Characterizing emergency clinician engagement with social drivers of health data among patients with opioid use disorder.

Abstract

To characterize emergency department (ED) clinician engagement with electronic health record (EHR)-based social drivers of health (SDOH) data; test whether engagement differs in encounters with opioid use disorder (OUD); and, among OUD encounters, assess whether engagement is associated with medications for OUD (MOUD). We conducted a cross-sectional study of adult ED encounters (January 2023-October 2024). OUD encounters, identified with a structured phenotype, were matched (1:2) to non-OUD encounters. Audit logs captured clinician engagement with structured SDOH questions ("SDOH Wheel"), ICD-10 Z codes in the Problem List, Social History free text, and social work notes. Engagement was any SDOH documentation or review of preexisting SDOH data during the encounter. Logistic regression estimated associations. Among 17 103 encounters (5701 OUD; 11 402 non-OUD), clinician SDOH documentation was rare (<1%). Clinicians most often reviewed the SDOH Wheel (1103/3953; 27.9%), followed by social work notes (1711/10 670; 16.0%), Z codes (29/620; 4.7%), and Social History free text (232/6942; 3.3%). Engagement occurred in 17.1% of encounters and was higher with OUD (23.1% vs 14.1%; OR 1.84, 95% CI 1.70-2.00). Among OUD encounters, engagement was not associated with MOUD (OR 1.27, 95% CI 0.95-1.70); however, MOUD treatment varied by race and ethnicity, reflecting persistent disparities. ED clinicians infrequently documented and favored review of structured, accessible SDOH data. Engagement increased in OUD encounters yet neither predicted MOUD nor mitigated racial and ethnic treatment disparities. EHR interfaces that surface SDOH data, coupled with targeted decision supports, might influence equitable, time-sensitive ED care.