scholarly journals Overdose-Associated Admissions Among People Who Inject Opioids at a County Safety-Net Hospital Following Implementation of a Syringe Services Program

2020 ◽  
Author(s):  
Kasha Bornstein ◽  
Austin Coye ◽  
Joan St. Onge ◽  
Hua Li ◽  
Amanda Muller ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Safety Net ◽  
Injection Drug ◽  
Dade County ◽  
Opioid Use ◽  
Service Programs ◽  
Florida Department ◽  
Safety Net Hospital ◽  
Before And After ◽  
Icd 10

Abstract Background Syringe service programs (SSPs) are an evidence-based harm reduction strategy that reduce dangerous sequelae of injection drug use among people who inject drugs (PWID) such as overdose. SSP services include safer injection education and community-based naloxone distribution programs. This study evaluates differences in overdose-associated hospital admissions following implementation of the first legal SSP in Florida, based in Miami-Dade County. Methods We performed a retrospective analysis of hospitalizations for injection drug-related sequelae at a county hospital before and after the implementation of the SSP. An algorithm utilizing ICD-10 codes for opioid use and sequelae was used to identify people who inject opioids (PWIO). Florida Department of Law Enforcement Medical Examiners Commission Report data was used to analyze concurrent overdose death trends in Florida counties. Results Over the 25-month study period, 302 PWIO admissions were identified; 146 in the pre-index vs. 156 in post-index. A total of 26 admissions with PWIO overdose were found; 20 pre-index and 6 post-index (p=0.0034). Conclusions Declining overdose-associated admissions among PWIO suggests early impacts following SSP implementation.

scholarly journals Hospital Admissions Among People Who Inject Opioids Following Syringe Services Program Implementation

2020 ◽  
Author(s):  
Kasha Bornstein ◽  
Austin Coye ◽  
Joan St. Onge ◽  
Hua Li ◽  
Amanda Muller ◽  
...  
Keyword(s):  
Program Implementation ◽  
Hospital Admissions ◽  
Injection Drug ◽  
Dade County ◽  
Opioid Use ◽  
Service Programs ◽  
Florida Department ◽  
Before And After ◽  
Icd 10 ◽  
Future Hospital

Abstract Background Syringe service programs (SSPs) are an evidence-based harm reduction strategy that reduce dangerous sequelae of injection drug use among people who inject drugs (PWID) such as overdose. SSP services include safer injection education and community-based naloxone distribution programs. This study evaluates differences in overdose-associated hospital admissions following implementation of the first legal SSP in Florida, based in Miami-Dade County. Methods We performed a retrospective analysis of hospitalizations for injection drug-related sequelae at a county hospital before and after the implementation of the SSP. An algorithm utilizing ICD-10 codes for opioid use and sequelae was used to identify people who inject opioids (PWIO). Florida Department of Law Enforcement Medical Examiners Commission Report data was used to analyze concurrent overdose death trends in Florida counties. Results Over the 25-month study period, 302 PWIO admissions were identified; 146 in the pre-index vs. 156 in post-index. A total of 26 admissions with PWIO overdose were found; 20 pre-index and 6 post-index (p=0.0034). Conclusions Declining overdose-associated admissions among PWIO suggests early impacts following SSP implementation. These results indicate a potential early benefit of SSP that should be further explored for its effects on future hospital admission and mortality.

scholarly journals 1643. Infectious Sequelae of Injection Drug Use at a County Safety-Net Hospital Decline Following Establishment of a Syringe Service Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S599-S600
Author(s):  
Kasha J Bornstein ◽  
Austin Coye ◽  
Joan St Onge ◽  
Tyler Bartholomew ◽  
Hardik Patel ◽  
...  
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Hospital Admissions ◽  
Cost Savings ◽  
Total Sample ◽  
Safety Net ◽  
Injection Drug ◽  
Dade County ◽  
Chi Square ◽  
Safety Net Hospital

