scholarly journals Using Drug Overdose Syndromic Surveillance Data to Impact Local Public Health Action

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Mandy Billman ◽  
Kayley Dotson
Keyword(s):  
Public Health ◽  
Best Practices ◽  
Drug Overdose ◽  
Syndromic Surveillance ◽  
The United States ◽  
Local Health ◽  
Roundtable Discussion ◽  
Public Health Action ◽  
Local Public Health ◽  
Drug Overdoses

Objective: The overall objective of this session is to discuss opportunities to use drug overdose syndromic surveillance (SyS) data to encourage action among local public health partners.After this roundtable discussion, participants will be able to:-Identify opportunities to promote use of drug overdose SyS data to their health partners.-Plan for potential drug overdose public health interventions.-Develop relationships with roundtable attendees to continue the conversation and sharing of ideas about use of drug overdose SyS data.Introduction: Since 2008, drug overdose deaths exceeded the number of motor vehicle traffic-related deaths in Indiana and the gap continues to widen1. As the opioid crisis rages on in the United States the federal government is providing funding opportunities to states, but it often takes years for best practices to be developed, shared, and published.Indiana State Department of Health (ISDH) has developed a standard process for monitoring and alerting local health partners of increases in drug overdoses captured in Indiana’s syndromic surveillance system (ESSENCE). ISDH is launching a pilot project to encourage local partners to start a conversation about overdose response capabilities and planning efforts in their community. Other states have published articles about drug overdose syndromic surveillance (SyS) data being used to inform local public health action, however, the local overdose response activity details were vague 2,3. With the opioid crisis continuing to spiral out of control in the United States, it is imperative to work together as local, state, and national partners to find potential solutions to this crisis.Description: Overdose Surveillance Epidemiologists from Indiana will lead a roundtable discussion about potential uses of syndromic surveillance (SyS) overdose data to kick-start overdose response and prevention efforts at the local and state level. Discussion will begin by the moderators highlighting best practices for overdose response using SyS data and some Indiana specific initiatives. Topics for the roundtable discussion will include:-Drug overdose query development and enhancement.-Dissemination strategies for SyS alerts of suspected drug overdoses.-Best practices for reporting SyS overdose data to partners and/or public.-Public health intervention and prevention strategies using real-time hospital emergency department (ED) data.-Review of national or regional work groups focused on drug overdose SyS.How the Moderator Intends to Engage the Audience in Discussions on the Topic: The moderators, Mandy Billman and Kayley Dotson, are Overdose Surveillance Epidemiologists for Indiana, and they intend to kick off the discussion by presenting a short handout that will highlight Indiana’s efforts to engage local health partners with near real-time drug overdose data, (i.e. monitoring and alerting local partners, developing a resource tool kit, sharing drug overdose queries, etc.). Mandy and Kayley will also develop a series of questions to actively engage participants in the discussion of bridging the gap from data to action using overdose surveillance data.

Use of syndromic surveillance data to monitor poisonings and drug overdoses in state and local public health agencies

2016 ◽  
Vol 22 (Suppl 1) ◽  
pp. i43-i49 ◽  
Author(s):  
Amy Ising ◽  
Scott Proescholdbell ◽  
Katherine J Harmon ◽  
Nidhi Sachdeva ◽  
Stephen W Marshall ◽  
...  
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Surveillance Data ◽  
Local Public Health ◽  
Public Health Agencies ◽  
Health Agencies ◽  
Drug Overdoses ◽  
State And Local

scholarly journals A Meaningful Journey to Onboard Syndromic Data through a Local HIE

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Jeffrey Johnson ◽  
Jessica Yen ◽  
Brit Colanter ◽  
Eric McDonald
Keyword(s):  
Public Health ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Agency ◽  
Meaningful Use ◽  
The United States ◽  
Lessons Learned ◽  
Local Health ◽  
Local Public Health ◽  
Public Health Agencies

This presentation aims to highlight key activities, technical approaches, data discoveries, lessons learned and outcomes achieved while onboarding local hospitals for syndromic Meaningful Use Stage 2 through a local health information exchange. The federal meaningful use initiative is currently a major driver to enable greater establishment of syndromic surveillance capacity across the United States. The role and efforts by local and state public health agencies in the syndromic onboarding process varies greatly. We describe efforts from a local public health agency to onboard, validate and integrate meaningful use syndromic information.

scholarly journals Tracking drug-related overdoses at the local level: Using Syndromic Surveillance in the CO-NCR

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Emery Shekiro ◽  
Lily Sussman ◽  
Talia Brown
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Real Time ◽  
Drug Overdose ◽  
Syndromic Surveillance ◽  
Case Definition ◽  
Chief Complaint ◽  
Discharge Diagnosis ◽  
Diagnosis Codes ◽  
Drug Overdoses

