Using 42 CFR part 2 revisions to integrate substance use disorder treatment information into electronic health records at a safety net health system.

Background: Regulations put in place to protect the privacy of individuals receiving substance use disorder (SUD) treatment have resulted in an unintended consequence of siloed SUD treatment and referral information outside of the integrated electronic health record (EHR). Recent revisions to these regulations have opened the door to data integration, which creates opportunities for enhanced patient care and more efficient workflows. We report on the experience of one safety-net hospital system integrating SUD treatment data into the EHR.

Total cost of care associated with opioid use disorder treatment.

The opioid epidemic in the United States disproportionately affects Medicaid beneficiaries than other groups. This results in a significant financial burden on state Medicaid programs. In this analysis, we investigate the association of medication for opioid use disorder (MOUD) treatment initiation and linkage to ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients.

A retrospective, descriptive study of hepatitis C testing, prevalence, and care continuum among adults on probation.

Background: Despite constituting the largest segment of the correctional population, individuals on court-ordered probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We conducted a retrospective, descriptive analysis to estimate prevalence of diagnosed HCV and the subsequent HCV care cascade among a cohort of individuals enrolled in an adult probation program over a 25-month period in Denver, Colorado.

Methods: We utilized probabilistic matching with first and last name, sex, and birthdate to identify individuals enrolled in probation between July 1, 2016 and July 30, 2018 who had a medical record at the participating safety-net healthcare institution as of December 31, 2019.

Defining Opioid-related Problems Using a Health Care Safety Net Institution's Inpatient Electronic Health Records: Limitations of Diagnosis-based Definitions.

Background: Measuring clinically relevant opioid-related problems in health care systems is challenging due to the lack of standard definitions and coding practices. Well-defined, opioid-related health problems (ORHPs) would improve prevalence estimates and evaluation of clinical interventions, crisis response, and prevention activities. We sought to estimate prevalence of opioid use disorder (OUD), opioid misuse, and opioid poisoning among inpatients at a large, safety net, health care institution.

Hepatitis C Testing and Linkage to Care Among Adults on Probation in a Large US City.

Background: Despite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage to care. We implemented an HCV testing and patient navigation program at an adult probation department.

Methods: Adults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a laboratory-based HCV ribonucleic acid (RNA) assay if anti-HCV positive.

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

Introduction: The national and state economic burden of the opioid crisis is substantial. This study estimated the number of hospitalizations associated with opioid use disorder (OUD) or opioid misuse (OM) and the cost of those hospitalizations at Denver Health (DH) Medical Center, a large, urban safety-net hospital.

Methods: For 2017, direct inpatient medical costs for hospitalizations associated with OUD or OM at DH Medical Center were estimated and categorized by group and insurance type.

Evaluating Population Coverage in a Regional Distributed Data Network: Implications for Electronic Health Record-Based Public Health Surveillance.

Objective: Electronic health records (EHRs) hold promise as a public health surveillance tool, but questions remain about how EHR patients compare with populations in health and demographic surveys. We compared population characteristics from a regional distributed data network (DDN), which securely and confidentially aggregates EHR data from multiple health care organizations in the same geographic region, with population characteristics from health and demographic surveys.

Methods: Ten health care organizations participating in a Colorado DDN contributed data for coverage estimation.

The Detection of Opioid Misuse and Heroin Use From Paramedic Response Documentation: Machine Learning for Improved Surveillance.

Background: Timely, precise, and localized surveillance of nonfatal events is needed to improve response and prevention of opioid-related problems in an evolving opioid crisis in the United States. Records of naloxone administration found in prehospital emergency medical services (EMS) data have helped estimate opioid overdose incidence, including nonhospital, field-treated cases. However, as naloxone is often used by EMS personnel in unconsciousness of unknown cause, attributing naloxone administration to opioid misuse and heroin use (OM) may misclassify events.

Monitoring opioid addiction and treatment: Do you know if your population is engaged?

Background: Assessment of people affected by opioid-related problems and those receiving care is challenging due to lack of common definitions and scattered information. We sought to fill this gap by demonstrating a method to describe a continuum of opioid addiction care in a large, public safety-net institution.

Methods: Using 2017 clinical and administrative data from Denver Health (DH), we created operational definitions for opioid use disorder (OUD), opioid misuse (OM), and opioid poisoning (OP).

Using Spatial Analysis to Inform Community Immunization Strategies.

Introduction: Recent pertussis outbreaks in the United States suggest our response to local disease outbreaks (eg, vaccine-preventable ) may benefit from understanding and applying spatial analytical methods that use data from immunization information systems at a subcounty level.

Methods: A 2012 study on Denver, CO, residents less than 19 years of age confirmed pertussis cases and immunization information system records were geocoded and aggregated to the census tract (CT) level. An algorithm assessed whether individuals were up-to-date (UTD) for pertussis vaccines.

Integration of family planning services into a sexually transmitted disease clinic setting.

Background: Sexually transmitted diseases (STDs) and unintended pregnancy are significant and costly public health concerns. Integrating family planning services (FPS) into STD visits provides an opportunity to address both concerns simultaneously. Our objectives were to create an electronic eligibility reminder to identify male and female patients eligible for FPS during an STD clinic visit and measure FPS use, additional cost of integrated services, and patient/provider satisfaction and to explore the impact on incident pregnancy and STDs.

Normalizing HIV testing in a busy urban sexually transmitted infections clinic.

Background: Increased awareness of HIV serostatus is a cornerstone of HIV prevention efforts. Thus, routine HIV testing in clinical settings has been identified as a priority. We report on our experience with making rapid HIV testing a routine procedure in a large STI clinic.