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Although emergency departments (EDs) are often the only sites of care for patients with opioid use disorder (OUD), a proven medication, buprenorphine, is underutilized by community emergency physicians when patients present with OUD. To explore this further, we first performed a qualitative study of 30 community emergency physicians. We then conducted a quantitative analysis of a national database of emergency department visits based on one of our main qualitative findings. Finally, we evaluated the results of the quantitative study in the context of our other main qualitative findings, exploring the Familiarity Principle and how it explained our quantitative findings in light of our qualitative results. The integrative analysis demonstrates that it is not the population of patients with OUD but rather the disease of OUD towards which stigma exists.Our original model for community emergency physician (CEP) prescription of buprenorphine to patients with OUD suggested that four themes predominantly factored into decision-making: (1) physician professional identity; (2) the image of (and stigma towards) patients with OUD; (3) physician education and professional development; and (4) additional resources for care. While some of these findings had been described previously, the concept of stigma appeared to be novel and so formed the basis for a confirmatory quantitative study. To explore ideas further, we performed a quantitative analysis of a national database of 267 million ED visits over four years. We found that ED resource utilization for patients with OUD who presented because of typical ED complaints (chest and abdominal pain) was similar to ED resource utilization for patients without OUD. This finding suggested that any CEP bias towards this population did not translate into less care during ED visits for non-OUD concerns.To further understand the counterintuitive results, we returned to our qualitative findings. We analyzed them in the light of the Familiarity Principle and determined that the other three qualitative findings—physician identity, education, and resources—allowed CEPs to treat patients with OUD similarly when they presented with non-OUD concerns, given their overall comfort with the medical issues, if not the patients. This comfort appeared to override CEPs’ stigma towards this patient population. This finding may be the key to developing effective methods to increase the appropriate treatment of these patients when they present with OUD concerns.

Objectives: To quantify clinical concepts relevant to radiology consultation requests and assess rates of clinical decision support (CDS) attributes documented in Emergency Department provider notes at the time of image order entry. Methods: We reviewed data from encounters for patients with headaches during which head CT was performed. We compared relevant concepts extracted via natural language processing of notes to image order requisitions. We reviewed data from encounters for patients with falls, trauma, or bicycle accidents during which cervical spine imaging was performed and reviewed rates of CDS attributes and agreement with concepts in CDS module. Results: We identified a significant number of encounters where provider EHR documentation was available at the time of image order entry applicable to order requisitions as well as CDS rules and exclusion criteria. Significantly more concepts relevant to headache were extracted from notes compared to order requisitions. Discussion: EHR Clinical documentation provides a source of valuable information that could be used in an automated fashion to improve communication between ordering providers and radiologists and enhance the order entry process. Conclusion: Future work is needed to integrate and automate within the EHR to optimize documentation and communication of clinically useful information in the ordering process., Master of Medical Sciences in Biomedical Informatics