Objective: In order to better describe local drug-related overdoses, we developed a novel syndromic case definition using discharge diagnosis codes from emergency department data in the Colorado North Central Region (CO-NCR). Secondarily, we used free text fields to understand the use of unspecified diagnosis fields.Introduction: The United States is in the midst of a drug crisis; drug-related overdoses are the leading cause of unintentional death in the country. In Colorado the rate of fatal drug overdose increased 68% from 2002-2014 (9.7 deaths per 100,000 to 16.3 per 100,000, respectively)1, and non-fatal overdose also increased during this time period (23% increase in emergency department visits since 2011)2. The CDC’s National Syndromic Surveillance Program (NSSP) provides near-real time monitoring of emergency department (ED) events across the country, with information uploaded daily on patient demographics, chief complaint for visit, diagnosis codes, triage notes, and more. Colorado North Central Region (CO-NCR) receives data for 4 local public health agencies from 25 hospitals across Adams, Arapahoe, Boulder, Denver, Douglas, and Jefferson Counties.Access to local syndromic data in near-real time provides valuable information for local public health program planning, policy, and evaluation efforts. However, use of these data also comes with many challenges. For example, we learned from key informant interviews with ED staff in Boulder and Denver counties, about concern with the accuracy and specificity of drug-related diagnosis codes, specifically for opioid-related overdoses.Methods: Boulder County Public Health (BCPH) and Denver Public Health (DPH) developed a query in Early Notification of Community Based Epidemics (ESSENCE) using ICD-10-CM codes to identify cases of drug-related overdose [T36-T51] from October 2016 to September 2017. The Case definition included unintentional, self-harm, assault and undetermined poisonings, but did not include cases coded as adverse effects or underdosing of medication. Cases identified in the query were stratified by demographic factors (i.e., gender and age) and substance used in poisoning. The first diagnosis code in the file was considered the primary diagnosis. Chief complaint and triage note fields were examined to further describe unspecified cases and to describe how patients present to emergency departments in the CO-NCR. We also explored whether detection of drug overdose visits captured by discharge diagnosis data varied by patient sex, age, or county.Results: The query identified 2,366 drug-related overdoses in the CO-NCR. The prevalence of drug overdoses differed across age groups. The detection of drug overdoses was highest among our youth and young adult populations; 16 to 20 year olds (16.0%), 21-25 year olds (11.4%), 26-30 year olds (11.4%). Females comprised 56.1% of probable general drug overdoses. The majority of primary diagnoses (31.0%) included poisonings related to diuretics and other unspecified drugs (T50), narcotics (T40) (12.6%), or non-opioid analgesics (T39) (7.8%). For some cases with unspecified drug overdose codes there was additional information about drugs used and narcan administration found in the triage notes and chief complaint fields.Conclusions: Syndromic surveillance offers the opportunity to capture drug-related overdose data in near-real time. We found variation in drug-related overdose by demographic groups. Unspecified drug overdose codes are extremely common, which likely negatively impacts the quality of drug-specific surveillance. Leveraging chief complaint and triage notes could improve our understanding of factors involved in drug-related overdose with limitations in discharge diagnosis. Chart reviews and access to more fields from the ED electronic health record could improve local drug surveillance.

scholarly journals Enhancing Drug Overdose Alerts with Spatial Visualization

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Kayley Dotson ◽  
Robert Gottlieb
Keyword(s):  
Public Health ◽  
Drug Overdose ◽  
Surveillance System ◽  
Local Health ◽  
County Level ◽  
Health Departments ◽  
Local Health Departments ◽  
Emergency Department Data ◽  
Drug Overdoses ◽  
Overdose Deaths

