Table 2.
Quality measurement framework for ED treatment of opioid use disorder: structural, process, and ED and population health outcomes for opioid use disorder primary prevention, harm reduction, and treatment.
| Outcome Measures |
||||
|---|---|---|---|---|
| OUD Domain | Structural Measures | Process Measures | ED | Population |
| Primary prevention | Availability of nonopioid pain management | Patient education about opioid safe storage and disposal on discharge | Adverse events after ED discharge after receiving new opioids | Patients with unintended prolonged opioid use |
| PDMP-EMR integration | Trial of nonopioid analgesics before opioid initiation when indicated | ED revisitation for analgesia-associated adverse medication events | New OUD per-capita incidence | |
| “Safe prescribing” ED policies | Median days opioids prescribed | OUD prevalence | ||
| Median MME/day per ED visit | Opioid overdose incidence | |||
| Frequency of benzodiazepine and opioid coprescribing | ||||
| Harm reduction | ED naloxone distribution policy | Proportion ED OUD patients: a) Provision of overdose prevention and response patient education |
Risk-adjusted inhospital mortality for overdose | Risk-adjusted repeated nonfatal overdose |
| Community syringe access program | b) Discharged with/prescribed naloxone | Risk-adjusted repeated fatal overdose | ||
| c) Referred to a syringe access program | Risk-adjusted 30-day repeated ED visit for nonfatal opioid overdose | Risk-adjusted out-of-hospital overdose mortality | ||
| d) Referred to community resources | HCV and HIV incidence and prevalence | |||
| Buprenorphine-waivered providers (ED and community) | Structured screening and diagnostic questionnaires | Repeated ED visit rates for opioid overdose, opioid withdrawal, or complications of injection drug use | ||
| addiction medicine specialist consultation access | Urine toxicology testing | Opioid withdrawal scale at ED discharge | Proportion patients engaged in formal addiction treatment at 30 days | |
| Treatment | Availability of outpatient providers of medication for OUD | Proportion ED OUD patients: | Proportion patients maintaining receipt of medication for OUD at 30 days | |
| Community opioid treatment programs and providers | a) With initiated medication for OUD | Risk-adjusted inhospital mortality for overdose | Risk-adjusted repeated nonfatal overdose | |
| Hospital or community bridge clinics | b) Prescribed medication for OUD | Risk-adjusted repeated fatal overdose | ||
| c) Linked to outpatient OUD treatment | Risk-adjusted out-of-hospital overdosemortality | |||
| d) Counseled by health promotion advocates, counselors, or social workers | ||||