Quality Framework for Emergency Department Treatment of Opioid Use Disorder
- Summary: Emergency departments (EDs) are a key point of access to medical care for patients with opioid use disorder (OUD). This paper describes a quality improvement framework for EDs that could help standardize care, reduce care inequities, and improve outcomes for patients with OUD.
Emergency departments (EDs) are on the front lines of the opioid epidemic, caring for increasing numbers of opioid overdose patients. From 2016 to 2017, ED visits for opioid overdose increased 30% nationwide; however, only a minority of those visits resulted in linkage to treatment.
As a key point of access to medical care, the ED is well positioned to improve outcomes for patients with OUD. Quality measurement and improvement initiatives for other medical conditions commonly presented in the ED, like heart attack and stroke, have helped standardize practice, reduce care inequities, accelerate implementation and adoption, and improve outcomes for patients. The same could be true for similar campaigns related to OUD.
In May 2017, the National Institute on Drug Abuse’s (NIDA’s) Center for the Clinical Trials Network convened experts in quality measurement from the American College of Emergency Physicians’ (ACEP’s) Clinical Emergency Data Registry, researchers in emergency and addiction medicine, and representatives from federal agencies, including NIDA and the Centers for Medicare & Medicaid Services (CMS).
The discussion covered a range of relevant topics, including integration of quality measures into electronic health records, measurement priorities, ways to leverage data already being collected, ED substance use disorder research, and trends in ED clinical practice related to OUD.
The author team refined the meeting summary into a proposed opioid use disorder quality improvement framework, described in detail in this article. The framework provides a clear outline for future research and policy approaches to ED OUD quality improvement, including opportunities for strengthening primary prevention, harm reduction, and treatment.