Records with documented age 16 or older, PLUS records with UNKNOWN age (protocol excludes only patients CONFIRMED under 16, so unknown-age records are included and flagged as a documentation gap). This is the denominator for the funnel.

Buprenorphine appears in the medications-given list AND there is no POSITIONAL pertinent-negative blocking it. A PN value at the same comma index as buprenorphine means it was considered but NOT administered — those records are reported separately, not as "given".

Whether naloxone was administered, and whether the medication-response field documents improvement. Improvement after naloxone is the clinical signal that opioid withdrawal — and a buprenorphine opportunity — may follow.

An eligible patient who received naloxone, improved, and has documented alcohol/drug-use indicators. Candidates are screened for exclusions before being counted as buprenorphine-eligible.

Documented contraindications — altered mental status, methadone, alcohol intoxication, benzodiazepines, polysubstance use, severe medical illness (narrative keywords), or pertinent-negative codes (contraindication / allergy / criteria-not-met). A candidate with any exclusion is NOT a missed opportunity. Keyword sets and codes are editable in bupe_config.py.

A buprenorphine-eligible patient (candidate with no exclusion) who did NOT receive buprenorphine. This is the headline QI finding — each case is itemized in the flag sheet for review.

NEMSIS 3.5.1 has no national COWS element — the only discrete scale fields are GCS, Pain, and Stroke. COWS is therefore read from a vendor CUSTOM field FIRST (auto-detected by header keyword), with the free-text narrative as the fallback. Scores bucket to 0–4 subclinical, 5–12 mild, 13–24 moderate, 25–36 moderately severe, 37+ severe. Each score records its source (field vs narrative); a candidate with no COWS documented is flagged. Keywords and patterns are editable in bupe_config.py.

Age groups, sex, and race for all records (race lists collapse to “Multiple Races”). Reported for equity review across the eligible population.