Impact of an electronically-integrated clinical pathway on hospital initiation of medications for alcohol use disorder and subsequent hospital utilization.

Background: Medications for alcohol use disorder (MAUD) are underutilized and multiple barriers and disparities in treatment initiation have been identified. Effective hospital-based strategies to promote MAUD use are not well-defined.

Objective: To determine whether an electronic health record (EHR)-integrated clinical pathway increases MAUD initiation.

Methods: We conducted a prospective observational cohort study with consecutive adult inpatients diagnosed with alcohol use disorder (AUD) and withdrawal requiring treatment who were admitted to a health system comprising a mix of community and tertiary academic medical centers. The impact of voluntary use of an AUD EHR-integrated clinical pathway on MAUD initiation (main outcome) and ED return or readmission for any cause within 30 days of discharge (secondary outcomes) was evaluated.

Results: Among 2630 inpatient medicine encounters, the pathway was utilized in 17.8%. Pathway utilization was associated with 4.31 (confidence interval [CI]: 3.10-5.99, p < .001) increased odds of MAUD initiation as compared with encounters without pathway utilization (31% vs. 15.4%). There were no differences in rates of 30-day ED returns (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.35-1.62; p = .47) or 30-day readmissions (OR: 1.19; 95% CI: 0.80-1.76; p = .40) and no differences in MAUD initiation by race or ethnicity when the pathway was utilized versus not utilized.

Conclusions and relevance: Utilization of an EHR-integrated clinical pathway for individuals with AUD significantly increased MAUD initiation at hospital discharge. These findings support the use of an EHR-integrated clinical pathway as an implementation tool for overcoming barriers to MAUD initiation and may be a generalizable strategy for increasing low rates of MAUD prescribing for patients with AUD.