Abstract Background Infectious sequelae of injection drug use (ISIDU) and overdose are frequent but preventable among people who inject drugs (PWID). Syringe service programs (SSP) are an evidence-based harm reduction strategy to reduce incidence of ISIDU among PWID. Additionally, SSPs are noted to produce significant cost-savings for healthcare systems. Under current state legislation, Miami houses the only SSP in Florida, the IDEA SSP. This study builds on previous work characterizing morbidity and cost of ISIDU. This study sought to evaluate differences in admission rates and associated ISIDU costs at Jackson Memorial Hospital (JMH) in Miami before and after implementation of the IDEA SSP. Methods Retrospective data collected from a chart review of patients hospitalized for ISIDU and overdose was used to evaluate morbidity and cost of ISIDU at JMH from December 1, 2015 to December 1, 2017, stratified by December 1, 2016—the opening of the IDEA SSP—as an index date. An algorithm utilizing ICD-10 codes for drug use and sequelae was used to identify PWID population. Specific infections investigated were: endocarditis, osteomyelitis, bacteremia- and/or -sepsis (BOS), and skin-and-soft-tissue-infections (SSTIs). Pearson’s chi-square test for independence used to report P-values for associations between infections and total charges using a 2-tailed t-test. Results 726 admissions were identified during the study period, 328 PWID in the pre-index cohort vs. 398 in the post-index cohort. The median age of total sample was 45.24. 95.12% of the pre-index cohort were uninsured or had publicly-funded insurance vs. 96.48% post-index. Most ISIDU did not change significantly between pre-post cohorts, although bacteremia and sepsis declined significantly among opioid injectors (P = 0.026). Overdoses decreased significantly among PWID generally (57% decline pre-post; P = 0.0006), as well as for patients who inject opioids specifically (70% decline pre-post; P = 0.0034). Median cost declined by 20.5% among PWID, and 29.1% among opioid injectors in particular. Conclusion ISIDU continues to represent significant morbidity for PWID in Miami-Dade County and substantial cost to the health system. Severe infections, including bacteremia and sepsis, declined significantly among opioid injectors, the PWID subset most strongly associated with local SSP services. This change following the establishment of a local SSP suggests direct effects on the frequency of hospital admissions for ISIDU. Despite local increases in drug use, overall PWID frequency and ISIDU charges did not change significantly. OD and admission frequency amongst opioid users and cost-per-patient declined between groups, suggesting a potential decrease in ISIDU and attendant costs. While median charges per admission declined, they were statistically insignificant and may represent stagnation in ISIDU-associated costs following SSP establishment. Diminishment in opioid user admissions and OD suggest additional possible positive epidemiological effects of the SSP. Weaknesses included difficulty of associating outcomes, limited post-index time period, and potential misclassification when establishing a standardized algorithm for PWID identification. Disclosures All authors: No reported disclosures.

Abstract 16520: Predictors of Thirty Day Readmission in a Vulnerable and Underserved Urban Heart Failure Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexandra B Steverson ◽  
Paul Marano ◽  
Caren Chen ◽  
Yifei Ma ◽  
Rachel Stern ◽  
...  
Keyword(s):  
Heart Failure ◽  
Substance Use ◽  
San Francisco ◽  
Chart Review ◽  
Safety Net ◽  
Housing Status ◽  
Medical Comorbidities ◽  
Increased Risk ◽  
Safety Net Hospital ◽  
Icd 10

Introduction: Heart failure (HF) readmission quality metrics disproportionately impact reimbursement in safety net hospitals. Prior research has demonstrated the effect of medical comorbidities on readmission, however, there is a paucity of data on predictors of readmission in vulnerable and underserved HF patients. We sought to evaluate the effect of demographics, medical and social comorbidities on risk of 30 day readmission in an academic safety net hospital in San Francisco. Methods: We performed a retrospective chart review from 2018 to 2020. Patients were included if treated for HF while on inpatient cardiology or medicine services and were assigned an ICD-10 discharge code for HF. Patients less than 21 years old were excluded. Demographics and comorbidities were obtained through evaluation of ICD-10 discharge codes and chart review. Multivariate modeling was used to determine predictors of 30 day readmission. Results: The study population included 383 patients in which the mean age was 60±13 years and 73% (n=282) were male. 44% (170) were Black, 23% (88) were Latinx, 33% (127) were not housed, 97% (371) had public insurance, and 21% (81) had a diagnosis of mental illness. 46% (177) had CAD, 76% (291) hypertension, and 36% (177) DM. Substance use was common with 30% (114) using methamphetamines, 36% (138) cocaine, 18% (69) opioids, and 35% (135) alcohol. On multi-variate analysis, EF less than 40% (75%, 285) was the only medical comorbidity associated with an increased risk of readmission (OR 1.86, 1.1-3.1, p= 0.018). Social variables associated with increased risk of readmission included identifying as Black (OR 2.26, 1.03-5.0, p= 0.043) or Latinx (OR 3.43, 1.41-7.59, p= 0.006), homelessness (OR 3.02, 1.76-5.18, p=<0.001), and specific substance use: methamphetamine (OR 2.23, 1.39-3.57, p=0.001), cocaine (OR 1.63, 1.03-2.57, p= 0.037), opioids (OR 1.81, 1.05-3.13, p= 0.033), and alcohol (OR 2.26, 1.43-3.58, p= 0.001). Conclusion: Race, housing status and substance use were more strongly associated with readmission risk than medical comorbidities in a population of urban, vulnerable and underserved HF patients. Interventions to improve HF readmission metrics should consider addressing racial and social disparities in similar populations.

