No abstract

Objective 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. Methods 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. Results 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. Conclusions A noninterruptive decision support intervention was associated with higher THN prescribing in a pre-post study across a multiinstitution health system.

Intimate partner violence is, unfortunately, a common problem (25% of women) for which screening in primary care is a recommended service. In this paper, we describe modifications to a commercial EHR system (Epic) designed to support confidential screening for and management of IPV in primary care settings. Modifications include the use of an exam room computer as a kiosk for patient-generated health data entry, storage of data in a hidden location, the use of rule-based alerting methods to direct providers to access data, and electronic form-based tools for case management and documentation. While preserving privacy, this approach also allows access by provider type and authorized setting, including use for population health management. The approach was tested in a pilot study and found to be feasible, to have good compliance for provider screening (65%) and is being evaluated in a stepped-wedge trial in other primary care clinics across a large academic health system.

Electronic health records of a sentinel population of pregnant persons were queried to perform sexually transmitted infection surveillance. This approach may improve the accuracy of national case estimates of sexually transmitted infections.