcomes included the numbers of ED clinicians with an X-waiver to prescribe buprenorphine and ED visits with buprenorphine administered or prescribed an...