A Multi-modal Quality- Improvement Study of Strategies for Enhancing Adoption of Naloxone- Prescribing Clinical Decision Support
MetadataShow full item record
ABSTRACT: Objectives: Clinical Decision Support (CDS) has enormous potential to improve health outcomes and healthcare in general. Our working hypothesis is that CDS in the form of Best Practice Advisory for naloxone prescription can enhance availability of this life saving drug as part of the armamentarium in the struggle against “opioid epidemic”. However, there are many candidate methods for effecting this enhancement in naloxone prescription. Methods: A before and after analysis of the overall naloxone prescription ratio was done after implementation of the risk-based opioid overdose alert recommending naloxone prescription in May 2018 at Johns Hopkins Bayview Medical Center’s electronic medical record (Epic). In an effort to enhance adoption of the naloxone prescription recommendation via the implemented clinical decision support, we designed three interventions: Narcan teaching session, remote academic detailing and targeted emails to low naloxone prescribing providers. The aim of the research design was to study the before-after impact of these interventions on the prescription behavior of end user. Results: The four studied interventions targeted a range of 2,161 to 62 providers across Johns Hopkins Bayview Medical Center (JHBMC). The results show an increase in prescription ratio from a baseline 3.1% to 13.5% (95% C.I = +9.0% ‒ +11.5 %, p= <0.001) as a result of naloxone alert deployed on electronic medical record, 46.8% to 60.7% (95% C.I = +9.4% ‒ +18 %, p= <0.001) by remote academic detailing (educational emails) and 15.4% to 65.9% (95% C.I = +43% ‒ +58 %, p= <0.001) by targeted audit emails to low prescribing providers. However, there is insufficient evidence to conclude the impact, or lack thereof, of face to face educational teaching sessions (Narcan teaching session). Conclusion: In this age of increase in reliance on health I.T, organizations are introducing novel and innovative interventions to improve both patient experience and provider performance. In order to make these I.T integrations robust, analysis of their quality, effectiveness and usability is beneficial for optimizing end user adoption. Results of this study strongly suggest that provider behavior, in response to naloxone decision support, can be improved by quality improvement initiatives such as designed in this study. .