ObjectiveThis poster presentation shares Indiana’s approach of alerting local health departments (LHDs) with near real-time drug overdose data and how this process has been enhanced through mapping and analysis with a geographic information system (GIS).IntroductionSince 2008, drug overdose deaths exceeded the number of motor vehicle traffic-related deaths in Indiana, and the gap continues to widen1. While federal funding opportunities are available for states, it often takes years for best practices to be developed, shared, and published. Similarly, local health departments (LHDs) may experience lengthy delays to receive finalized county health statistics.Indiana collects and stores syndromic emergency department data in the Public Health Emergency Surveillance System (PHESS) and uses the Electronic Surveillance System for the Early Notification of Community-based Epidemics version 1.21 (ESSENCE) to monitor public health events and trends. In July 2017, the Indiana Overdose Surveillance Team (IOST) developed a standard process for monitoring and alerting local health partners of increases in drug overdoses captured in ESSENCE at the county level. ISDH is enhancing these alerts by mapping the data in GIS and providing spatiotemporal data to LHDs to inform more targeted intervention and prevention efforts.MethodsThe IOST monitors drug overdoses statewide by analyzing daily queries from ESSENCE and sending email alerts to LHDs that are experiencing a statistically significant increase in suspected overdose activity at a hospital or county level. The IOST then requests that LHDs complete an overdose response feedback survey describing their actions after receiving an overdose alert.The IOST GIS analyst has enhanced overdose alerts by utilizing daily emergency department data queries from the PHESS database based on chief complaint and diagnosis text. Python™ and ArcGIS™ are used to deduplicate and geocode records, calculate the rate of cases within a hexagonal grid, and calculate the kernel density of case counts to show patterns at the neighborhood level. Comparisons to previous time periods are also calculated. Temporal and spatial scales of analysis are flexible, but 7 days and 30 days are used most often. Results are mapped in an HTML file using an open source Python package for dissemination to LHDs.ResultsBetween July 26, 2017, and Sept. 4, 2018, the IOST sent 89 suspected overdose alerts to LHDs. Alerts were sent to 45 different LHDs, of which 22 received multiple alerts (range: 1-9 repeat alerts). LHDs were requested to complete the survey on their initial alert, and a total of 31 jurisdictions completed this survey (31/45 = 69%). The majority of the LHD respondents (27/31 = 87%) wanted to continue receiving overdose alert emails.Our enhanced spatial analysis project has mapped more than 500 cases per week. Geocoding was successful for approximately 87% of the addresses received through PHESS. Neighborhoods in urban areas with higher counts have been identified, though variability from week to week is high. Areas of high overdose rates that cross county boundaries have also been detected, which would not have been possible using ESSENCE alone.ConclusionsNotifying LHDs of near real-time drug overdose trends is a catalyst for drug overdose planning and response efforts in Indiana. GIS mapping of the data provides an easy way for LHDs to view and share spatial trends with their local planning partners and identify community intervention strategies that can reduce drug overdose rates and improve outcomes for overdose survivors.References1 Overdose Prevention [Internet]. Indianapolis: Indiana State Department of Health; 2017. Indiana Special Emphasis Report: Drug Overdose Deaths 1999-2015; August 2017. [cited 2017 Sept 25]. Available from: http://www.in.gov/isdh/files/2017_SER_Drug_Deaths_Indiana.pdf 

scholarly journals What is the utility of using syndromic surveillance systems during large subnational infectious gastrointestinal disease outbreaks? An observational study using case studies from the past 5 years in England

2016 ◽  
Vol 144 (11) ◽  
pp. 2241-2250 ◽  
Author(s):  
D. TODKILL ◽  
A. J. ELLIOT ◽  
R. MORBEY ◽  
J. HARRIS ◽  
J. HAWKER ◽  
...  
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Gastrointestinal Disease ◽  
Disease Outbreaks ◽  
Temporal Distribution ◽  
Health Utility ◽  
Local Health ◽  
Surveillance Systems ◽  
Public Health Action ◽  
Spatio Temporal

SUMMARYSyndromic surveillance systems in England have demonstrated utility in the early identification of seasonal gastrointestinal illness (GI) tracking its spatio-temporal distribution and enabling early public health action. There would be additional public health utility if syndromic surveillance systems could detect or track subnational infectious disease outbreaks. To investigate using syndromic surveillance for this purpose we retrospectively identified eight large GI outbreaks between 2009 and 2014 (four randomly and four purposively sampled). We then examined syndromic surveillance information prospectively collected by the Real-time Syndromic Surveillance team within Public Health England for evidence of possible outbreak-related changes. None of the outbreaks were identified contemporaneously and no alerts were made to relevant public health teams. Retrospectively, two of the outbreaks – which happened at similar times and in proximal geographical locations – demonstrated changes in the local trends of relevant syndromic indicators and exhibited a clustering of statistical alarms, but did not warrant alerting local health protection teams. Our suite of syndromic surveillance systems may be more suited to their original purposes than as means of detecting or monitoring localized, subnational GI outbreaks. This should, however, be considered in the context of this study's limitations; further prospective work is needed to fully explore the use of syndromic surveillance for this purpose. Provided geographical coverage is sufficient, syndromic surveillance systems could be able to provide reassurance of no or minor excess healthcare systems usage during localized GI incidents.