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

Estimating costs of hospitalizations associated with opioid use disorder or opioid misuse at a large, urban safety-net hospital—Denver, Colorado, 2017

2021 ◽  
Vol 218 ◽  
pp. 108306
Author(s):  
Aziza Arifkhanova ◽  
Emily McCormick Kraus ◽  
Alia Al-Tayyib ◽  
Julie Taub ◽  
Annette Encinias ◽  
...  
Keyword(s):  
Safety Net ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals Partnering with State Health Departments to Address Injection-Related Infections during the Opioid Epidemic: Experience at a Safety Net Hospital

2021 ◽  
Author(s):  
Rebecca H Burns ◽  
Cassandra M Pierre ◽  
Jai G Marathe ◽  
Glorimar Ruiz-Mercado ◽  
Jessica L Taylor ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Medical Center ◽  
Safety Net ◽  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Curative Therapy ◽  
Safety Net Hospital

Abstract Massachusetts is one of the epicenters of the opioid epidemic and has been severely impacted by injection-related viral and bacterial infections. A recent increase in newly diagnosed human immunodeficiency virus (HIV) infections among persons who inject drugs in the state highlights the urgent need to address and bridge the overlapping epidemics of opioid use disorder (OUD) and injection-related infections. Building on an established relationship between the Massachusetts Department of Public Health (MDPH) and Boston Medical Center (BMC), the Infectious Diseases section has contributed to the development and implementation of a cohesive response involving ambulatory, inpatient, emergency department and community-based services. We describe this comprehensive approach including the rapid delivery of antimicrobials for the prevention and treatment of HIV, sexually transmitted diseases, systemic infections such as endocarditis, bone and joint infections, as well as curative therapy for chronic hepatitis C virus (HCV) in a manner that is accessible to patients on the addiction-recovery continuum. We also provide an overview of programs that provide access to medications for opioid use disorder (MOUD), harm reduction services including overdose education and distribution of naloxone. Finally, we outline lessons learned to inform initiatives in other settings.

scholarly journals The Impact of Payer Status on Hospital Admissions: Evidence from an Academic Medical Center

2021 ◽  
Author(s):  
Yanying Zhao ◽  
Ioannis Ch. Paschalidis ◽  
Jianqiang Hu
Keyword(s):  
Access To Care ◽  
Low Income ◽  
Hospital Admissions ◽  
Medical Center ◽  
Conditional Logistic Regression ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Safety Net ◽  
Safety Net Hospital ◽  
The Impact

Abstract Background: Inequity exists in accessing to care for patients with different payer statuses. However, there are few studies on the difference of hospital admissions. This study aims to examine how the payer status affects patients hospitalization from the perspective of a safety-net hospital. Methods: We extracted all patients with visiting record in this medical center between 5/1/2009-4/30/2014, and then linked the outpatient and inpatient records three year before target admission time to patients. We conduct a retrospective observational study using a conditional logistic regression methodology. To control the illness of patients with different diseases in training the model, we construct a three-dimension variable with data stratification technology. The model is validated on a dataset distinct from the one used for training. Results: Payer status is strongly associated with a patient’s admission. Patients covered by private insurance or uninsured are less likely to be admitted than those totally or partially insured by government. For uninsured patients, inequity in access to hospitalization is observed. Among all non-clinical influential factors considered in our study, payer status is a significant important factor. Conclusion: Attention is needed on improving the access to care for vulnerable (low-income) patients, for example, by actively advertising free care programs, reaching out to community organizations with better access to these individuals, or offering assurances that access to care is not linked to immigration procedures. Also, in order to reduce preventable admissions, basic preventive care services should be enhanced.

scholarly journals Evaluation of a Pharmacist-Based Intervention to Reduce Readmissions in Geriatric High-Utilizer Patients: A Pilot Study

2019 ◽  
Vol 10 (2) ◽  
pp. 9
Author(s):  
Sara Turbow ◽  
Kruti Shah ◽  
Katherine Penziner ◽  
Michael Knauss
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Hospital Admissions ◽  
Safety Net ◽  
High Risk Population ◽  
Original Research ◽  
Beers Criteria ◽  
Southeastern Us ◽  
Safety Net Hospital ◽  
High Utilizer

Purpose: The goal of this study was to determine if a pharmacist-led intervention to improve medication safety at hospital discharge reduced the number of hospital readmissions among geriatric high-utilizer patients. This study is the first to test a pharmacist-based intervention in a high-utilizer population. Methods: This was a quasi-experimental pilot study done at a safety-net hospital in the southeastern US. Fifty-seven patients 65 years old and older who were in the 95th percentile for number of hospital admissions in a year were included. On the day of discharge, one of the study pharmacists reviewed the discharge medication list and calculated the Medication Appropriateness Index (MAI) for each medication and reviewed for Beers Criteria. Any medication identified as potentially high-risk or inappropriate was flagged by the pharmacist and discussed with the team. The primary outcome was the number of admissions in the year following the intervention in the intervention group versus the control group. Results: There were no statistically significant differences in the number of admissions, the MAI scores, or the number of medications meeting Beers Criteria between the two groups. Conclusion: Although this study did not demonstrate a decrease in hospital admissions, it shows that pharmacist review of medications at discharge can identify potentially unnecessary medications that could lead to confusion or adverse events. Further research is necessary to identify interventions to prevent readmissions in this high-risk population.   Article Type: Original Research

Analysis of Opioid Use Following Curative Cancer Treatment at a Large Urban Safety-net Hospital

2018 ◽  
Vol 34 (10) ◽  
pp. 885-889 ◽  
Author(s):  
Amanda S. Cass ◽  
Joyce T. Alese ◽  
Chaejin Kim ◽  
Marjorie A. Curry ◽  
Jennifer A. LaFollette ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Safety Net ◽  
Opioid Use ◽  
Safety Net Hospital ◽  
Urban Safety
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