To address the urgent opioid epidemic public health threat in Northeastern New York State, the Emergency Department Alternatives to Opioids at the Albany Med Health System (ED-ALT AMHS) will adapt evidence-based practices to 1) improve person-centered care (PCC) for those with pain conditions in the ED, 2) implement an ED-ALT program, and 3) increase capacity and coordination of care for those with opioid use disorder (OUD) and pain and opioid use. The project will be implemented in the AMHS four hospital EDs with a greater catchment area of 2.8 million people spanning 25 counties and a combined total volume of over 170,000 annual ED visits. Among these visits, the program will have an impact on an estimated 83,000 (49%) patient encounters in the ED per year with persons reporting pain, among whom an estimated over 37,000 (45%) yearly would be expected to receive an opioid either in the ED or upon discharge without the project intervention (for a total of over 235,000 patient encounters with pain conditions in the ED and over 106,000 patient encounters in which opioids would be prescribed over the three-year project period without the project intervention). The ED-ALT AMHS project will serve our population of focus which includes people residing in rural, urban, and suburban areas with an estimated self-reported 51% female; 16.1% under 18 years; 23.6% 65 years and over; 80% White; 11.9% Black or African American; 1.2% Asian, Native Hawaiian, or Pacific Islander; 0.01% American Indian/Alaska Native; and 3.9% Hispanic or Latino.1
The program aims to improve the culture of person-centered care for all patients in the ED with pain conditions, improve the use of alternatives to opioids (ALTOs) for pain, and strengthen capacity and existing resources for screening, medications, and care for patients with OUD or pain and opioid use in the ED. These aims will be achieved by identifying key performance and outcome gaps in the provision of PCC for persons with pain conditions in the ED through patient interviews and ED provider and nursing staff focus groups and developing and implementing locally-informed PCC strategies and training for ED providers and nursing staff. To improve the use of ALTOs in the AMHS EDs, the project team will 1) develop and implement training for providers and nursing staff in ALTO best practices and directed strategies to address differing pain conditions in the ED; 2) develop electronic health record clinical decision support (order sets and best practice alerts) and 3) train ED providers and nurses in two integrative non-pharmacologic therapies (mindful breathing and music therapies). Additionally, ED provider and nurse training will be expanded through training and education in screening, brief intervention and referral to treatment (SBIRT) and ED provider training in medications for OUD and buprenorphine for pain in the ED. Finally, the proposed project will improve care for patients with pain who use opioids through training and coordination of multidisciplinary care and strengthening partnerships with community organizations.