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Adaptive Decision Support for Addiction Treatment Master
Adaptive Decision Support for Addiction Treatment (ADAPT)
Who can join
Ages 18 and older · All sexes
Full eligibility criteria
Inclusion Criteria: * Emergency department patient * 18 years of age or older * Moderate to severe opioid use disorder Exclusion Criteria: * Under 18 years of age * Pregnant * Currently receiving medication for opioid use disorder
About the study
This study refines and optimizes the EMBED\* clinical decision support (CDS; see NCT03658642) to increase number of ED physicians following standard of care for the administration of buprenorphine to appropriate patients with opioid use disorder.
This study does not have open enrollment. Investigators will use a Multiphase Optimization STrategy (MOST) framework study with preparation, optimization, and confirmatory phases.
Optimization Phase: This phase has two stages. In stage 1, investigators will conduct a 2x2x2 factorial trial to expand EMBED is expanded to include sustainable implementation strategies: nurse prompt for withdrawal assessment, and targeted clinician prompts to use the CDS along with individualized patient resources to promote equity and motivate readiness to start treatment. In Stage 2, investigators will improve CDS usability via serial randomized testing to inform iterative refinement of the CDS interface and workflow to minimize user errors, task disruption, and abandonment through identification of specific targets for improvement via application of novel CDS outcome measures in serial randomized tests.
Evaluation phase: Investigators will conduct a randomized trial to compare the efficacy effectiveness of the optimized package compared to the original on ED-initiation of buprenorphine rates in patients with OUD.
\*EMBED is a user user-centered, clinician clinician-facing clinical decision support system integrated into the electronic health record workflow to facilitate initiating buprenorphine in the emergency department by: diagnosing opioid use disorder with a checklist based on the diagnostic criteria of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), assessing the severity of withdrawal with the Clinical Opioid Withdrawal Scale (COWS), motivating patients to accept treatment with a scripted brief negotiation interview, and automating the electronic health record workflow, including clinical and after visit documentation, order entry, prescribing, and referral for ongoing treatment in the community
What is being tested
- EMBED CDS (other)
- Nurse prompt to complete COWS (other)
- Provider Prompt (other)
- Patient facing materials (other)
- Optimized EMBED (other)
- Name of Intervention (other)
Sponsor: Yale University · Participants: 1,912 · Started: Mar 21, 2025
Contact the study team
- Edward Melnick, MD, MHS · Phone: 203-785-4363
Official record on ClinicalTrials.gov — NCT06799117
Locations in the U.S.
| Connecticut | Yale New Haven Shoreline Medical Center, Guilford Yale New Haven Hospital, New Haven Yale New Haven Hospital- St. Raphael, New Haven |
Conditions
From ClinicalTrials.gov, data retrieved Sep 30, 2026. Each study sets its own eligibility; the study team decides who can join.