Identifying and Characterizing Models of Substance Use Treatment in Outpatient Substance Use Treatment Facilities.

Background: Given that individuals with substance use disorders (SUDs) have a variety of needs beyond substance use, it is critical to examine the comprehensiveness of services offered within outpatient SUD treatment facilities, where many individuals with SUDs receive care. This study's objective is to develop clusters of services offered, and assess organizational, policy, and environmental characteristics associated with having a more comprehensive treatment model.

Methods: We conducted a principal component analysis (PCA) using data on SUD treatment facilities (n=8, 197) from the 2022 Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities.

Examining the Relationship Between Local Governmental Expenditures on the Social Determinants of Health and County-Level Overdose Deaths, 2017-2020.

Context: Prior studies have examined the social determinants of health (SDOH) characteristics of counties with elevated rates of overdose deaths. However, this research often ignores variation in upstream governmental investment in these SDOH categories.

Objective: To examine the association of local governmental investments in SDOH with drug overdose mortality at the county level, controlling for demographic and socioeconomic characteristics.

The Ecology of Economic Distress and Life Expectancy.

Objectives: To determine whether life expectancy (LE) changes between 2000 and 2019 were associated with race, rural status, local economic prosperity, and changes in local economic prosperity, at the county level.

Methods: Between 12/1/22 and 2/28/23, we conducted a retrospective analysis of 2000 and 2019 data from 3,123 United States counties. For Total, White, and Black populations, we compared LE changes for counties across the rural-urban continuum, the local economic prosperity continuum, and for counties in which local economic prosperity dramatically improved or declined.

Trends in the availability of comprehensive services within outpatient substance use treatment facilities from 2018 to 2022.

Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients' medical and social needs. To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022. We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities ( = 13,793).

Barriers and Facilitators to Establishing Partnerships for Substance Use Disorder Care Transitions Between Safety-Net Hospitals and Community-Based Organizations.

Background: The effectiveness of hospital-based transitional opioid programs (TOPs), which aim to connect patients with substance use disorders (SUD) to ongoing treatment in the community following initiation of medication for opioid use disorder (MOUD) treatment in the hospital, hinges on successful patient transitions. These transitions are enabled by strong partnerships between hospitals and community-based organizations (CBOs). However, no prior study has specifically examined barriers and facilitators to establishing SUD care transition partnerships between hospitals and CBOs.

Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017-2020.

Introduction: Despite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017-2020.

Methods: This longitudinal analysis of 2,846 counties from 2017-2020 used bivariate and multivariate Generalized Estimating Equations models to estimate associations between county overdose mortality rates and SDOH characteristics, including the fines and forfeitures measure.

Comparing Rates of Undiagnosed Hypertension and Diabetes in Patients With and Without Substance Use Disorders.

Background: Individuals with substance use disorders (SUDs) have increased risk for developing chronic conditions, though few studies assess rates of diagnosis of these conditions among patients with SUDs.

Objective: To compare rates of undiagnosed hypertension and diabetes among patients with and without an SUD.

Design: Cross-sectional analysis using electronic health record (EHR) data from 58 primary care clinics at a large, urban, healthcare system in New York.

Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization.

Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018-2022).

Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services.

Introduction: Hospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use-related complications. Transitional opioid programs-which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services-have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States.

Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals.

Background: Hospitals are a key touchpoint to reach patients with substance use disorders (SUDs) and link them with ongoing community-based services. Although there are many acute care interventions to initiate SUD treatment in hospital settings, less is known about what services are offered to transition patients to ongoing care after discharge. In this study, we explore what SUD care transition strategies are offered across nonprofit US hospitals.

A Year After Implementation of the Telehealth Waiver: Being Offered and Utilizing Video-Specific Telehealth Among Dual-Eligible Medicare Recipients During the COVID-19 Pandemic.

Objective: Telehealth is an essential tool to provide access to care while reducing infection exposure for high-risk populations during the COVID-19 pandemic. Our study aims to examine factors associated with telehealth availability and usage among Medicare and dual-eligible recipients 1 year after implementation of the Medicare's temporary telehealth waiver.

Design, Setting, And Participant: A cross-sectional, phone survey with a national representative sample of Medicare recipients.

Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology.

Background: Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies.

Assessing Differences in Social Determinants of Health Screening Rates in a Large, Urban Safety-Net Health System.

Introduction/objective: Previous studies have evaluated the implementation of standardized social determinants of health (SDOH) screening within healthcare settings, however, less is known about where screening gaps may exist following initial implementation based on facility characteristics. The objective of this study is to assess differences in screening rates for SDOH at a large, urban healthcare system.

Methods: We used electronic health record data obtained from NYC Health + Hospitals primary care sites from 2019 to 2022.

Stakeholder Perspectives on Data-Driven Solutions to Address Cardiovascular Disease and Health Equity in New York City.

Introduction: There is growing recognition of the importance of addressing the social determinants of health in efforts to improve health equity. In dense urban environments such as New York City, disparities in chronic health conditions (e.g.

Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them.

While rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015-2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript.

Substance Use Disorder Program Availability in Safety-Net and Non-Safety-Net Hospitals in the US.

Importance: Safety-net hospitals (SNHs) are ideal sites to deliver addiction treatment to patients with substance use disorders (SUDs), but the availability of these services within SNHs nationwide remains unknown.

Objective: To examine differences in the delivery of different SUD programs in SNHs vs non-SNHs across the US and to determine whether these differences are increased in certain types of SNHs depending on ownership.

Design, Setting, And Participants: This cross-sectional analysis used data from the 2021 American Hospital Association Annual Survey of Hospitals to examine the associations of safety-net status and ownership with the availability of SUD services at acute care hospitals in the US.

Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals: 2015-2021.

Objectives: Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs.

Methods: We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports.

Facilitation of team-based care to improve HTN management and outcomes: a protocol for a randomized stepped wedge trial.

Background: There are well-established guidelines for treating hypertension (HTN), yet only half of patients with HTN meet the defined target of < 140/90. Team-based care (TBC) is an evidence-based strategy for improving blood pressure (BP) management and control. TBC is defined as the provision of health services by at least two health professionals "who work collaboratively with patients and their caregivers to accomplish shared goals to achieve coordinated, high-quality care".

Exploring Barriers and Facilitators to Integrating a Harm Reduction Approach to Substance Use in Three Medical Settings.

Background: Evidence suggests that harm reduction, a public health strategy aimed at reducing the negative consequences of a risky health behavior without requiring elimination of the behavior itself, may be a promising approach for minimizing drug-related harms while engaging individuals with substance use disorders (SUDs) in care. However, philosophical clashes between the medical and harm reduction models may pose barriers to adopting harm reduction approaches within medical settings.

Objective: To identify barriers and facilitators to implementing a harm reduction approach toward care within healthcare settings.

Integrating Harm Reduction into Medical Care: Lessons from Three Models.

Background: Substance use disorders (SUDs) are at a national high, with significant morbidity and mortality. Harm reduction, a public-health strategy aimed at reducing the negative consequences of a risky behavior without necessarily eliminating the behavior, represents a useful approach to engage patients with SUDs in care. The objective of this article is to describe how 3 medical practices operationalized harm reduction as a framework toward patient care and identify the common practices undertaken across these settings to integrate harm reduction and medical care.

Strategies to support substance use disorder care transitions from acute-care to community-based settings: A Scoping review and typology.

Background: Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies.