A Phased-Implementation Feasibility and Proof-of-Concept Study to Assess Incorporating the NIDA CTN Common Data Elements (CDEs) Into the Electronic Health Record (EHR) in Large Primary Care Settings ("CDE-EHR-PC" Study), Phase 3

Completed

Interventions: Behavioral: Meetings with implementation leader(s)
Behavioral: the SAAS survey
Behavioral: Patient surveys

Brief Summary: This is a 4-phase study to implement the NIDA CDEs in primary care settings. Collecting and utilizing the CDEs in clinical practice requires a strategy for implementing screening to collect substance use information that populates the CDEs, and assisting primary care medical staff to offer appropriate interventions by providing clinical decision support (CDS) and a mechanism for making referrals to addiction treatment. Investigators aim to maximize the efficient adoption of screening, CDS, and treatment referrals by integrating all of these activities into the electronic health record (EHR).

The study will be conducted at three sites, representing three large health systems. Each phase will include deliverables essential to move to the next phase, and an independent Advisory Committee will review progress and make recommendations at each transition about how best to progress to each subsequent phase. Based on progress during earlier phases, the Advisory Committee may recommend expansion to additional clinics or health systems during the second part of Phase 4.

Detailed Description: SPECIFIC AIMS

1. To program the NIDA CTN CDEs, the NIDA/ASAM electronic Clinical Quality Measure (eCQM), and a lean decision support module into Epic.

2. To study the process of implementation of screening and referral using Epic-driven CDEs and CDS in three primary care clinics / practices, including defining potential barriers and facilitators to their adoption.

3. To evaluate the impact of implementation on:

* Patient level outcomes (diagnosis, treatment referral);

* Medical staff level outcomes (screening and assessment, clinical interventions including counseling and treatment referral); and

* Systems level outcomes (logistics and costs of introducing the CDEs, feasibility).

Recruitment & Eligibility

Inclusion Criteria

English speaking adult individuals age 18 years or older, and current employee or patient at a Wave 1 clinic with direct patient contact.

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Clinic A1	Meetings with implementation leader(s)	-
Clinic A2	Patient surveys	-
Clinic B2	Patient surveys	-
Clinic B1	the SAAS survey	-
Clinic B2	the SAAS survey	-
Clinic B4	Patient surveys	-
Clinic A1	the SAAS survey	-
Clinic A2	Meetings with implementation leader(s)	-
Clinic B1	Meetings with implementation leader(s)	-
Clinic B2	Meetings with implementation leader(s)	-
Clinic B3	the SAAS survey	-
Clinic B3	Patient surveys	-
Clinic A1	Patient surveys	-
Clinic A2	the SAAS survey	-
Clinic B1	Patient surveys	-
Clinic B3	Meetings with implementation leader(s)	-
Clinic B4	Meetings with implementation leader(s)	-
Clinic B4	the SAAS survey	-

Primary Outcome Measures

Name	Time	Method
Adoption of screening	12 Months	% patients presenting for primary care visits who were screened in the past 12 months
Referral of high risk patients	12 Months	% patients with high risk use who received referral to specialty care
Provider adoption of CDS	12 Months	% patients with positive screens for which CDS was launched and completed

Secondary Outcome Measures

Name	Time	Method

Locations (2): Massachusetts General Hospital
🇺🇸
Boston, Massachusetts, United States
Icahn School of Medicine at Mount Sinai
🇺🇸
New York, New York, United States

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