Accuracy of Medical Examiner’s Assessment for Near–Real-Time Surveillance of Fatal Drug Overdoses, King County, Washington, March 2017–February 2018

2021 ◽  
pp. 003335492110084
Author(s):  
Kirsten Vannice ◽  
Julia Hood ◽  
Nicole Yarid ◽  
Meagan Kay ◽  
Richard Harruff ◽  
...  
Keyword(s):  
Public Health ◽  
Positive Predictive Value ◽  
Real Time ◽  
Negative Predictive Value ◽  
Drug Overdose ◽  
Predictive Value ◽  
Death Certificate ◽  
King County ◽  
Public Health Response ◽  
Drug Overdoses

Objectives Up-to-date information on the occurrence of drug overdose is critical to guide public health response. The objective of our study was to evaluate a near–real-time fatal drug overdose surveillance system to improve timeliness of drug overdose monitoring. Methods We analyzed data on deaths in the King County (Washington) Medical Examiner’s Office (KCMEO) jurisdiction that occurred during March 1, 2017–February 28, 2018, and that had routine toxicology test results. Medical examiners (MEs) classified probable drug overdoses on the basis of information obtained through the death investigation and autopsy. We calculated sensitivity, positive predictive value, specificity, and negative predictive value of MEs’ classification by using the final death certificate as the gold standard. Results KCMEO investigated 2480 deaths; 1389 underwent routine toxicology testing, and 361 were toxicologically confirmed drug overdoses from opioid, stimulant, or euphoric drugs. Sensitivity of the probable overdose classification was 83%, positive predictive value was 89%, specificity was 96%, and negative predictive value was 94%. Probable overdoses were classified a median of 1 day after the event, whereas the final death certificate confirming an overdose was received by KCMEO an average of 63 days after the event. Conclusions King County MEs’ probable overdose classification provides a near–real-time indicator of fatal drug overdoses, which can guide rapid local public health responses to the drug overdose epidemic.

Toolkit for Epidemiologic Response to an Acute Chemical Release

2016 ◽  
Vol 10 (4) ◽  
pp. 631-632 ◽  
Author(s):  
Mary Anne Duncan ◽  
Maureen F. Orr
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Technical Assistance ◽  
Local Health ◽  
Toxic Substances ◽  
Public Health Action ◽  
Public Health Agencies ◽  
Chemical Release ◽  
State And Local ◽  
The Many

AbstractWhen a large chemical incident occurs and people are injured, public health agencies need to be able to provide guidance and respond to questions from the public, the media, and public officials. Because of this urgent need for information to support appropriate public health action, the Agency for Toxic Substances and Disease Registry (ATSDR) of the US Department of Health and Human Services has developed the Assessment of Chemical Exposures (ACE) Toolkit. The ACE Toolkit, available on the ATSDR website, offers materials including surveys, consent forms, databases, and training materials that state and local health personnel can use to rapidly conduct an epidemiologic investigation after a large-scale acute chemical release. All materials are readily adaptable to the many different chemical incident scenarios that may occur and the data needs of the responding agency. An expert ACE team is available to provide technical assistance on site or remotely. (Disaster Med Public Health Preparedness. 2016;10:631–632)

scholarly journals Use of Emergency Department Data to Monitor and Respond to an Increase in Opioid Overdoses in New Hampshire, 2011-2015

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 73S-79S ◽  
Author(s):  
Elizabeth R. Daly ◽  
Kenneth Dufault ◽  
David J. Swenson ◽  
Paul Lakevicius ◽  
Erin Metcalf ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
New Hampshire ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
The United States ◽  
Chief Complaint ◽  
Public Health Response ◽  
Syndromic Surveillance System ◽  
Icd Codes

Objectives: Opioid-related overdoses and deaths in New Hampshire have increased substantially in recent years, similar to increases observed across the United States. We queried emergency department (ED) data in New Hampshire to monitor opioid-related ED encounters as part of the public health response to this health problem. Methods: We obtained data on opioid-related ED encounters for the period January 1, 2011, through December 31, 2015, from New Hampshire’s syndromic surveillance ED data system by querying for (1) chief complaint text related to the words “fentanyl,” “heroin,” “opiate,” and “opioid” and (2) opioid-related International Classification of Diseases ( ICD) codes. We then analyzed the data to calculate frequencies of opioid-related ED encounters by age, sex, residence, chief complaint text values, and ICD codes. Results: Opioid-related ED encounters increased by 70% during the study period, from 3300 in 2011 to 5603 in 2015; the largest increases occurred in adults aged 18-29 and in males. Of 20 994 total opioid-related ED visits, we identified 18 554 (88%) using ICD code alone, 690 (3%) using chief complaint text alone, and 1750 (8%) using both chief complaint text and ICD code. For those encounters identified by ICD code only, the corresponding chief complaint text included varied and nonspecific words, with the most common being “pain” (n = 3335, 18%), “overdose” (n = 1555, 8%), “suicidal” (n = 816, 4%), “drug” (n = 803, 4%), and “detox” (n = 750, 4%). Heroin-specific encounters increased by 827%, from 4% of opioid-related encounters in 2011 to 24% of encounters in 2015. Conclusions: Opioid-related ED encounters in New Hampshire increased substantially from 2011 to 2015. Data from New Hampshire’s ED syndromic surveillance system provided timely situational awareness to public health partners to support the overall response to the opioid epidemic.

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