NCT06872190 · University of California, San Francisco
Using Clinical Decision Support to Provide Social Risk-Informed Care for Opioid Use Disorder in the Emergency Department
What this study is about
The overarching goal of this proposal is to integrate patient social risk information into an existing electronic health record (EHR)-based clinical decision support (CDS) tool (CDSv1) to facilitate emergency department (ED)-initiated, social risk-informed opioid use disorder (OUD) medication treatment and ultimately improve treatment adherence and follow up.
View original scientific description
The overarching goal of this proposal is to integrate patient social risk information into an existing electronic health record (EHR)-based clinical decision support (CDS) tool (CDSv1) to facilitate emergency department (ED)-initiated, social risk-informed opioid use disorder (OUD) medication treatment and ultimately improve treatment adherence and follow up. The investigators will evaluate the feasibility and acceptability of the social care-enhanced CDS tool, CDSv2, (compared to CDSv1) at a single study site (UCSF) as an intervention to increase medication treatment adherence and follow up for adult ED patients experiencing opioid use disorder using a mixed-methods, before-after approach.
Interventions
OTHER
ED-Based Clinical Decision Support for Opioid Use Disorder
The original clinical decision support (CDS) tool, EMergency department initiated BuprenorphinE for opioid use Disorder or EMBED, was designed by researchers at Yale to support emergency department (ED) clinicians with varying levels of experience prescribing buprenorphine for patients with opioid use disorder (OUD). The tool alerts ED providers of a patient who is potentially eligible for MOUD using Epic's storyboard. The provider must then click on the notification to open the OUD evaluation tool, which has multiple components: OUD assessment, OUD diagnosis, withdrawal assessment, and readiness for treatment. These components are then paired with an orderset, "ED Opioid Use Disorder Treatment" that includes nursing orders, prescriptions for buprenorphine and ancillary medications, and substance use disorder discharge resources.
OTHER
Social Care-Enhanced Clinical Decision Support for Opioid Use Disorder
The investigators will use human-centered design to adapt the basic CDS tool to incorporate patient social needs, involving patients, staff, and end-user ED clinicians in the iterative design process. This tool is being actively developed.
Primary outcome measures
CDSv1 clinician launch
Time frame: 12 months
Percentage of ED clinicians who launch CDSv1 for patients with OUD
CDSv1 encounter launch
Time frame: 12 months
Percentage of eligible encounters (i.e., encounters including patients with OUD as defined by the EHR-derived phenotype) where CDSv1 was launched by clinician
CDSv2 clinician launch
Time frame: 12 months
Percentage of ED clinicians who launch CDSv2 for patients with OUD
CDSv2 encounter launch
Time frame: 12 months
Percentage of eligible encounters (i.e., encounters including patients with OUD as defined by the EHR-derived phenotype) where CDSv2 was launched by clinician
CDSv1 adherence to OUD treatment recommendations
Time frame: 12 months
For ED visits in which CDSv1 is launched, investigators will assess the percentage of times either buprenorphine, methadone, or naltrexone was prescribed by an ED clinician
CDSv2 adherence to OUD treatment recommendations
Time frame: 12 months
For ED visits in which CDSv2 is launched, investigators will assess the percentage of times either buprenorphine, methadone, or naltrexone was prescribed by an ED clinician
CDSv2 adherence to social care recommendations
Time frame: 12 months
For ED visits in which CDSv2 is launched, investigators will assess the percentage of times social care recommendations (to be determined, based on results from Aim 2) were followed by ED clinicians
CDSv1 acceptability
Time frame: During first 6 months of CDSv1 deployment
Acceptability of Intervention Measure 4-item survey to assess clinician acceptability of CDSv1. Response scales range from "1 = Completely disagree" to "5 = Completely agree", with higher scores indicating greater success.
CDSv1 appropriateness
Time frame: During first 6 months of CDSv1 deployment
Intervention Appropriateness Measure 4-item survey to assess clinician perception of CDSv1 appropriateness. Response scales range from "1 = Completely disagree" to "5 = Completely agree", with higher scores indicating greater success.
CDSv2 acceptability
Time frame: During first 6 months of CDSv2 deployment
Acceptability of Intervention Measure 4-item survey to assess clinician acceptability of CDSv2. Response scales range from "1 = Completely disagree" to "5 = Completely agree", with higher scores indicating greater success.
