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| ID | Type | Description | Link |
|---|---|---|---|
| 5UG1DA015831-15 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute on Drug Abuse (NIDA) | NIH |
| The Emmes Company, LLC | INDUSTRY |
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The purpose of this study is to evaluate the impact of (1) Implementation Facilitation (IF) on rates of provision of Emergency Department (ED)-initiated buprenorphine/naloxone (BUP) treatment with referral for ongoing medication-assisted treatment (MAT) and the (2) effectiveness of IF on patient engagement in formal addiction treatment at 30 days.
The study was originally proposed to use a Hybrid Type 3 Effectiveness-Implementation framework and a modified stepped wedge design.
Original protocol registration language: The study will be conducted at four EDs with a high prevalence of patients with untreated opioid use disorder (OUD). The four sites will receive the same sequence of evaluations and interventions: the baseline evaluation period after the standard dissemination practice, the IF phase, and continuation of facilitation into the IF evaluation period. The timing of initiation of the study activities at each site will be randomly offset by ~ 3 month increments to accommodate logistical constraints of simultaneous implementation at all sites. The study populations will include (1) ED providers and staff involved in the treatment of patients with OUD; (2) Community opioid treatment provider and program staff involved in providing care for patients with OUD referred from the ED; and (3) ED patients with moderate to severe OUD.
Exploratory analyses have been added to assess the impact of COVID-19 and social distancing guidance on drug use and drug supply; access to medications for opioid use disorder; and COVID19 disease from the perspectives of patient participants and ED leadership.
Upon results entry, changes were made to reflect that the study design originally was described as a "modified step wedge" but ultimately was not designed or implemented as such, as there was no substantial overlap of the baseline evaluation and IF evaluation periods. Thus, the statistical plan was adjusted accordingly.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Evidenced-based Practice Dissemination | Experimental | Evaluating standard dissemination practice compared with implementation facilitation |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard Dissemination Practice | Other | Emergency department provider education using a grand rounds format. The content of the lecture will cover the scope of the opioid problem, ED specific facts related to the epidemic, potential models of intervention including the results of publications outlining the efficacy of ED-initiated BUP. |
| Measure | Description | Time Frame |
|---|---|---|
| Implementation (Considered the Primary Outcome) | The primary implementation outcome will be evaluated assessing the rate of ED-initiated BUP therapy with referral for ongoing MAT | 12 months |
| Effectiveness | The primary effectiveness outcome is defined as the rates of patient engagement in formal addiction treatment on the 30th day post enrollment. | 30 Days Post Enrollment |
| Measure | Description | Time Frame |
|---|---|---|
| Implementation: ED Organizational Readiness to Change Assessment (ORCA) Score | ED ORCA score relating to ED-initiated BUP with referral for ongoing MAT. Scores are dichotomized as less ready (scores 0-6) or most ready (scores 7-10). | Pre IF (Baseline) |
| Measure | Description | Time Frame |
|---|---|---|
| Implementation: ED Provider Readiness and Preparedness Ruler Score | ED provider readiness and preparedness ruler score to initiate BUP and provide referral for ongoing MAT. | Pre IF (Baseline) |
| Implementation: ED Provider Readiness and Preparedness Ruler Score |
Patient Inclusion Criteria:
Patient Exclusion Criteria:
ED and Community Participants Inclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gail D'Onofrio, MD, MS | Department of Emergency Medicine, Yale School of Medicine | Principal Investigator |
| David A Fiellin, MD | Department of Internal Medicine, Yale School of Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Johns Hopkins Hospital | Baltimore | Maryland | 21287 | United States | ||
| The Mount Sinai Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25919527 | Background | D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015 Apr 28;313(16):1636-44. doi: 10.1001/jama.2015.3474. | |
| 33307301 | Background | Coupet E Jr, D'Onofrio G, Chawarski M, Edelman EJ, O'Connor PG, Owens P, Martel S, Fiellin DA, Cowan E, Richardson L, Huntley K, Whiteside LK, Lyons MS, Rothman RE, Pantalon M, Hawk K. Emergency department patients with untreated opioid use disorder: A comparison of those seeking versus not seeking referral to substance use treatment. Drug Alcohol Depend. 2021 Feb 1;219:108428. doi: 10.1016/j.drugalcdep.2020.108428. Epub 2020 Nov 26. |
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A total of 27,748 patients were screened during the baseline evaluation period and 394 were enrolled and analyzed. During the IF evaluation period, 26,456 were screened and 362 enrolled and analyzed. The study was originally conceived as a "modified step wedge" but not designed or implemented as such, as there was no substantial overlap of the baseline evaluation and IF evaluation periods. A total of 975 unique providers were assessed across the study periods via survey.
