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Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder.
West J Emerg Med. 2016 Jan; 17(1):28-34.WJ

Abstract

INTRODUCTION

There is a paucity of literature supporting the use of electronic alerts for patients with high frequency emergency department (ED) use. We sought to measure changes in opioid prescribing and administration practices, total charges and other resource utilization using electronic alerts to notify providers of an opioid-use care plan for high frequency ED patients.

METHODS

This was a randomized, non-blinded, two-group parallel design study of patients who had 1) opioid use disorder and 2) high frequency ED use. Three affiliated hospitals with identical electronic health records participated. Patients were randomized into "Care Plan" versus "Usual Care groups". Between the years before and after randomization, we compared as primary outcomes the following: 1) opioids (morphine mg equivalents) prescribed to patients upon discharge and administered to ED and inpatients; 2) total medical charges, and the numbers of; 3) ED visits, 4) ED visits with advanced radiologic imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) studies, and 5) inpatient admissions.

RESULTS

A total of 40 patients were enrolled. For ED and inpatients in the "Usual Care" group, the proportion of morphine mg equivalents received in the post-period compared with the pre-period was 15.7%, while in the "Care Plan" group the proportion received in the post-period compared with the pre-period was 4.5% (ratio=0.29, 95% CI [0.07-1.12]; p=0.07). For discharged patients in the "Usual Care" group, the proportion of morphine mg equivalents prescribed in the post-period compared with the pre-period was 25.7% while in the "Care Plan" group, the proportion prescribed in the post-period compared to the pre-period was 2.9%. The "Care Plan" group showed an 89% greater proportional change over the periods compared with the "Usual Care" group (ratio=0.11, 95% CI [0.01-0.092]; p=0.04). Care plans did not change the total charges, or, the numbers of ED visits, ED visits with CT or MRI or inpatient admissions.

CONCLUSION

Electronic care plans were associated with an incremental decrease in opioids (in morphine mg equivalents) prescribed to patients with opioid use disorder and high frequency ED use.

Authors+Show Affiliations

Baystate Medical Center and Tufts University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.ARAMCO, Department of Emergency Medicine, Dharan, Saudi Arabia.Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts.Baystate Medical Center and Tufts University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts.Baystate Medical Center, Department of Academic Affairs Administration, Springfield, Massachusetts.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

26823927

Citation

Rathlev, Niels, et al. "Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization By High Frequency Emergency Department Users With Opioid Use Disorder." The Western Journal of Emergency Medicine, vol. 17, no. 1, 2016, pp. 28-34.
Rathlev N, Almomen R, Deutsch A, et al. Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder. West J Emerg Med. 2016;17(1):28-34.
Rathlev, N., Almomen, R., Deutsch, A., Smithline, H., Li, H., & Visintainer, P. (2016). Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder. The Western Journal of Emergency Medicine, 17(1), 28-34. https://doi.org/10.5811/westjem.2015.11.28319
Rathlev N, et al. Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization By High Frequency Emergency Department Users With Opioid Use Disorder. West J Emerg Med. 2016;17(1):28-34. PubMed PMID: 26823927.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized Controlled Trial of Electronic Care Plan Alerts and Resource Utilization by High Frequency Emergency Department Users with Opioid Use Disorder. AU - Rathlev,Niels, AU - Almomen,Reda, AU - Deutsch,Ashley, AU - Smithline,Howard, AU - Li,Haiping, AU - Visintainer,Paul, Y1 - 2016/01/12/ PY - 2015/07/31/received PY - 2015/10/28/revised PY - 2015/11/20/accepted PY - 2016/1/30/entrez PY - 2016/1/30/pubmed PY - 2016/11/12/medline SP - 28 EP - 34 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 17 IS - 1 N2 - INTRODUCTION: There is a paucity of literature supporting the use of electronic alerts for patients with high frequency emergency department (ED) use. We sought to measure changes in opioid prescribing and administration practices, total charges and other resource utilization using electronic alerts to notify providers of an opioid-use care plan for high frequency ED patients. METHODS: This was a randomized, non-blinded, two-group parallel design study of patients who had 1) opioid use disorder and 2) high frequency ED use. Three affiliated hospitals with identical electronic health records participated. Patients were randomized into "Care Plan" versus "Usual Care groups". Between the years before and after randomization, we compared as primary outcomes the following: 1) opioids (morphine mg equivalents) prescribed to patients upon discharge and administered to ED and inpatients; 2) total medical charges, and the numbers of; 3) ED visits, 4) ED visits with advanced radiologic imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) studies, and 5) inpatient admissions. RESULTS: A total of 40 patients were enrolled. For ED and inpatients in the "Usual Care" group, the proportion of morphine mg equivalents received in the post-period compared with the pre-period was 15.7%, while in the "Care Plan" group the proportion received in the post-period compared with the pre-period was 4.5% (ratio=0.29, 95% CI [0.07-1.12]; p=0.07). For discharged patients in the "Usual Care" group, the proportion of morphine mg equivalents prescribed in the post-period compared with the pre-period was 25.7% while in the "Care Plan" group, the proportion prescribed in the post-period compared to the pre-period was 2.9%. The "Care Plan" group showed an 89% greater proportional change over the periods compared with the "Usual Care" group (ratio=0.11, 95% CI [0.01-0.092]; p=0.04). Care plans did not change the total charges, or, the numbers of ED visits, ED visits with CT or MRI or inpatient admissions. CONCLUSION: Electronic care plans were associated with an incremental decrease in opioids (in morphine mg equivalents) prescribed to patients with opioid use disorder and high frequency ED use. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/26823927/Randomized_Controlled_Trial_of_Electronic_Care_Plan_Alerts_and_Resource_Utilization_by_High_Frequency_Emergency_Department_Users_with_Opioid_Use_Disorder_ L2 - http://escholarship.org/uc/item/1tn4k7k9 DB - PRIME DP - Unbound Medicine ER -