Clinical Decision Support to Improve System Naloxone Co-prescribing

Conditions: Medication Abuse
Harm Reduction
Opioid Overdose
Opioid Prescribing

Interventions: Other: Naloxone Co-prescribing Clinical Decision Support (CDS)

Brief Summary: The objective of this study is to evaluate the impact of a clinical decision support (CDS) alert to facilitate the co-prescribing of naloxone, an opioid overdose reversal agent, with high-risk opioid prescriptions. Prescribing naloxone with opioids is a best practice described in the 2022 US Center for Disease Control and Prevention (CDC) guidelines on opioid prescribing. The CDS can improve quality of care delivered by improving compliance with the guideline defined best practices. The project will compare CDS alert facilitated co-prescribing of naloxone with high-risk opioid prescriptions vs usual care to evaluate the effectiveness of the CDS alert for improving naloxone prescribing. The patients are not assigned to an intervention and will be receiving any changes in care as part of their routine medical care, rather than a specific intervention that is distinct from their usual medical care. The researchers hypothesize that the CDS alert will be acceptable to providers while increasing naloxone co-prescribing which will reduce the number of opioid overdoses in subsequent 6 months.

Detailed Description: Clinical decision support tools help clinicians make treatment decisions based on routinely collected data and offer a promising strategy to implement evidence-based practices for safe and effective pain management. This project will use clinical decision support tools embedded into electronic health records to help healthcare providers make treatment decisions that align with opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC). The project will also use information from prescription drug monitoring programs, insurance claims, and mortality data to evaluate patient outcomes. This research will evaluate how prescribing practices that align with CDC guidelines affect patient outcomes and whether clinical decision support tools provide an advantage over standard care practices for pain management.

Recruitment & Eligibility

Inclusion Criteria

Patients receiving an opioid prescription at discharge from inpatient/ED or close visit in outpatient settings where the clinical decision support (CDS) is implemented

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Clinical Decision Support (CDS): Naloxone Alert	Naloxone Co-prescribing Clinical Decision Support (CDS)	Encounters where the naloxone clinical decision support (CDS) alert fired. CDS logic is programmed to fire alert when a provider places and order for a high-risk opioid analgesic prescription to a patient without an active naloxone prescription. High-risk prescription logic to trigger the Naloxone CDS: \[(NOT 1 AND (2 AND AT LEAST 1 OF (3, 4, 5, 6))) AND 7 AND NOT 8\] 1. ACTIVE OR PENDED NALOXONE PRESCRIPTION ORDER 2. OPIOID SCRIPT BEING PLACED CRITERIA 3. DAILY Milligram Morphine Equivalent (MME) \>=90 UNSIGNED ORDER 4. DAILY MME \>=90 EXISTING 5. DIAGNOSIS OF OPIOID USE DISORDER 6. DIAGNOSIS HISTORY OF OPIOID OVERDOSE 7. PROVIDER LOGGED INTO ELLIGIBLE DEPARTMENTS 8. DISCHARGE TO HOSPICE

Primary Outcome Measures

Name	Time	Method
Percentage of a high-risk opioid analgesic prescriptions receiving a co-prescription of naloxone	18 months	The number of high-risk opioid encounters where a naloxone prescription was written with the opioid divided by the total number of encounters where a high-risk opioid prescription was written.

Secondary Outcome Measures

Name	Time	Method
Clinical decision support (CDS) acceptance rate	18 months	The number of times providers accepted the Clinical decision support (CDS) suggestion and co-prescribed naloxone with a high-risk opioid divided by the total number of times a high-risk opioid prescription triggered the CDS alert.
Subsequent opioid overdose/poisonings rates	Six months after an encounter where the naloxone clinical decision support fired for the provider	The number of patients who had a diagnosis of opioid overdose or poisoning in the six months following the index visit with a high-risk opioid prescribed.
Naloxone dispensed rate	In the 3 days after the naloxone prescription is written	The number of patients who were dispensed a naloxone prescription divided by the number of naloxone prescriptions written.

Locations (1): University of Colorado Hospital
🇺🇸
Aurora, Colorado, United States