Department of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
J Am Med Inform Assoc. 2023 Mar 16;30(4):683-691. doi: 10.1093/jamia/ocac257.
Opioid-related overdose (OD) deaths continue to increase. Take-home naloxone (THN), after treatment for an OD in an emergency department (ED), is a recommended but under-utilized practice. To promote THN prescription, we developed a noninterruptive decision support intervention that combined a detailed OD documentation template with a reminder to use the template that is automatically inserted into a provider's note by decision rules. We studied the impact of the combined intervention on THN prescribing in a longitudinal observational study.
ED encounters involving an OD were reviewed before and after implementation of the reminder embedded in the physicians' note to use an advanced OD documentation template for changes in: (1) use of the template and (2) prescription of THN. Chi square tests and interrupted time series analyses were used to assess the impact. Usability and satisfaction were measured using the System Usability Scale (SUS) and the Net Promoter Score.
In 736 OD cases defined by International Classification of Disease version 10 diagnosis codes (247 prereminder and 489 postreminder), the documentation template was used in 0.0% and 21.3%, respectively (P < .0001). The sensitivity and specificity of the reminder for OD cases were 95.9% and 99.8%, respectively. Use of the documentation template led to twice the rate of prescribing of THN (25.7% vs 50.0%, P < .001). Of 19 providers responding to the survey, 74% of SUS responses were in the good-to-excellent range and 53% of providers were Net Promoters.
A noninterruptive decision support intervention was associated with higher THN prescribing in a pre-post study across a multiinstitution health system.
阿片类药物相关的过量用药（OD）死亡人数仍在不断增加。在急诊科（ED）治疗 OD 后，携带纳洛酮（THN）回家是一种推荐但未充分利用的做法。为了促进 THN 的处方，我们开发了一种非中断决策支持干预措施，将详细的 OD 文档模板与使用模板的提醒相结合，该提醒通过决策规则自动插入到提供者的记录中。我们在一项纵向观察研究中研究了该联合干预措施对 THN 处方的影响。
在 ED 中，对涉及 OD 的患者进行回顾，评估在将自动插入医生记录中的使用高级 OD 文档模板的提醒嵌入到医生记录中之前和之后，模板的使用情况和 THN 的处方情况是否发生了变化：（1）模板的使用情况，（2）THN 的处方情况。使用卡方检验和中断时间序列分析来评估影响。使用系统可用性量表（SUS）和净推荐值（NPS）来衡量可用性和满意度。
在根据国际疾病分类第 10 版诊断代码定义的 736 例 OD 病例中（247 例预提醒和 489 例后提醒），模板的使用比例分别为 0.0%和 21.3%（P < 0.0001）。提醒对 OD 病例的敏感性和特异性分别为 95.9%和 99.8%。使用文档模板可使 THN 处方的比例增加一倍（25.7%对 50.0%，P < 0.001）。在 19 名回应调查的提供者中，74%的 SUS 回答处于良好到优秀范围，53%的提供者是净推荐者。
在一项跨多机构卫生系统的前后研究中，非中断决策支持干预措施与 THN 处方率的提高有关。
