Precision Public Health Using Data And Technology To Inform Policy And Improve Practice. Monica Bharel, MD MPH Commissioner of Public Health

Transcription

1 Precision Public Health Using Data And Technology To Inform Policy And Improve Practice Monica Bharel, MD MPH Commissioner of Public Health

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4 M a p p i n g

5 H e a l t h P r i o r i t y Social Determinant of Health Education Built Environment Mental Health and Wellness Employment Homelessness and Housing Stability Substance Use Disorder Preventable chronic disease Housing Social Environment Violence

6 ESPnet: EHR Support for Public Health JAMIA 2009;16:18-24 Am J Public Health 2012;102:S325 S332 Am J Public Health 2014;104:

7 ESPnet participating sites

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9 Number of deaths Opioid Related Deaths Figure 1. Opioid 1 -Related Deaths, All Intents Massachusetts Residents: January December ,400 2,200 2,000 1,800 1,600 1,400 1,200 1, Confirmed Estimated 2,107 1,799 1,990 1,670 1,

10 Opioid Related Deaths

11 Opioid Overdose Death Rates by County vs

12 Chapter 55 Data Mapping

13 Academic Brandeis University Boston University Brown University Harvard Medical School Harvard School of Public Health Massachusetts College of Pharmacy and Health Sciences Massachusetts Institute of Technology Northeastern University Tufts University University of Massachusetts Amherst University of Massachusetts Boston University of Massachusetts Medical School State and Federal Government Agencies Hospitals & Private Industry Baystate Health Beth Israel Deaconess Medical Center Boston Medical Center Brigham & Women s Hospital Children s Hospital GE IBM Liberty Mutual Massachusetts General Hospital Massachusetts League of Community Health Centers McKinsey & Company The MITRE Corporation Partners Healthcare PwC Rand Corporation Boston Public Health Commission Center for Health Information and Analysis Department of Housing and Community Development Department of Mental Health Department of Correction Department of Public Health Executive Office of Health and Human Services Executive Office of Public Safety and Security Federal Bureau of Investigation High Intensity Drug Trafficking Area (NE) Health Policy Commission Massachusetts Sheriffs Association MassIT Office of the Chief Medical Examiner State Auditor s Office

14 Report Organization Re-Estimating Baseline Time line and Influences At Risk Populations

15 % OUD in MA Population Opioid Use Disorder (OUD) 5.0% Estimated OUD Population Rises Signficantly Between % 3.0% 2.0% 1.0% 0.0%

16 % Suviving of Those Who Died Time From Initial Rx to Overdose Death 100 Average Survival Time For Those Who Died of Opioid Overdose was 36 Months Months from Initial Prescription

17 Cumulative Incidence (%) Treatment with Medication 2.5 Figure 2: Cumulative Incidence of Opioid-Related Death by OAT Status Patients treated with methadone and/or buprenorphine (Opioid Agonist Treatment or OAT that block the effect of opioids) following a non-fatal overdose were significantly less likely to die; however, very few patients (~5%) engage in OAT following a nonfatal overdose Engaged in OAT Not Engaged in OAT

18 Death Rate Per 100,000 Persons with Histories of Incarceration Opioid Death Rate 120 Times Higher for Individuals with Histories of Incarceration Incarceration History No Incarceration History

19 Death Rate Per 100,000 Persons Experiencing Homelessness Opioid Death Rate 30 Times Higher for the Homeless Individuals Homeless (Modeled) Not Homeless

20 Deaths Per 100,000 Individuals with Serious Mental Illness Very High Rates of Fatal Opioid Overdoses for Persons with Some Mental Health Diagnoses 86.1* Anxiety Depression ADHD SMI Neuro Cog MA *Among MassHealth members only

21 Pregnant and Postpartum Risk Rate of Opioid Overdose Events Increase Sharply After Delivery for OUD Mothers 1 year before delivery, prior to conception First Trimester Second Trimester Third Trimester 0 42 days after delivery days after delivery days after delivery Overdose Events / 1 Million Person Days

22 Data visualization

23 Revamped Helpline

24 MassPAT 6.5 million searches Nearly 57,000 registered 97% prescribers of Schedule ll or lll 31 states

25 PMP Activity Trends

26 Additional Resources Massachusetts Helpline: Massachusetts Responds to The Opioid Epidemic: With links to current stats & Chapter 55 Report Mass.gov/opioidresponse Stop Addiction Before It Starts: Mass.gov/stopaddiction