Previsione di machine-apprendimento e riduzione delle overdose con i nudghi EHR (mPROVEN)

Patients in the practices randomized to the Usual Care arm will receive standard care practice without change.

Patients in the practices randomized to the Usual Care arm will receive standard care practice without change.

An elevated-risk flag will be embedded in the EHR and prominently displayed in the chart during encounters for patients identified as having elevated-risk for opioid overdose.

Clinicians seeing patients at elevated predicted risk will see a flag on the EHR 'storyboard' during in person or telephone encounters indicating the patient is at elevated predicted risk of opioid overdose. The clinician will have the option of including this information into their decision-making process when providing care. There will be no best practice alerts/behavioral nudges in this arm.

An elevated-risk flag will be embedded in the EHR and prominently displayed in the chart during encounters for patients identified as having elevated-risk for opioid overdose. This flag will be combined with a set of best practice alerts/behavioral nudges that will trigger when certain conditions are met during encounters with elevated-risk patients.

Clinicians seeing patients at elevated predicted risk for opioid overdose will see a flag on the EHR storyboard indicating that the patient is at elevated predicted risk.

Clinicians will also receive up to 4 best practice alerts/behavioral nudges during an in-person or telephone primary care encounter with elevated risk patients when certain requirements are met: 1) if the patient does not have an active naloxone prescription on their medication list, the clinicians will receive an active choice alert during any medication ordering to encourage naloxone prescription; 2) if the patient's opioid dosage is >50 MME, OR they are ordered a new opioid prescription, OR they have an overlapping opioid and benzodiazepine prescription order, the clinicians will receive an accountable justification alert when the relevant order is entered.

• Flag a rischio elevato incorporato EHR con avvisi di best practice (BPAS)

This outcome measures a composite of three prescribing practices associated with a reduced risk of opioid overdose. Each of the three is assigned a value of one point, with the composite score ranging from 0 to 3:

1. Naloxone prescription: Evidence of a prescription for naloxone.
2. Opioid dosage < 50 morphine milligram equivalents (MME) per day: No prescriptions exceeding 50 MME/day during the measurement period.
3. No opioid and benzodiazepine overlap: No concurrent prescriptions for opioids and benzodiazepines.

The composite score will be treated as a 3-point ordinal measure reflecting adherence to these prescribing practices.

This outcome measures a composite of three prescribing practices associated with a reduced risk of opioid overdose. Each of the three is assigned a value of one point, with the composite score ranging from 0 to 3: 1. Naloxone prescription: Evidence of a prescription for naloxone. 2. Opioid dosage < 50 morphine milligram equivalents (MME) per day: No prescriptions exceeding 50 MME/day during the measurement period. 3. No opioid and benzodiazepine overlap: No concurrent prescriptions for opioids and benzodiazepines. The composite score will be treated as a 3-point ordinal measure reflecting adherence to these prescribing practices.

The presence of an active naloxone prescription, determined by evidence of a naloxone order, a naloxone fill, or both.

The average daily opioid dosage, calculated in morphine milligram equivalents (MME), is evaluated using prescription fills data as the primary source. If fills data are unavailable, prescription orders data will be used. This measure reflects whether the average daily MME exceeds 50 during the specified time period.

This outcome evaluates overlapping opioid and benzodiazepine use, determined by the following criteria:

(A) Active overlap on the index date: Both an opioid and a benzodiazepine prescription fill are active on the index date.

(B) Historical overlap: At least one opioid and one benzodiazepine prescription order within the past 28 days.

Overlap is defined as meeting any of the above.

This outcome evaluates the presence of overlapping opioid and benzodiazepine use where opioid MME is > 50, defined as above.

This outcome measures the occurrence of any emergency department (ED) or inpatient visit during the specified time period.

This outcome measures the occurrence of any emergency department (ED) or inpatient visit specifically attributed to an overdose during the specified time period.