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Klinisk beslutningsstøtte for at forbedre system-naloxon-samordination

28. september 2026 opdateret af: University of Colorado, Denver

The objective of this study is to evaluate the impact of a clinical decision support (CDS) alert to facilitate the co-prescribing of naloxone, an opioid overdose reversal agent, with high-risk opioid prescriptions. Prescribing naloxone with opioids is a best practice described in the 2022 US Center for Disease Control and Prevention (CDC) guidelines on opioid prescribing. The CDS can improve quality of care delivered by improving compliance with the guideline defined best practices. The project will compare CDS alert facilitated co-prescribing of naloxone with high-risk opioid prescriptions vs usual care to evaluate the effectiveness of the CDS alert for improving naloxone prescribing. The patients are not assigned to an intervention and will be receiving any changes in care as part of their routine medical care, rather than a specific intervention that is distinct from their usual medical care. The researchers hypothesize that the CDS alert will be acceptable to providers while increasing naloxone co-prescribing which will reduce the number of opioid overdoses in subsequent 6 months.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Clinical decision support tools help clinicians make treatment decisions based on routinely collected data and offer a promising strategy to implement evidence-based practices for safe and effective pain management. This project will use clinical decision support tools embedded into electronic health records to help healthcare providers make treatment decisions that align with opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC). The project will also use information from prescription drug monitoring programs, insurance claims, and mortality data to evaluate patient outcomes. This research will evaluate how prescribing practices that align with CDC guidelines affect patient outcomes and whether clinical decision support tools provide an advantage over standard care practices for pain management.

Undersøgelsestype

Observationel

Tilmelding (Faktiske)

114272

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

    • Colorado
      • Aurora, Colorado, Forenede Stater, 80045
        • University of Colorado Hospital

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

12 år til 89 år (Barn, Voksen, Ældre voksen)

Tager imod sunde frivillige

Ja

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

Residents and visitors to the state of Colorado who seek healthcare within the University of Colorado Health (UCHealth) system.

Beskrivelse

Inclusion Criteria:

  • Patients receiving an opioid prescription at discharge from inpatient/ED or close visit in outpatient settings where the clinical decision support (CDS) is implemented

Exclusion Criteria:

  • Patients <12 and >89 year of age
  • Cancer diagnosis
  • Hospice care/palliative care
  • Sickle cell disease diagnosis
  • Patients who arrived in error
  • Patients who were triaged to obstetrics

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Observationsmodeller: COHORT
  • Tidsperspektiver: PROSPECTIVE

Kohorter og interventioner

Gruppe / kohorte
Intervention / Behandling
Clinical Decision Support (CDS): Naloxone Alert

Encounters where the naloxone clinical decision support (CDS) alert fired. CDS logic is programmed to fire alert when a provider places and order for a high-risk opioid analgesic prescription to a patient without an active naloxone prescription.

High-risk prescription logic to trigger the Naloxone CDS:

[(NOT 1 AND (2 AND AT LEAST 1 OF (3, 4, 5, 6))) AND 7 AND NOT 8]

  1. ACTIVE OR PENDED NALOXONE PRESCRIPTION ORDER
  2. OPIOID SCRIPT BEING PLACED CRITERIA
  3. DAILY Milligram Morphine Equivalent (MME) >=90 UNSIGNED ORDER
  4. DAILY MME >=90 EXISTING
  5. DIAGNOSIS OF OPIOID USE DISORDER
  6. DIAGNOSIS HISTORY OF OPIOID OVERDOSE
  7. PROVIDER LOGGED INTO ELLIGIBLE DEPARTMENTS
  8. DISCHARGE TO HOSPICE

Clinical decision support in the form of an EHR-integrated, provider facing alert suggesting (a) the opioid medication order is considered high risk for overdose and (b) to nudge providers to add a naloxone prescription to the opioid prescription to mitigate risk in the event of an overdose.

Usual Care

Control group of contemporary encounters where clinical decision support (CDS) is not active. Usual care.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Percentage of a high-risk opioid analgesic prescriptions receiving a co-prescription of naloxone
Tidsramme: 18 months

The number of high-risk opioid encounters where a naloxone prescription was written with the opioid divided by the total number of encounters where a high-risk opioid prescription was written.

18 months

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Clinical decision support (CDS) acceptance rate
Tidsramme: 18 months

The number of times providers accepted the Clinical decision support (CDS) suggestion and co-prescribed naloxone with a high-risk opioid divided by the total number of times a high-risk opioid prescription triggered the CDS alert.

18 months
Subsequent opioid overdose/poisonings rates
Tidsramme: Six months after an encounter where the naloxone clinical decision support fired for the provider

The number of patients who had a diagnosis of opioid overdose or poisoning in the six months following the index visit with a high-risk opioid prescribed.

Six months after an encounter where the naloxone clinical decision support fired for the provider
Naloxone dispensed rate
Tidsramme: In the 3 days after the naloxone prescription is written

The number of patients who were dispensed a naloxone prescription divided by the number of naloxone prescriptions written.

In the 3 days after the naloxone prescription is written

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Jason A Hoppe, DO, University of Colorado, Denver

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

1. juli 2024

Primær færdiggørelse (Faktiske)

31. oktober 2025

Studieafslutning (Faktiske)

1. april 2026

Datoer for studieregistrering

Først indsendt

14. februar 2024

Først indsendt, der opfyldte QC-kriterier

14. februar 2024

Først opslået (Faktiske)

22. februar 2024

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

29. september 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

28. september 2026

Sidst verificeret

1. september 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • 23-2356
  • R61DA057610 (U.S. NIH-bevilling/kontrakt)

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

JA

IPD-planbeskrivelse

De-identified quantitative EHR data utilized in this project will be housed on the National Addiction and HIV Data Archive Program (NAHDAP) website.

IPD-delingstidsramme

Data will be provided to NAHDAP after study results are published in peer-reviewed journals.

IPD-delingsadgangskriterier

Prior to downloading study data, the individual will have to register with the site and agree to a standard data use agreement.

IPD-deling Understøttende informationstype

  • STUDY_PROTOCOL

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

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Studerer et amerikansk FDA-reguleret enhedsprodukt

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