A University of Michigan research project, called the “System for Opioid Overdose Surveillance” (S.O.S.) is leveraging health data from multiple sources to understand the impact of opioid use and abuse. Great Lakes Health Connect (GLHC) has partnered with the S.O.S. project to gather clinical information from acute care emergency departments in Michigan. This data is combined with clinical information from emergency medical services and medical examiners to provide further insight into the number and general location of opioid-related abuse, overdose, and death.
This research is conducted in collaboration with many partners, including the Office of National Drug Control Policy (ONDCP), and the High Intensity Drug Trafficking Areas (HIDTA) program.
The US Centers for Disease Control and Prevention (CDC) reports that deaths from prescription opioids have more than quadrupled since 1999. Opioids are a class of drug that include prescription pain medications like morphine, codeine, and oxycodone, as well as synthetic formulations like fentanyl, and illicit street drugs like heroin. The overprescribing and misuse of these highly addictive pain medications has contributed to a national health crisis, with widespread social and economic implications. More than 115 Americans die from opioid overdoses every day , and opioids are a key contributing factor in the tripling of the total rate of drug overdose deaths in the U.S. in the last 25 years .
Michigan is not exempt from this crisis. According to Michigan Automated Prescription System (MAPS) data, 11 Million prescriptions for opioids were written in 2016, enough for more than one prescription for every person in the state. Deaths from opioid and heroin overdoses in Michigan have more than doubled since 2012. More than 2,400 Michiganders died of drug overdoses in 2016, placing the state well above the national average. This exceeds the number of deaths from traffic crashes or gun fatalities.
The S.O.S. project was developed by the University of Michigan Injury Prevention Center, the UM Acute Care Research Unit (ACRU), and the UM Transportation Research Institute (UMTRI) as a response to this public health crisis.
Fundamental to the S.O.S. project’s success is the ability to capture and aggregate patient data from different sources, which provides a more complete picture of the problem. Standard practice when quantifying this type of data is to sort it according to the patient’s “chief complaint” at the time they present. The challenge in aggregating this data across treatment areas such as those involved in the S.O.S. project, is that chief complaint can be subjective, and may differ, or even change as a patient transitions from one area to the next. This dynamic presents a risk of skewing the data, and reducing its value.
The S.O.S. project links the data according to “Internal Classification of Disease” (ICD-10) codes as a universal “source of truth”. GLHC contributes Admissions, Discharge, and Transfer (ADT) data from all involved hospital emergency departments, filtered according to 24 opioid-related ICD-10 codes. The S.O.S. project then combines this information with ICD-10 data culled from Emergency Medical Services (EMS) and the Medical Examiners Medicolegal Death Investigation (MDI) Log.
Mahshid Abir, MD, MSC., serves as the Principal Investigator for the S.O.S. project. She is an emergency medicine physician and a prolific health services researcher with a joint appointment at the University of Michigan and the RAND Corporation. Amanda Kogowski, MPH, assists her in program coordination.
Dr. Abir describes opioid addiction as “a disease of despair”. “It does not discriminate based on age, gender, race, or socioeconomic status… It’s an equal opportunity destroyer”, she says. Patient privacy and the security of their health information are of utmost concern to Dr. Abir and her team. The regulations for disclosure of patient health information involving controlled substances is highly restricted to protect individual privacy. Reporting of the data collected by the S.O.S. project is based on broad geographic and population-based parameters. The project de-identifies, and never reports on individual patients.
Dr. Abir also asserts that “getting to the point of prevention first requires adequate response capacity in the acute care environment.” The healthcare system, particularly in recent years, has focused on preventative care and chronic disease state management. While these are certainly important and worthy pursuits that may reduce the need for acute care in the long term (definitive outcomes data is currently inconclusive) emergency room visits continue to increase across the US. As baby boomers age, and health care costs continue to rise, the need for acute care will persist. The S.O.S. project presents one example of understanding how an emergent, population-based health issue can be addressed in a way that is better informed, more accessible, and affordable. Dr. Abir’s previous experience influenced the design of the S.O.S project. The structure is scalable and transferable to communities outside the pilot program’s focus area of Washtenaw County. Other regions and states across the country could replicate the project, and the design methodology is also transferable to understanding other population-based health issues.
Dr. Abir’s work as a researcher is complimented by her practice as an emergency medicine physician. “Emergency Medicine is my muse, and is what inspires me”, she stated. “Emergency medicine requires that you know a lot about a lot of things, and the ability to synthesize sometimes limited information really quickly, to make decisions that will have a direct impact on the condition of the patient you are treating. Emergency Medicine is the only specialty that offers a 360 degree view of the entire care continuum. We are constantly interfacing with EMS and accepting referrals from ambulatory, skilled nursing, urgent care, and post-acute rehab providers. And of course, we are regularly referring patients for admission into the hospital setting for acute care as well. You are exposed to every kind of people at their most vulnerable, regardless of demographics or socio-economic status. If you are paying attention, you get a profound sense of the human condition”, she concluded.
There are no fewer than seventeen opioid-focused research projects and programs currently underway at the University of Michigan. The volume of efforts applied to the problem reveals both the urgency and the complexity of creating a solution. This reality is another motivating factor driving the S.O.S. project. “One of the biggest challenges we are addressing is gaining an accurate understanding of the scale of the problem”, Abir explained. “We can’t assume that patterns of abuse are static”.
According to the Michigan Department of Licensing and Regulatory Affairs (LARA), Michigan’s collaborative strategy to curb the opioid epidemic is making progress, there has been a reduction in the number of opioid prescriptions since 2015. It is hoped that the insight provided by the S.O.S. project will contribute to this momentum for the benefit of our state as well as other communities across the nation.
“Great Lakes Health Connect is privileged to work with Dr. Abir, and her team at the University of Michigan”, said Doug Dietzman, Executive Director at GLHC. “As a community resource, GLHC is always seeking out opportunities to demonstrate new applications for our solutions and services”, he continued. “Being part of the S.O.S. project is a meaningful expression of our mission”, he concluded.