Project Grant K23DA060993

USING CLINICAL DECISION SUPPORT TO PROVIDE SOCIAL RISK-INFORMED CARE FOR OPIOID USE DISORDER IN THE EMERGENCY DEPARTMENT - PROJECT SUMMARY/ABSTRACT DR. MELANIE MOLINA IS AN ASSISTANT CLINICAL PROFESSOR OF EMERGENCY MEDICINE AT THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO (UCSF) WHOSE LONG-TERM GOAL IS TO BECOME AN INDEPENDENT INVESTIGATOR STUDYING HOW TO LEVERAGE HEALTH INFORMATION TECHNOLOGY TO IMPROVE CARE FOR PATIENTS EXPERIENCING SOCIAL DISADVANTAGE. TO ACHIEVE THIS GOAL, SHE WILL DEVELOP CRITICAL SKILLS IN CLINICAL INFORMATICS, HUMAN-CENTERED DESIGN, AND IMPLEMENTATION SCIENCE BY: 1) COMPLETING FORMAL COURSEWORK IN SQL AND CLARITY DATA MODEL FUNDAMENTALS, HUMAN-CENTERED DESIGN, AND DESIGNING INDIVIDUAL-LEVEL IMPLEMENTATION STRATEGIES, 2) ATTENDING STRUCTURED DIDACTICS, RESEARCH GROUP MEETINGS, JOURNAL CLUBS, AND WORKS-IN-PROGRESS SESSIONS, AND 3) PERFORMING GOAL- DIRECTED TRAINING ACTIVITIES IN DATA QUERY, RETRIEVAL, AND ANALYSIS, CONTEXTUAL INQUIRY AND FOCUS GROUP DESIGN, AND INTERVENTION IMPLEMENTATION AND PILOT DATA COLLECTION. THE RESEARCH INFRASTRUCTURE AND RESOURCES AT UCSF, INCLUDING THE CENTER FOR CLINICAL INFORMATICS AND IMPROVEMENT RESEARCH AND THE CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE, WILL PROVIDE DR. MOLINA WITH ALL THE SUPPORT NECESSARY TO COMPLETE THE WORK PROPOSED IN HER CAREER DEVELOPMENT APPLICATION. DR. MOLINA HAS ASSEMBLED AN EXCEPTIONAL MENTORSHIP TEAM: DR. LAURA GOTTLIEB (PRIMARY MENTOR) IS A PROFESSOR OF FAMILY AND COMMUNITY MEDICINE WITH EXPERTISE IN SOCIAL DETERMINANTS OF HEALTH, DR. JULIA ADLER-MILSTEIN (CO-MENTOR) IS A PROFESSOR OF MEDICINE AND CHIEF OF THE DIVISION OF CLINICAL INFORMATICS WITH EXPERTISE IN ELECTRONIC HEALTH RECORD (EHR) DATA, AND DR. COURTNEY LYLES (CO-MENTOR) IS A PROFESSOR IN THE DEPARTMENT OF PUBLIC HEALTH SCIENCES AT UC DAVIS WITH EXPERTISE IN HUMAN-CENTERED DESIGN AND IMPLEMENTATION SCIENCE METHODOLOGIES. THE OVERARCHING GOAL OF THIS PROPOSAL IS TO INTEGRATE PATIENT SOCIAL RISK INFORMATION INTO AN EXISTING EHR- BASED CLINICAL DECISION SUPPORT (CDS) TOOL TO FACILITATE ED-INITIATED, SOCIAL RISK-INFORMED OPIOID USE DISORDER (OUD) MEDICATION TREATMENT AND ULTIMATELY IMPROVE TREATMENT ADHERENCE AND FOLLOW UP. DR. MOLINA WILL START BY EXTRACTING METADATA FROM EPIC'S REPORTING DATABASE CAPTURING WHETHER DISCRETE SOCIAL RISK DATA WERE DOCUMENTED AND/OR REVIEWED BY ED CLINICIANS FOR OUD-RELATED ED ENCOUNTERS (AIM 1). USING INSIGHTS FROM AIM 1-IN ADDITION TO A HUMAN-CENTERED DESIGN APPROACH WITH SEMI-STRUCTURED QUALITATIVE INTERVIEWS OF KEY ED STAFF AND PATIENT STAKEHOLDERS-SHE WILL INTEGRATE PATIENT SOCIAL RISKS INTO AN EXISTING CDS TOOL FOR OUD TREATMENT, CREATING A PROTOTYPE THAT PROVIDES SOCIAL CARE-ENHANCED OUD TREATMENT RECOMMENDATIONS (AIM 2). SHE WILL THEN EVALUATE THE FEASIBILITY AND ACCEPTABILITY OF THE SOCIAL CARE-ENHANCED CDS TOOL AT THE UCSF ED AS AN INTERVENTION TO INCREASE TREATMENT ADHERENCE AND FOLLOW UP USING A MIXED-METHODS, BEFORE-AFTER APPROACH (AIM 3). THIS PROPOSAL FULFILLS THE NATIONAL INSTITUTE OF DRUG ABUSE RESEARCH PRIORITY OF UNDERSTANDING HOW TO ADAPT EXISTING SERVICES INTO MORE PATIENT-CENTERED MODELS OF CARE.