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| ID | Title | Description |
|---|---|---|
| FG000 | Baseline Evaluation Period Cohort | Evaluating standard dissemination practice compared with implementation facilitation Standard Dissemination Practice: Emergency department provider education using a grand rounds format. The content of the lecture will cover the scope of the opioid problem, ED specific facts related to the epidemic, potential models of intervention including the results of publications outlining the efficacy of ED-initiated BUP. Implementation Facilitation (IF): IF involves a "formative evaluation" to identify the specific and dynamic needs of stakeholders and the context for implementation of evidence-based practices. This evaluation informs the initial tailoring and refinement of the IF, which includes a bundle of services tailored to meet site-specific needs, such as identifying and engaging local stakeholders, providing extensive ongoing education, tailoring program to the site and monitoring performance and offering feedback. |
| FG001 | IF Evaluation Period | Evaluating standard dissemination practice compared with implementation facilitation Standard Dissemination Practice: Emergency department provider education using a grand rounds format. The content of the lecture will cover the scope of the opioid problem, ED specific facts related to the epidemic, potential models of intervention including the results of publications outlining the efficacy of ED-initiated BUP. Implementation Facilitation (IF): IF involves a "formative evaluation" to identify the specific and dynamic needs of stakeholders and the context for implementation of evidence-based practices. This evaluation informs the initial tailoring and refinement of the IF, which includes a bundle of services tailored to meet site-specific needs, such as identifying and engaging local stakeholders, providing extensive ongoing education, tailoring program to the site and monitoring performance and offering feedback. |
| FG002 | Providers - Baseline Period | Unique total number of providers added during Baseline Period |
| FG003 | Providers - 6 Month Period | Unique total number of providers added at 6 Month Period |
| FG004 | Providers - 12 Month Period | Unique total number of providers added at the 12 Month Period |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Baseline characteristics were not collected for providers.
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| ID | Title | Description |
|---|---|---|
| BG000 | Baseline Evaluation Period Cohort | Evaluating standard dissemination practice compared with implementation facilitation Standard Dissemination Practice: Emergency department provider education using a grand rounds format. The content of the lecture will cover the scope of the opioid problem, ED specific facts related to the epidemic, potential models of intervention including the results of publications outlining the efficacy of ED-initiated BUP. Implementation Facilitation (IF): IF involves a "formative evaluation" to identify the specific and dynamic needs of stakeholders and the context for implementation of evidence-based practices. This evaluation informs the initial tailoring and refinement of the IF, which includes a bundle of services tailored to meet site-specific needs, such as identifying and engaging local stakeholders, providing extensive ongoing education, tailoring program to the site and monitoring performance and offering feedback. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Implementation (Considered the Primary Outcome) | The primary implementation outcome will be evaluated assessing the rate of ED-initiated BUP therapy with referral for ongoing MAT | Posted | Count of Participants | Participants | 12 months |
|
Data was collected over 12 months.
