Abstract
OBJECTIVES: To characterize emergency department (ED) clinician engagement with electronic health record (EHR)-based social drivers of health (SDOH) data; test whether engagement differs in encounters with opioid use disorder (OUD); and, among OUD encounters, assess whether engagement is associated with medications for OUD (MOUD) treatment. MATERIALS AND METHODS: We conducted a cross-sectional study of adult ED encounters (January 2023-October 2024). OUD encounters, identified with a structured phenotype, were matched (1:2) to non-OUD encounters. Audit logs captured clinician engagement with structured SDOH questions ("SDOH Wheel"), ICD-10 Z codes in the Problem List, Social History free text, and social work notes. Engagement was any SDOH documentation or review of preexisting SDOH data during the encounter. Logistic regression estimated associations. RESULTS: Among 17,103 encounters (5,701 OUD; 11,402 non-OUD), clinician SDOH documentation was rare (<1%). Clinicians most often reviewed Z codes (610/620; 98.4%), followed by the SDOH Wheel (1,103/3,953; 27.9%), social work notes (1,711/10,670; 16.0%), and Social History free text (232/6,942; 3.3%). Engagement occurred in 19.5% of encounters and was higher with OUD (26.6% vs 16.0%; adjusted odds ratio [aOR] 1.91, 95% CI 1.77-2.07). Among OUD encounters, engagement showed no clear association with MOUD (aOR 1.11, 95% CI 0.84-1.47), yet racial and ethnic disparities persisted. DISCUSSION: ED clinicians infrequently document but do review structured, accessible SDOH data. Engagement is higher in OUD encounters yet shows no definitive link with MOUD, while disparities persist. Interface designs that surface SDOH and targeted EHR decision support warrant evaluation to inform equitable, time-sensitive ED care.