Table 2 Summary of the multilevel determinants of ED initiation of buprenorphine through integration of the EMBED clinical decision support tool, guided by PRISM
PRISM domain | Determinants |
|---|---|
Intervention (organizational perspective) | • Clinician level: evidence to support buprenorphine initiation and the EMBED CDS • Clinician level: ability to observe positive results from using the intervention, such finding out when a patient establishes care for OUD treatment after discharge |
Recipients (organizational characteristics) | • Organizational level: perspective on buprenorphine initiation, including establishing buprenorphine initiation as a cultural norm within the department and communicating that clearly to all frontline clinicians and staff |
Implementation and sustainability infrastructure | • Organizational level: ability to tailor the intervention to the local environment, including identifying existing interdisciplinary team members in the ED and the organization to implement the intervention, and the ability to integrate the CDS tool within the EHR • Organizational level: commitment to implement and sustain intervention through activities such as designating local champions/experts • Clinician level: sufficient training and support for prescribing clinicians |
External environment | • Ability to link patients for ongoing treatment |