There was no adverse event monitoring for providers taking part in the study.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Baseline Evaluation Period Cohort | Evaluating standard dissemination practice compared with implementation facilitation Standard Dissemination Practice: Emergency department provider education using a grand rounds format. The content of the lecture will cover the scope of the opioid problem, ED specific facts related to the epidemic, potential models of intervention including the results of publications outlining the efficacy of ED-initiated BUP. Implementation Facilitation (IF): IF involves a "formative evaluation" to identify the specific and dynamic needs of stakeholders and the context for implementation of evidence-based practices. This evaluation informs the initial tailoring and refinement of the IF, which includes a bundle of services tailored to meet site-specific needs, such as identifying and engaging local stakeholders, providing extensive ongoing education, tailoring program to the site and monitoring performance and offering feedback. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Gail D'Onofrio | Yale University | (203) 785-7059 | gail.donofrio@yale.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | May 22, 2018 | Jul 13, 2022 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Sep 20, 2021 | Jul 15, 2022 | SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Oct 18, 2016 | Nov 16, 2022 | ICF_002.pdf |
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| ID | Term |
|---|---|
| D009293 | Opioid-Related Disorders |
| ID | Term |
|---|---|
| D000079524 | Narcotic-Related Disorders |
| D019966 | Substance-Related Disorders |
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
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Note: Care Providers and Research Associates are masked during Baseline Evaluation Period
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|
| Implementation Facilitation (IF) | Other | IF involves a "formative evaluation" to identify the specific and dynamic needs of stakeholders and the context for implementation of evidence-based practices. This evaluation informs the initial tailoring and refinement of the IF, which includes a bundle of services tailored to meet site-specific needs, such as identifying and engaging local stakeholders, providing extensive ongoing education, tailoring program to the site and monitoring performance and offering feedback. |
|
ED provider readiness and preparedness ruler score to initiate BUP and provide referral for ongoing MAT |
| post IF Evaluation Period (12 months) |
| Implementation: ED Provider Readiness and Preparedness Ruler Score | ED provider readiness and preparedness ruler score to initiate BUP and provide referral for ongoing MAT | Post IF (6 months) |
| Effectiveness: Illicit Opioid Urine Toxicology | Rates of illicit opioid negative urines | 30 days post enrollment |
| Effectiveness: Healthcare Service Utilization | All Healthcare Service Utilization Inpatient and Outpatient | 30 days post enrollment |
| Effectiveness: Overdose Event | Overdose event (past 30 days) captured by participant self-report, state medical examiner records, National Death Index and review of medical records | 30 days post enrollment |
| Effectiveness: Opioid Use | Self-reported days of illicit opioid use (past 7 days) as measured by Time-Line Follow-Back methods at 30 days | 30 days post enrollment |
| Effectiveness: HIV Risk | HIV risk taking behaviors (past 30 days) as measured by HIV Risk Taking Behavior Scale | 30 days post enrollment |
| Implementation: Community ORCA Score | Community opioid treatment provider/program ORCA score relating to receiving patients with OUD who have received ED-initiated BUP | Pre IF (Baseline) |
| Implementation: Community ORCA Score | Community opioid treatment provider/program ORCA score relating to receiving patients with OUD who have received ED-initiated BUP | Post IF (6 months) |
| Implementation: Community ORCA Score | Community opioid treatment provider/program ORCA score relating to receiving patients with OUD who have received ED-initiated BUP | post IF Evaluation Period (12 months) |
| Implementation: Community Readiness and Preparedness Ruler Score | Community opioid treatment provider/program readiness and preparedness ruler score to continue MAT for patients with OUD who have received ED-initiated BUP | Pre IF (Baseline) |
