EMBED: A Pragmatic Trial of User Centered Clinical Decision Support for EMergency Department Initiated BuprenorphinE for Opioid Use Disorder, 5 U.S. states, 2019-2021

Buprenorphine (BUP) is a highly efficacious drug for treatment of addiction for Opioid Use Disorder (OUD) patients. Although it is safe and effective to initiate this treatment in the emergency departments (ED) where a lot of OUD patients seek care, due to challenges related to lack of knowledge, etc. this practice has not been widely adopted. The goal of this trial was to test the efficacy of a user centered clinical decision support (CDS) tool (EMBED) that was developed to facilitate ED clinicians to administer/prescribe BUP for OUD patients presenting to the ED. This was an 18-month long, pragmatic, parallel, group randomized trial implemented across 18 ED clusters (21 sites) in 5 healthcare systems randomly allocated in 1:1 ratio to intervention versus usual care arm. For the intervention, CDS was to support diagnosis and withdrawal assessment and automate electronic health record (EHR) documentation. The primary outcome was the initiation of BUP in ED at patient level.