Adaptive Decision Support for Addiction Treatment (ADAPT) Serial Randomized Testing for Usability, Round 3

This study is stage 3, rapid response testing (RRT), of the optimization phase of alarger study which refines and optimizes the EMBED* clinical decision support (CDS); seeNCT03658642 to increase number of ED physicians following standard of care for theadministration of buprenorphine to appropriate patients with opioid use disorder.Investigators will use a Multiphase Optimization Strategy (MOST) framework withpreparation, optimization, and confirmatory phases.In stage 2, optimization phase, investigators will conduct serial rapid‐cycle randomizedtesting to inform iterative refinement of the CDS interface and workflow to minimize usererrors, task disruption, and abandonment through identification of specific targets forimprovement via application of novel CDS outcome measures with the goal of improving CDSusability.Five rounds of A‐B testing are expected. The more successful condition will be tested inthe subsequent round against a novel test condition. In this second round investigatorswill randomize an alert to providers to order a consult with addiction counselors. Futurerounds will be planned, with arms and interventions added, as the project progresses inorder to build on insights gained in each round.Phase 3, the evaluation phase will consist of a randomized trial of the optimized packagecompared to the original EMBED and the evaluation phase in which investigators willcompare the efficacy of the optimized, multicomponent CDS package to the original EMBEDCDS on ED‐initiation of buprenorphine rates in patients with OUD in a randomized trial.*EMBED is a user centered, clinician facing clinical decision support system integratedinto the electronic health record workflow to facilitate initiating buprenorphine in theemergency department by: diagnosing opioid use disorder with a checklist based on thediagnostic criteria of the DSM‐5 (Diagnostic and Statistical Manual of Mental Disorders,fifth edition), assessing the severity of withdrawal with the Clinical Opioid WithdrawalScale (COWS), motivating patients to accept treatment with a scripted brief negotiationinterview, and automating the electronic health record workflow, including clinical andafter visit documentation, order entry, prescribing, and referral for ongoing treatmentin the communityThis study does not have open enrollment.