Enhancing Emergency Department Care for Alcohol Use Disorder Using Clinical Decision Support.
Funded Grant
Overview
Affiliation
View All
Overview
description
PROJECT ABSTRACT With the career goal of becoming an independent health services researcher, Dr. Jacob Lebin describes a mentored research project and a rigorous career development plan which will prepare him to become a leader in the integration of alcohol use disorder (AUD) treatment in the emergency department (ED) setting. Unhealthy alcohol use is a leading cause of preventable death in the U.S., contributing to 178,000 deaths annually and rising ED utilization. Almost 10% of ED patients have an AUD, and for many, the ED is their primary and only point of contact with the healthcare system – highlighting how EDs are uniquely positioned to contribute towards improved care of AUD. Despite this opportunity, evidence-based AUD interventions, such as ED prescribing of medications for AUD (MAUD), are hindered by challenges in identifying problematic alcohol use, limited clinician knowledge and comfort with MAUD, and the competing demands of the ED environment that constrain attention to AUD care. The overarching goal of this five-year K23 award is to develop and test an electronic health record (EHR)-embedded clinical decision support (CDS) tool to improve the identification and treatment of AUD in the ED and to support the candidate's transition to research independence. The proposed project will use a user-centered design approach and implementation science framework to iteratively develop and evaluate a CDS tool that integrates MAUD (naltrexone and acamprosate) prescribing and social work interventions into routine ED workflows. Study aims include: 1) a qualitative investigation to identify key components and intuitive language for a CDS tool through interviews with patients and focus groups of ED clinicians, pharmacists, nurses, and social workers; 2) development and iterative optimization of an EHR-based CDS prototype using rapid-cycle, user-centered design methods, followed by usability testing; and 3) a 12-month interrupted time series study across both academic and community ED settings to assess initial implementation outcomes of the CDS in improving evidence-based AUD care delivery. The candidate, an emergency medicine physician and medical toxicologist with postdoctoral training in addiction medicine, will pursue a tailored training plan to acquire skills in qualitative methods, gain experience in integrating implementation science methods with user-centered design, and pragmatic study design and analysis. The project is guided by a multidisciplinary team of NIH-funded mentors with complementary expertise in clinical decision support, EHR embedded studies, and addiction care. The innovation of this research lies in the creation of an ED-specific CDS to engage patients with alcohol misuse and leveraging the ED visit as a critical “teachable moment”. The public health impact is substantial: improving AUD care delivery in the ED may reduce alcohol-related harms, especially among high-risk populations who may not access traditional care. Results from this study will inform a future type III hybrid effectiveness-implementation trial and contribute to the implementation of AUD interventions in the ED.
