Clinical Decision Support for Opioid Use Disorders in Medical Settings (COMPUTE 2.0)

Clinic-Randomized Trial of Clinical Decision Support for Opioid Use Disorders in Medical Settings (COMPUTE 2.0)

Through CTN-0076-Ot (Clinical Decision Support for Opioid Use Disorders in Medical Settings: Pilot Usability Testing in an EMR (COMPUTE)), our team has iteratively developed and piloted a web-based and electronic health record (EHR)-integrated Opioid Use Disorder (OUD) Clinical Decision Support (CDS) system to offer expert guidance to primary care providers (PCPs) on the diagnosis and management of OUD. The OUD-CDS has been implemented within the EPIC EHR of one large care system and was piloted with 55 providers to ensure content validity and provider satisfaction. The team will now implement this OUD-CDS in a large multi-site clinic-randomized controlled trial to evaluate its impact on practice process measures and patient outcomes. The investigators also aim to prepare for scalability (i.e., integration into usual primary care practice after the study is complete) and dissemination by evaluating facilitators and barriers to implementation, determining the costs of implementation and maintenance, and assessing the short-term cost impacts of the OUD-CDS.

The study will include three large diverse care systems and randomize a minimum of 30 clinics to receive the OUD-CDS intervention or usual care (UC). In intervention clinics, the OUD-CDS will identify patients who are at high risk for OUD or diagnosed with OUD; use data stored in the EHR for each eligible patient to assemble treatment recommendations tailored to each patient's current needs; display these recommendations to PCPs via the OUD-CDS user interface; and store analytic data from all targeted visits. In UC clinics, the OUD-CDS will run invisibly in the background to identify high-risk or OUD patients, assemble treatment recommendations tailored to each eligible patient's needs, and store analytic data from all targeted visits.

Study Overview

• Status: Completed
• Conditions: Opioid-use Disorder
• Intervention / Treatment: Other: Opioid Wizard

Detailed Description

The proposed study will include 3 large diverse healthcare systems and randomize a minimum of 30 clinics equally within each system to receive the OUD-CDS intervention or UC. In intervention and UC clinics, the OUD-CDS will identify study-eligible patients, those who are at high risk for OUD or diagnosed with OUD; and will use data stored in the EHR to assemble treatment recommendations tailored to the needs of each study-eligible patient. In intervention clinics, these treatment recommendations will be displayed via the OUD-CDS user interface. Finally, data from all targeted visits in all randomized clinics will be stored in a data repository for analysis and reporting needs. The targeted visits for each study-eligible patient in all randomized clinics will be the index visit, the first visit at which the OUD-CDS identifies that the patient is study eligible, and all post-index visits through the end of the intervention period, regardless of continued eligibility. This pragmatic cluster-randomized design is the optimal design to effectively and efficiently implement this tool in primary care clinics while protecting against study contamination and allowing for collection of process and outcome data at UC clinics.

Mixed Methods Approach: Virtually every evidence-based intervention in medicine has turned out to be difficult to implement and maintain in real life practice and to fall far short of fidelity to the process used in randomized trials. As a result, a whole new field of dissemination and implementation research has been developing over the last 20 years. These studies have now gone well beyond the previous paradigm of focusing on changing the attitudes and behaviors of individual physicians to a growing awareness that the need instead is to alter the environment in which physicians work so that it is easier to do the desired evidence-based thing than to stick with old established habit patterns. That means focusing change efforts on organizational factors and practice systems. The Solberg conceptual framework has proven to be particularly helpful in clarifying this new approach.

Simultaneously, there has been increasing interest in transitioning effectiveness clinical trials from traditionally highly selective and controlled circumstances to pragmatic trials that make use of normal care delivery processes and patients.[35] The measurement of such trials has been facilitated by the development of a conceptual framework called RE-AIM, an acronym for 5 key facets of such studies - Reach, Effectiveness, Adoption, Implementation, and Maintenance. Recently, the developers of RE-AIM have recognized the need for more flexible use of this framework, greater use of qualitative methods to understand why interventions are not used consistently, and making adaptations in the implementation approach based on such understandings. The investigators propose to use the RE-AIM framework to guide (1) a monitoring system for intervention problems, (2) a mixed methods evaluation of the reasons for those problems, and (3) modification of the intervention to reduce those problems. These steps will be reiterated in a cyclic fashion, resulting in a more sophisticated approach to the long-standing quality improvement emphasis on Plan-Do-Study-Act rapid cycle tests of change. Furthermore, the team will take advantage of the staggered implementation of the study through three different care systems to ensure that the solutions for intervention problems in Site 1 are not assumed to be the same as the approach in subsequent sites without further RE-AIM monitoring and evaluation.