CDSv2 appropriateness
Time frame: During first 6 months of CDSv2 deployment
Intervention Appropriateness Measure 4-item survey to assess clinician perception of CDSv2 appropriateness. Response scales range from "1 = Completely disagree" to "5 = Completely agree", with higher scores indicating greater success.
Patient recruitment CDSv1
Time frame: 12 months
Number of patients who receive OUD medication as a result of CDSv1 who are enrolled for primary outcome ascertainment
Patient recruitment CDSv2
Time frame: 12 months
Number of patients who receive OUD medication as a result of CDSv2 who are enrolled for primary outcome ascertainment
ED clinicians' perceptions of CDSv1
Time frame: Within first 8 months of CDSv1 deployment
Themes emerging from semi-structured qualitative interviews exploring clinician perceptions of CDSv1
ED patients' perceptions of CDSv1
Time frame: Within first 8 months of CDSv1 deployment
Themes emerging from semi-structured qualitative interviews exploring patient perceptions of receiving treatment from CDSv1
ED clinicians' perceptions of CDSv2
Time frame: Within first 8 months of CDSv2 deployment
Themes emerging from semi-structured qualitative interviews exploring clinician perceptions of CDSv2
ED patients' perceptions of CDSv2
Time frame: Within first 8 months of CDSv2 deployment
Themes emerging from semi-structured qualitative interviews exploring patient perceptions of receiving social risk-informed treatment from CDSv2
Feasibility of primary endpoint collection for CDSv1
Time frame: 13 months
Percentage of participants for whom data on OUD medication adherence and follow up are successfully collected at 30 days for CDSv1
Feasibility of primary endpoint collection for CDSv2
Time frame: 13 months
Percentage of participants for whom data on OUD medication adherence and follow up are successfully collected at 30 days for CDSv2
Who can participate
This study lists these criteria on ClinicalTrials.gov. A study coordinator reviews eligibility during screening — this page does not determine whether you qualify.
Inclusion criteria
- All University of California, San Francisco ED providers (residents, attendings, advanced practice providers) who have used either CDSv1 or CDSv2 will be eligible to participate in surveys and interviews regarding feasibility and acceptability.
- English-speaking patients ≥18 years of age presenting to the UCSF ED with opioid use disorder who receive medication treatment (as a result of CDSv1 or CDSv2) will be eligible to participate.
Exclusion criteria
- \- Participants will be excluded if:
- they have a medical or psychiatric condition requiring hospitalization at the index ED visit,
- are actively suicidal, are cognitively impaired,
- present from an extended care facility, or
- require opioids for a pain condition.
Where
- San Francisco, California
Collaborators
National Institute on Drug Abuse (NIDA)
Related conditions & keywords
Frequently asked questions
What is a clinical trial?
A clinical trial is a research study that tests new medical treatments, drugs, devices, or procedures to determine their safety and effectiveness. Trials are carefully designed and monitored to protect participants while advancing medical knowledge.
Is it safe to participate?
Clinical trials follow strict safety guidelines and ethical standards. Trials must be reviewed and approved, and participants are closely monitored by medical professionals throughout the study. You can withdraw at any time if you choose.
Will I be compensated?
Many clinical trials offer compensation for your time, travel expenses, and inconvenience. The specific compensation varies by study and will be discussed during the screening process. All study-related medical care is typically provided at no cost to participants.
Will I receive a placebo instead of treatment?
When effective treatment exists, participants typically receive either the standard treatment plus the study intervention, or the standard treatment plus placebo. You would not be denied effective care. Placebos are primarily used when no proven treatment is available, or in addition to standard care. Your trial consent form will clearly explain what treatments you may receive.
Can I leave a trial if I change my mind?
Absolutely. Participation in clinical trials is completely voluntary. You have the right to withdraw from the study at any time, for any reason, without penalty or loss of benefits to which you are otherwise entitled.
How long does a clinical trial last?
Trial duration varies widely depending on the study design and purpose. Some trials last just a few weeks, while others may continue for months or years. The study coordinator will provide specific timeline information during your screening call.
Data: ClinicalTrials.gov · synced Jun 29, 2026 · Source of record for eligibility and locations