Developing and Evaluating a Machine-Learning Opioid Overdose Prediction & Risk-Stratification Tool in Primary Care

Not Applicable

Recruiting

• Conditions: Opiate Overdose; Opioid-Related Disorders; Narcotic-Related Disorders; Substance-related Disorders; Chemically-Induced Disorders; Mental Disorders

• Registration Number: NCT06810076
• Lead Sponsor: University of Pittsburgh

Brief Summary

This clinical trial aims to evaluate the pilot implementation of a machine-learning (ML)-driven clinical decision support (CDS) tool designed to predict opioid overdose risk within the electronic health record (EHR) system at UF Health Internal Medicine and Family Medicine clinics in Gainesville, Florida. The study will use a pre- versus post-implementation design to compare outcomes within clinics, focusing on measures such as naloxone prescribing rates and opioid overdose occurrences. Researchers will also assess the usability, acceptability, and feasibility of the CDS tool through qualitative interviews with primary care clinicians (PCPs) in the participating clinics.

Detailed Description

This clinical trial evaluates the pilot implementation of a ML-driven CDS tool designed to predict opioid overdose risk within the electronic health record (EHR) system at thirteen UF Health internal medicine and family medicine clinics in Gainesville, Florida.

The implementation process involved backend and frontend development and integration of the CDS tool. For backend integration, the investigators reviewed clinical workflows, designed a data flow plan to incorporate risk scores into patient charts, and collaborated with UF Health IT and Integrated Data Repository (IDR) Research Services to address alert implementation, data flow, server specifications, and responsibilities. Risk assessments approved by UF Health IT and the institutional review board (IRB) ensured secure access to patient health information (PHI) and enabled EHR integration. For frontend development, the investigators used a user-centered design approach to create the CDS tool prototype, incorporating feedback from PCPs during formative interviews to refine the user interface and ensure timely, actionable alerts through the EPIC system without disrupting clinical workflows.

The study primarily aims to assess the usability, acceptance, and feasibility of the CDS tool six months post-implementation through mixed-method evaluations. Researchers will use semi-structured interviews and an online questionnaire to collect feedback from PCPs, focusing on alert usability, preferences, and outcomes. Quantitative analyses will evaluate alert penetration, usage patterns, and PCP actions, while qualitative analyses will explore themes and insights from override comments to guide tool optimization. Researchers will also explore secondary patient-level outcomes using EHR data such as naloxone prescriptions.

Study Timeline

• Study First Submitted: 2025-01-27
• Study First Submitted QC: 2025-01-30
• Study First Posted: 2025-02-05
• Status Verified: 2025-04
• Study Start: 2025-04-08
• Last Update Submitted: 2025-04-08
• Last Update Posted: 2025-04-11
• Primary Completion: 2026-04-07
• Study Completion: 2026-10-02

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 2000

Inclusion Criteria

For PCP level outcomes assessment

• PCPs
• practicing in any of the 13 participating clinics (10 UF Health Family Medicine clinics and 3 UF Health Internal Medicine) in Gainesville, Florida.

For patient level outcomes assessment:

Inclusion criteria: Patients who seen in any of the 9 participating UF Health clinics who

• are aged ≥18 years
• received any opioid prescription in the past year prior to their clinic visit.
• are identified as being at elevated risk for overdose by the ML algorithm.

Exclusion Criteria

Patients who

• had malignant cancer diagnosis or hospice care prior to study enrollment

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Primary Outcome Measures

Name	Time	Method
Composite patient-level outcomes related to opioids	From enrollment and up to 12 months (3, 6, 12 months) post implementation of the OPA	The CDS tool will generate an Overdose Prevention Alert (OPA) when a PCP signs an opioid order in Epic®. To evaluate the tool's effectiveness, researchers will conduct within-clinic comparisons (pre- vs. post-implementation) and examine a composite of patient-level outcomes post-implementation, including the proportion of patients having any of the following 6 outcomes: 1. receipt of a naloxone order or prescription fill; 2. absence of opioid overdose diagnoses and naloxone administration; 3. absence of ED visits or hospitalizations due to opioid overdose or OUD; 4. absence of overlapping opioid and benzodiazepine use; 5. absence of high-dose opioid use (average daily morphine milligram equivalent ≥50); 6. receipt of referrals to non-pharmacological pain management (e.g., physical therapy, chiropractic care).
PCP's use feedback of the Overdose Prevention Alert (OPA)	From enrollment and up to 7 months post implementation of the OPA	An online questionnaire for PCPs who interacted with OPA includes 12 Likert-scale items (4-point scale: 1 = Strongly Disagree to 4 = Strongly Agree) assessing OPA's acceptability, appropriateness, and feasibility: 1. OPA's information was clear.; 2. OPA was easy to use.; 3. OPA helps identify patients at increased overdose risk.; 4. OPA helps understand patient's overdose risk.; 5. OPA provides risk management recommendations.; 6. OPA identifies the right patients with elevated overdose risk.; 7. OPA notifies the correct healthcare team member (i.e., PCPs).; 8. A pop-up alert is an appropriate notification approach.; 9. Signing an opioid order is the right time for OPA.; 10. Alert frequency is appropriate.; 11. I prefer OPA over the legacy naloxone alert (see picture).; 12. I want this OPA to continue to operate in my EHR.; Mean scores (with standard deviations \[SD\]) will be calculated across all items, as well as individual average scores (SD).

Secondary Outcome Measures

Name	Time	Method
Receipt of a naloxone order or prescription fill	From enrollment and up to 12 months (3, 6, 12 months) post implementation of the Overdose Prevention Alert (OPA)	Proportion of patients receiving alert who have a naloxone order or prescription fill
Absence of opioid overdose diagnoses and naloxone administration	From enrollment and up to 12 months (3, 6, 12 months) post implementation	Proportion of patients receiving alert who do not have an opioid overdose diagnoses and naloxone administration
Absence of ED visits or hospitalizations due to opioid overdose or OUD	From enrollment and up to 12 months (3, 6, 12 months) post implementation	Proportion of patients receiving alert who do not have ED visits or hospitalizations due to opioid overdose or opioid use disorder (OUD)
Absence of overlapping opioid and benzodiazepine use	From enrollment and up to 12 months (3, 6, 12 months) post implementation	Proportion of patients receiving alert who do not have overlapping opioid and benzodiazepine use
Absence of high-dose opioid use (average daily morphine milligram equivalent ≥50)	From enrollment and up to 12 months (3, 6, 12 months) post implementation	Proportion of patients receiving alert who do not have high-dose opioid use (average daily morphine milligram equivalent ≥50).
Receipt of referrals to non-pharmacological pain management (e.g., physical therapy, chiropractic care	From enrollment and up to 12 months (3, 6, 12 months) post implementation	Proportion of patients receiving alert who have referrals to non-pharmacological pain management (e.g., physical therapy, chiropractic care).

Trial Locations

Locations (1)

University of Florida Health Internal Medicine and Family Medicine; 🇺🇸 Gainesville, Florida, United States