| Implementation: Community Readiness and Preparedness Ruler Score | Community opioid treatment provider/program readiness and preparedness ruler score to continue MAT for patients with OUD who have received ED-initiated BUP | Post IF (6 months) |
| Implementation: Community Readiness and Preparedness Ruler Score | Community opioid treatment provider/program readiness and preparedness ruler score to continue MAT for patients with OUD who have received ED-initiated BUP | post IF Evaluation Period (12 months) |
| Implementation: ED Organizational Readiness to Change Assessment (ORCA) Score | ED ORCA score relating to ED-initiated BUP with referral for ongoing MAT | Post IF (6 months) |
| Implementation: ED Organizational Readiness to Change Assessment (ORCA) Score | ED ORCA score relating to ED-initiated BUP with referral for ongoing MAT | Post IF Evaluation Period (12 months) |
| Implementation: Fidelity | Fidelity will be measured using a critical action checklist relating to the provision of ED-initiated BUP with referral for ongoing MAT in eligible patients. | Baseline Period (Baseline) |
| Implementation: Fidelity | Fidelity will be measured using a critical action checklist relating to the provision of ED-initiated BUP with referral for ongoing MAT in eligible patients. | IF Evaluation Period (18 months) |
| New York |
| New York |
| 10029 |
| United States |
| Weill Cornell Medical College | New York | New York | 10065 | United States |
| University of Cincinnati Medical Center | Cincinnati | Ohio | 45219 | United States |
| Harborview Medical Center | Seattle | Washington | 98104 | United States |
| 32782084 | Background | Chawarski MC, Hawk K, Edelman EJ, O'Connor P, Owens P, Martel S, Coupet E Jr, Whiteside L, Tsui JI, Rothman R, Cowan E, Richardson L, Lyons MS, Fiellin DA, D'Onofrio G. Use of Amphetamine-Type Stimulants Among Emergency Department Patients With Untreated Opioid Use Disorder. Ann Emerg Med. 2020 Dec;76(6):782-787. doi: 10.1016/j.annemergmed.2020.06.046. Epub 2020 Aug 8. |
| 32391893 | Background | Hawk KF, D'Onofrio G, Chawarski MC, O'Connor PG, Cowan E, Lyons MS, Richardson L, Rothman RE, Whiteside LK, Owens PH, Martel SH, Coupet E Jr, Pantalon M, Curry L, Fiellin DA, Edelman EJ. Barriers and Facilitators to Clinician Readiness to Provide Emergency Department-Initiated Buprenorphine. JAMA Netw Open. 2020 May 1;3(5):e204561. doi: 10.1001/jamanetworkopen.2020.4561. |
| 31064390 | Background | D'Onofrio G, Edelman EJ, Hawk KF, Pantalon MV, Chawarski MC, Owens PH, Martel SH, VanVeldhuisen P, Oden N, Murphy SM, Huntley K, O'Connor PG, Fiellin DA. Implementation facilitation to promote emergency department-initiated buprenorphine for opioid use disorder: protocol for a hybrid type III effectiveness-implementation study (Project ED HEALTH). Implement Sci. 2019 May 7;14(1):48. doi: 10.1186/s13012-019-0891-5. |
| 40865260 | Derived | Ryan D, Lu T, Edelman EJ, Hawk KF, O'Connor PG, Coupet E Jr, Jalali A, Owens PH, Fiellin DA, D'Onofrio G, Murphy SM. Microcosting implementation facilitation for emergency department-initiated buprenorphine for untreated opioid use disorder. Am J Emerg Med. 2025 Dec;98:124-129. doi: 10.1016/j.ajem.2025.08.002. Epub 2025 Aug 12. |
| 37017967 | Derived | D'Onofrio G, Edelman EJ, Hawk KF, Chawarski MC, Pantalon MV, Owens PH, Martel SH, Rothman R, Saheed M, Schwartz RP, Cowan E, Richardson L, Salsitz E, Lyons MS, Freiermuth C, Wilder C, Whiteside L, Tsui JI, Klein JW, Coupet E, O'Connor PG, Matthews AG, Murphy SM, Huntley K, Fiellin DA. Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder. JAMA Netw Open. 2023 Apr 3;6(4):e235439. doi: 10.1001/jamanetworkopen.2023.5439. |
| BG001 | IF Evaluation Period Cohort | Evaluating standard dissemination practice compared with implementation facilitation Standard Dissemination Practice: Emergency department provider education using a grand rounds format. The content of the lecture will cover the scope of the opioid problem, ED specific facts related to the epidemic, potential models of intervention including the results of publications outlining the efficacy of ED-initiated BUP. Implementation Facilitation (IF): IF involves a "formative evaluation" to identify the specific and dynamic needs of stakeholders and the context for implementation of evidence-based practices. This evaluation informs the initial tailoring and refinement of the IF, which includes a bundle of services tailored to meet site-specific needs, such as identifying and engaging local stakeholders, providing extensive ongoing education, tailoring program to the site and monitoring performance and offering feedback. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Education | Count of Participants | Participants |