• Study Type: Interventional
• Enrollment (Actual): 10891
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Minnesota
    • Bloomington, Minnesota, United States, 55425
      • HealthPartners
    • Duluth, Minnesota, United States, 55805
      • Essentia Health
  • Pennsylvania
    • Danville, Pennsylvania, United States, 17822-4400
      • Geisinger

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• be aged 18-75 years, inclusive, at the time of an index visit;
• have been diagnosed with OUD, currently prescribed MOUD, or identified by study algorithms as being at high risk of OUD.
• Be a patient at a study randomized clinic

Exclusion Criteria:

• those receiving active parenteral chemotherapy within the last year,
• those with stage 4 or equivalent cancer diagnosis
• those enrolled in hospice care or palliative care programs.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Receives OUD-CDS; Clinics will have access to the OUD-CDS (Opioid Wizard)	Other: Opioid Wizard; The Opioid Wizard is an OUD clinical decision support tool for primary care providers to help assess, diagnose, and treat OUD in primary care (where appropriate).
No Intervention: Does not Receive the OUD-CDS; Clinics will not have access to the OUD-CDS (Opioid Wizard). These will be "usual care" clinics.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Patients With OUD Diagnosis	Patient has an ICD10 diagnosis code for OUD assigned at an encounter or added to the problem list	Index visit date through 30 days post-index, inclusive.
Number of Patients With Naloxone Rescue Kit Order	Patient has a medication order for a naloxone rescue kit	Index visit date through 30 days post-index, inclusive.
Number of Patients With a MOUD Order or Referral	Patient has a medication order for a MOUD or referral for addiction treatment	Index visit date through 30 days post-index, inclusive.
Days Covered by MOUD Prescription	The sum of unique days covered by a MOUD order	Index visit date through 90 days post-index, inclusive, with 0 days assigned if there were no MOUD orders.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emergency Department Visits Per Patient-year		pre: one year through one day prior to the index visit; post: index visit through one year post-index or date of death, whichever was first.
Hospitalizations Per Patient-year		pre: one year through one day prior to the index visit; post: index visit through one year post-index or date of death, whichever was first.
Healthcare Costs	Healthcare costs for prescribed medications and clinical inpatient, emergency, and outpatient services incurred, as documented in insurance claims or clinical encounter data.	pre: one year through one day prior to the index visit; post: index visit through one year post-index or date of death, whichever was first.
All-cause Mortality Per 100 Patient-years.		index visit through one year post-index, inclusive
Overdoses Per 100 Patient-years.		pre: one year through one day prior to the index visit; post: index visit through one year post-index or date of death, whichever was first.

Collaborators and Investigators

• Sponsor: HealthPartners Institute
• Collaborators: National Institute on Drug Abuse (NIDA); The Emmes Company, LLC; Geisinger Clinic; Hennepin Healthcare Research Institute; Essentia Health
• Investigators: Principal Investigator: Gavin Bart, MD PhD FACP DFASAM, Hennepin Healthcare; Principal Investigator: Rebecca Rossom, MD, MSCR, HealthPartners Institute

Publications and helpful links

General Publications

• Olson AW, Bucaloiu A, Allen CI, Tusing LD, Henzler-Buckingham HA, Gregor CM, Freitag LA, Hooker SA, Rossom RC, Solberg LI, Wright EA, Haller IV, Romagnoli KM. 'Do they care?': a qualitative examination of patient perspectives on primary care clinician communication related to opioids in the USA. BMJ Open. 2025 Jan 7;15(1):e090462. doi: 10.1136/bmjopen-2024-090462.
• Olson AW, Haapala JL, Hooker SA, Solberg LI, Borgert-Spaniol CM, Romagnoli KM, Allen CI, Tusing LD, Wright EA, Haller IV, Rossom RC. The potential impact of clinical decision support on nonwaivered primary care clinicians' prescribing of buprenorphine. Health Aff Sch. 2023 Oct 11;1(4):qxad051. doi: 10.1093/haschl/qxad051. eCollection 2023 Oct.
• Rossom RC, Crain AL, Wright EA, Olson AW, Haller I, Haapala J, Dehmer SP, Hooker SA, Solberg L, O'Connor PJ, Borgert-Spaniol C, Gorodisher J, Miley K, Romagnoli K, Allen C, Tusing L, Ekstrom H, Appana D, Sperl-Hillen JM, Kobylinski M, Huntley K, McCormack J, Chen W, Bart G. Clinical Decision Support System for Primary Care of Opioid Use Disorder: A Randomized Clinical Trial. JAMA Intern Med. 2025 Sep 1;185(9):1079-1089. doi: 10.1001/jamainternmed.2025.2535.

Study record dates

Study Major Dates

• Study Start (Actual): November 12, 2019
• Primary Completion (Actual): December 31, 2023
• Study Completion (Actual): December 31, 2023

Study Registration Dates

• First Submitted: December 3, 2019
• First Submitted That Met QC Criteria: December 11, 2019
• First Posted (Actual): December 13, 2019

Study Record Updates

• Last Update Posted (Estimated): October 2, 2025
• Last Update Submitted That Met QC Criteria: September 16, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Narcotic-Related Disorders; Mental Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Opioid-Related Disorders; Physiological Effects of Drugs; Central Nervous System Depressants; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Narcotics; Analgesics, Opioid
• Other Study ID Numbers: CTN - 0095; UG1DA040316 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No