# Measuring Improvement in the Quality of ED-initiated Treatment for OUD using Observation

> **NIH NIH R33** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2022 · $804,473

## Abstract

Treatment of opioid use disorder (OUD) with buprenorphine (BUP) has significant individual and societal
benefits, and decreases the risk of death from overdose. Yet, few individuals have access to these treatments.
Narrowing the treatment gap by expanding access to treatment in Emergency Department (ED) settings is
widely viewed to be a public health priority. It has been 3 years since D’Onofrio et al.’s landmark paper
demonstrated the feasibility, safety, and efficacy of ED-initiated BUP, and, despite a highly visible opioid
epidemic, few EDs have adopted this life-saving intervention. Coincident with the intensifying opioid epidemic,
there have been increasing calls for development and use of quality measures to track and improve the quality
of care for OUD and implement policy strategies to identify and incentivize use of best practices. Through our
work, including leading two ongoing NIDA Clinical Trials Network multicenter studies of the implementation and
effectiveness of ED-initiated BUP and referral, our team has identified unique challenges to implementation
and collection of information about care quality. By providing an environment within and managed by the ED
that allows sufficient time for enhanced care, beyond a 4-6 hour ED visit, protocol-driven ED Observation Units
(EDOUs) would mitigate many identified challenges and promote better utilization of existing infrastructure.
Further, it would enable patients presenting for overdose to remain in the ED long enough to receive their first
dose of BUP prior to discharge.
In the R61 phase, we will build on our existing clinical protocols as well as linked process and outcome
measures of quality related to ED-initiated BUP and referral to be delivered during (1) a standard ED visit and
(2) an enhanced ED visit in EDOU. Then, for the R33 phase, we propose a multicenter, randomized controlled
trial in which patients with untreated OUD presenting to the University of Kentucky, NYU-Brooklyn (NYC), and
Bellevue Hospital (NYC) EDs are randomized (1:1) to treatment though one of the two clinical protocols with
outcomes assessed at the ED visit, 1, 3, and 6 months. We will evaluate processes and outcomes granularly to
inform the development of reliable, valid measures using data that could be captured without undue burden.
We will compare the relative effectiveness of the two approaches on the proportion of patients who receive ED-
initiated BUP and referral, are linked to formal OUD treatment within 7 days and engaged in treatment at 30
days. We will assess changes in patient reported outcomes and drug use, and conduct an economic
evaluation from a third-party payer perspective. Linking structural and process measures to population-level
outcomes will allow us to guide and define quality improvement to inform accountability and policy. Evaluating
the associations between patient-level characteristics, measure completion, and outcomes will help identify
population needs and apply strategies to im...

## Key facts

- **NIH application ID:** 10459308
- **Project number:** 5R33DA049265-04
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Ryan P McCormack
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $804,473
- **Award type:** 5
- **Project period:** 2020-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10459308

## Citation

> US National Institutes of Health, RePORTER application 10459308, Measuring Improvement in the Quality of ED-initiated Treatment for OUD using Observation (5R33DA049265-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10459308. Licensed CC0.

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