|
| Employment | Count of Participants | Participants |
|
| Unstable Housing | Spent at least one night in the past 12 months in any of the following places. | Count of Participants | Participants |
|
| Currently living in any of the following places | Count of Participants | Participants |
|
| Health insurance | Count of Participants | Participants |
|
| Primary Medical Provider | 393 out of 394 reported for Baseline Evaluation Period and 361 out of 362 reported for IF Evaluation Period | Count of Participants | Participants |
|
| Number of Positive UDS results by substance | Count of Participants | Participants |
|
| Overdose History | Count of Participants | Participants |
|
| Mental Health History | Count of Participants | Participants |
|
| OG001 | IF Evaluation Period Cohort | Evaluating standard dissemination practice compared with implementation facilitation Standard Dissemination Practice: Emergency department provider education using a grand rounds format. The content of the lecture will cover the scope of the opioid problem, ED specific facts related to the epidemic, potential models of intervention including the results of publications outlining the efficacy of ED-initiated BUP. Implementation Facilitation (IF): IF involves a "formative evaluation" to identify the specific and dynamic needs of stakeholders and the context for implementation of evidence-based practices. This evaluation informs the initial tailoring and refinement of the IF, which includes a bundle of services tailored to meet site-specific needs, such as identifying and engaging local stakeholders, providing extensive ongoing education, tailoring program to the site and monitoring performance and offering feedback. |
|
|
|
| Primary | Effectiveness | The primary effectiveness outcome is defined as the rates of patient engagement in formal addiction treatment on the 30th day post enrollment. | Posted | Count of Participants | Participants | 30 Days Post Enrollment |
|
|
|
|
| Secondary | Implementation: ED Organizational Readiness to Change Assessment (ORCA) Score | ED ORCA score relating to ED-initiated BUP with referral for ongoing MAT. Scores are dichotomized as less ready (scores 0-6) or most ready (scores 7-10). | Clinicians assessed at baseline. | Posted | Count of Participants | Participants | Pre IF (Baseline) |
|
|
|
| Other Pre-specified | Implementation: ED Provider Readiness and Preparedness Ruler Score | ED provider readiness and preparedness ruler score to initiate BUP and provide referral for ongoing MAT. | Not Posted | Pre IF (Baseline) | Participants |
| Other Pre-specified | Implementation: ED Provider Readiness and Preparedness Ruler Score | ED provider readiness and preparedness ruler score to initiate BUP and provide referral for ongoing MAT | Not Posted | post IF Evaluation Period (12 months) | Participants |
| Other Pre-specified | Implementation: ED Provider Readiness and Preparedness Ruler Score | ED provider readiness and preparedness ruler score to initiate BUP and provide referral for ongoing MAT | Not Posted | Post IF (6 months) | Participants |
| Other Pre-specified | Effectiveness: Illicit Opioid Urine Toxicology | Rates of illicit opioid negative urines | Not Posted | 30 days post enrollment | Participants |
| Other Pre-specified | Effectiveness: Healthcare Service Utilization | All Healthcare Service Utilization Inpatient and Outpatient | Not Posted | 30 days post enrollment | Participants |
| Other Pre-specified | Effectiveness: Overdose Event | Overdose event (past 30 days) captured by participant self-report, state medical examiner records, National Death Index and review of medical records | Not Posted | 30 days post enrollment | Participants |
| Other Pre-specified | Effectiveness: Opioid Use | Self-reported days of illicit opioid use (past 7 days) as measured by Time-Line Follow-Back methods at 30 days | Not Posted | 30 days post enrollment | Participants |
