A mixed methods assessment of an electronic health record-embedded intervention with supportive education and outreach to increase in-hospital opioid use disorder treatment initiation.

Abstract

In-hospital opioid use disorder medication (MOUD) initiation remains low despite its effectiveness to reduce mortality. Assess whether a non-interruptive electronic health record (EHR)-embedded intervention with supportive education and outreach increased in-hospital MOUD initiation without disrupting clinical workflow. In this mixed-methods study across 12 hospitals, we conducted an interrupted time series analysis of hospitalizations involving OUD and/or opioid poisoning. We condcuted a directed content analysis of interviews from 60 hospital-based clinicians, social workers, nurses, and pharmacists. The intervention involved MOUD initiation orders, discharge naloxone orders, and access to local OUD treatment resources. Strategies for adoption included clinican and nurse OUD education and required nurse trainings for Clinical Opiate Withdrawal Scale (COWS) assessments. Outcome measures included monthly changes of inpatient methadone administration ≥30 mg, discharge buprenorphine and naloxone prescriptions, and COWS assessments. Emergent themes from qualitative data provided context and possible explanations for quantitative results. From January 2021 to September 2024, there were 450,790 hospitalizations; 3.1% (n = 13,902) involved OUD/opioid poisoning; and, of these, 19.8% (n = 2750) involved MOUD. Between the pre- and post-intervention periods, there was no significant change in monthly methadone administrations or discharge naloxone prescriptions. Monthly buprenorphine discharge prescriptions decreased from 10.5% to 8.2% (slope decrease: -0.35, p < .001) in the post-implementation period. In the immediate post-intervention period, monthly COWS documentation increased from 7.3% to 14.5% (level change: 6.87; p < .001). Qualitative findings reflected a lack of intervention awareness due to limited leadership communication across hospitals. A non-interruptive EHR-embedded intervention with supportive education and outreach was insufficient to increase MOUD initiation.