Clinician Interaction, Exposure, and Adoption Network
Clinician exposure and conversion network for health care system 5 at 4 time points during the study. Each point represents a clinician, and the color denotes whether the clinician had converted to adopter status by the given time.Time-to-event modeling of first buprenorphine initiation using Cox proportional hazards was performed to examine factors associated with clinician adoption of the practice of ED initiation of buprenorphine. We adjusted for clinician type owing to training and regulatory differences by role (eg, the requirement for X-waiver training). Compared with APPs, attending physicians and resident physicians had a lower hazard ratio (HR) for converting to prescriber status (attending physicians, HR, 0.62; 95% CI, 0.43-0.90; resident physicians, HR, 0.52; 95% CI, 0.35-0.78). Intervention site status was also associated with higher rates of adoption (HR, 1.50; 95% CI, 1.04-2.18). The health care system where the clinician worked was significantly associated with the hazard of conversion. Health care system 1 had lower rates of buprenorphine prescribing than all other sites within the study (