| Other Pre-specified | Effectiveness: HIV Risk | HIV risk taking behaviors (past 30 days) as measured by HIV Risk Taking Behavior Scale | Not Posted | 30 days post enrollment | Participants |
| Other Pre-specified | Implementation: Community ORCA Score | Community opioid treatment provider/program ORCA score relating to receiving patients with OUD who have received ED-initiated BUP | Not Posted | Pre IF (Baseline) | Participants |
| Other Pre-specified | Implementation: Community ORCA Score | Community opioid treatment provider/program ORCA score relating to receiving patients with OUD who have received ED-initiated BUP | Not Posted | Post IF (6 months) | Participants |
| Other Pre-specified | Implementation: Community ORCA Score | Community opioid treatment provider/program ORCA score relating to receiving patients with OUD who have received ED-initiated BUP | Not Posted | post IF Evaluation Period (12 months) | Participants |
| Other Pre-specified | Implementation: Community Readiness and Preparedness Ruler Score | Community opioid treatment provider/program readiness and preparedness ruler score to continue MAT for patients with OUD who have received ED-initiated BUP | Not Posted | Pre IF (Baseline) | Participants |
| Other Pre-specified | Implementation: Community Readiness and Preparedness Ruler Score | Community opioid treatment provider/program readiness and preparedness ruler score to continue MAT for patients with OUD who have received ED-initiated BUP | Not Posted | Post IF (6 months) | Participants |
| Other Pre-specified | Implementation: Community Readiness and Preparedness Ruler Score | Community opioid treatment provider/program readiness and preparedness ruler score to continue MAT for patients with OUD who have received ED-initiated BUP | Not Posted | post IF Evaluation Period (12 months) | Participants |
| Other Pre-specified | Implementation: ED Organizational Readiness to Change Assessment (ORCA) Score | ED ORCA score relating to ED-initiated BUP with referral for ongoing MAT | Not Posted | Post IF (6 months) | Participants |
| Other Pre-specified | Implementation: ED Organizational Readiness to Change Assessment (ORCA) Score | ED ORCA score relating to ED-initiated BUP with referral for ongoing MAT | Not Posted | Post IF Evaluation Period (12 months) | Participants |
| Other Pre-specified | Implementation: Fidelity | Fidelity will be measured using a critical action checklist relating to the provision of ED-initiated BUP with referral for ongoing MAT in eligible patients. | Not Posted | Baseline Period (Baseline) | Participants |
| Other Pre-specified | Implementation: Fidelity | Fidelity will be measured using a critical action checklist relating to the provision of ED-initiated BUP with referral for ongoing MAT in eligible patients. | Not Posted | IF Evaluation Period (18 months) | Participants |
| 1 |
| 394 |
| 0 |
| 394 |
| 0 |
| 394 |
| EG001 | IF Evaluation Period | Evaluating standard dissemination practice compared with implementation facilitation Standard Dissemination Practice: Emergency department provider education using a grand rounds format. The content of the lecture will cover the scope of the opioid problem, ED specific facts related to the epidemic, potential models of intervention including the results of publications outlining the efficacy of ED-initiated BUP. Implementation Facilitation (IF): IF involves a "formative evaluation" to identify the specific and dynamic needs of stakeholders and the context for implementation of evidence-based practices. This evaluation informs the initial tailoring and refinement of the IF, which includes a bundle of services tailored to meet site-specific needs, such as identifying and engaging local stakeholders, providing extensive ongoing education, tailoring program to the site and monitoring performance and offering feedback. | 2 | 362 | 0 | 362 | 0 | 362 |
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| Unknown or Not Reported |
|
| Native Hawaiian or Other Pacific Islander |
|
| Black or African American |
|
| White |
|
| More than one race |
|
| Unknown or Not Reported |
|
| Some college, no degree |
|
| ≥ College degree |
|
| Emergency Department or none |
|
| Not reported |
|