Iscoe Mark S, Hooper Carolina Diniz, Levy Deborah R, Lutz John, Paek Hyung, Rose Christian, Kannampallil Thomas, Meeker Daniella, Dziura James D, Melnick Edward R
Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, United States.
Department of Biomedical Informatics and Data Sciences, Yale University School of Medicine, New Haven, Connecticut, United States.
Appl Clin Inform. 2025 Aug;16(4):1067-1076. doi: 10.1055/a-2595-0317. Epub 2025 Aug 20.
In the emergency department-initiated buprenorphine for opioid use disorder (EMBED) trial, a clinical decision support (CDS) tool had no effect on rates of buprenorphine initiation in emergency department (ED) patients with opioid use disorder. The Agency for Healthcare Research and Quality (AHRQ) recently released a CDS Performance Measure Inventory to guide data-driven CDS development and evaluation. Through partner co-design, we tailored AHRQ inventory measures to evaluate EMBED CDS performance and drive improvements.Relevant AHRQ inventory measures were selected and adapted using a partner co-design approach grounded in consensus methodology, with three iterative, multidisciplinary partner working group sessions involving stakeholders from various roles and institutions; meetings were followed by postmeeting surveys. The co-design process was divided into conceptualization, specification, and evaluation phases building on the Centers for Medicare and Medicaid Services' measure life cycle framework. Final measures were evaluated in three EDs in a single health system from January 1, 2023, to December 31, 2024.The partner working group included 25 members. During conceptualization, 13 initial candidate metrics were narrowed to 6 priority categories. These were further specified and validated as the following measures, presented with preliminary values based on the use of the current (i.e., preoptimization) EMBED CDS: eligible encounters with CDS engagement, 5.0% (95% confidence interval: 4.3-5.8%); teamwork on ED initiation of buprenorphine, 39.9% (32.5-47.3%); proportion of eligible users who used EMBED, 58.3% (50.9-65.8%); time spent on EMBED, 29.0 seconds (20.4-37.7 seconds); proportion of buprenorphine orders placed through EMBED, 6.5% (3.4-9.6%); and task completion, 13.8% (8.9-18.7%) for buprenorphine order/prescription.A measurement science framework informed by partner co-design was a feasible approach to develop measures to guide CDS improvement. Subsequent research could adapt this approach to evaluate other CDS applications.
在急诊科启动丁丙诺啡治疗阿片类药物使用障碍（EMBED）试验中，一种临床决策支持（CDS）工具对患有阿片类药物使用障碍的急诊科（ED）患者的丁丙诺啡启动率没有影响。医疗保健研究与质量局（AHRQ）最近发布了一份CDS性能测量清单，以指导数据驱动的CDS开发和评估。通过合作伙伴共同设计，我们对AHRQ清单测量方法进行了调整，以评估EMBED CDS的性能并推动改进。使用基于共识方法的合作伙伴共同设计方法选择并调整了相关的AHRQ清单测量方法，三个多学科合作伙伴迭代工作组会议邀请了来自不同角色和机构的利益相关者参与；会议之后进行会后调查。共同设计过程分为概念化、规范和评估阶段，以医疗保险和医疗补助服务中心的测量生命周期框架为基础。最终测量方法在一个医疗系统的三个急诊科进行了评估，时间从2023年1月1日至2024年12月31日。
合作伙伴工作组包括25名成员。在概念化阶段，13个初始候选指标被缩减为6个优先类别。这些类别进一步细化并验证为以下测量方法，并根据当前（即优化前）EMBED CDS的使用情况给出了初步值：CDS参与的合格就诊次数，5.0%（95%置信区间：4.3 - 5.8%）；急诊科启动丁丙诺啡的团队合作情况，39.9%（32.5 - 47.3%）；使用EMBED的合格用户比例，58.3%（50.9 - 65.8%）；在EMBED上花费的时间，29.0秒（20.4 - 37.7秒）；通过EMBED下达的丁丙诺啡订单比例，6.5%（3.4 - 9.6%）；以及丁丙诺啡订单/处方的任务完成率，13.8%（8.9 - 18.7%）。由合作伙伴共同设计提供信息的测量科学框架是开发指导CDS改进的测量方法的可行途径。后续研究可以采用这种方法来评估其他CDS应用。
