Impact of an electronically-integrated clinical pathway on hospital initiation of medications for alcohol use disorder and subsequent hospital utilization.

Abstract

Medications for alcohol use disorder (MAUD) are underutilized and multiple barriers and disparities in treatment initiation have been identified. Effective hospital-based strategies to promote MAUD use are not well-defined. To determine whether an electronic health record (EHR)-integrated clinical pathway increases MAUD initiation. We conducted a prospective observational cohort study with consecutive adult inpatients diagnosed with alcohol use disorder (AUD) and withdrawal requiring treatment who were admitted to a health system comprising a mix of community and tertiary academic medical centers. The impact of voluntary use of an AUD EHR-integrated clinical pathway on MAUD initiation (main outcome) and ED return or readmission for any cause within 30 days of discharge (secondary outcomes) was evaluated. Among 2630 inpatient medicine encounters, the pathway was utilized in 17.8%. Pathway utilization was associated with 4.31 (confidence interval [CI]: 3.10-5.99, p < .001) increased odds of MAUD initiation as compared with encounters without pathway utilization (31% vs. 15.4%). There were no differences in rates of 30-day ED returns (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.35-1.62; p = .47) or 30-day readmissions (OR: 1.19; 95% CI: 0.80-1.76; p = .40) and no differences in MAUD initiation by race or ethnicity when the pathway was utilized versus not utilized. Utilization of an EHR-integrated clinical pathway for individuals with AUD significantly increased MAUD initiation at hospital discharge. These findings support the use of an EHR-integrated clinical pathway as an implementation tool for overcoming barriers to MAUD initiation and may be a generalizable strategy for increasing low rates of MAUD prescribing for patients with AUD.