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A Cross-sectional study of all emergency ambulance runs reported by licensed Emergency Medical Services (EMS) providers between 2013 and 2019 was undertaken to determine if the sex of a patient exp...

BACKGROUND Compared with non-Veterans, Veterans are at higher risk of experiencing homelessness, which is associated with opioid overdose. OBJECTIVE To understand how homelessness and Veteran status are related to risks of nonfatal and fatal opioid overdose in Massachusetts. DESIGN A cross-sectional study. PARTICIPANTS All residents aged 18 years and older during 2011-2015 in the Massachusetts Department of Public Health's Data Warehouse (Veterans: n=144,263; non-Veterans: n=6,112,340). A total of 40,036 individuals had a record of homelessness, including 1307 Veterans and 38,729 non-Veterans. MAIN MEASURES The main independent variables were homelessness and Veteran status. Outcomes included nonfatal and fatal opioid overdose. RESULTS A higher proportion of Veterans with a record of homelessness were older than 45 years (77% vs. 48%), male (80% vs. 62%), or receiving high-dose opioid therapy (23% vs. 15%) compared with non-Veterans. The rates of nonfatal and fatal opioid overdose in Massachusetts were 85 and 16 per 100,000 residents, respectively. Among individuals with a record of homelessness, these rates increased 31-fold to 2609 and 19-fold to 300 per 100,000 residents. Homelessness and Veteran status were independently associated with higher odds of nonfatal and fatal opioid overdose. There was a significant interaction between homelessness and Veteran status in their effects on risk of fatal overdose. CONCLUSIONS Both homelessness and Veteran status were associated with a higher risk of fatal opioid overdoses. An understanding of health care utilization patterns can help identify treatment access points to improve patient safety among vulnerable individuals both in the Veteran population and among those experiencing homelessness.

BACKGROUND: As stimulant use increases across the United States, emergency medical services (EMS) are crucial touchpoints in the health care system. To better measure the prevalence of stimulant use, misuse, and EMS incidents related to stimulant intoxication, definitions for stimulant-related incidents (SRIs) are needed. METHODS: We used the Massachusetts Ambulance Trip Record Information System (MATRIS) from 2013 to 2020 to develop definitions of stimulant-related incidents. EMS runs reported to MATRIS were categorized based on stimulant-related words and symptoms. The three tiers were “any stimulant use” (class 1), “problematic stimulant use” (class 2), and “acute stimulant-related incidents” (class 3). A group of four reviewers studied over 650 cases in eight rounds to refine the search terms, achieving definitions with a correct characterization of over 80% of cases that the code selected. RESULTS: SRI definitions were applied against all EMS runs within Massachusetts between 2013 and 2020 (n = 6,584,836 runs). Of these, 43,538 (0.7%) met the class 1 definition, 38,669 (0.6%) met the class 2 definition, and 19,157 (0.3%) met the class 3 definition. Incidents at all tiers of severity increased over time and were more likely to occur among younger adults and males. Race and ethnicity data indicated that Hispanic/Latinx and Black non-Hispanic/non-Latinx residents formed a disproportionately large percentage of SRIs relative to their total percentage of EMS runs. CONCLUSIONS: The prevalence of all three tiers of SRIs are increasing in Massachusetts, and this protocol provides a source of administrative data on stimulant use that complements sources such as hospital, treatment-based, and/or prescribing records.

Background and aims While prescribed and illicit opioid use are primary drivers of the national surges in overdose deaths, opioid overdose deaths in which stimulants are also present are increasing in the U.S. We determined the social determinants and sociodemographic factors associated with opioid-only versus polysubstance opioid overdose deaths in Massachusetts. Particular attention was focused on the role of stimulants in opioid overdose deaths. Methods We analyzed all opioid-related overdose deaths from 2014 to 2015 in an individually-linked population database in Massachusetts. We used linked postmortem toxicology data to identify drugs present at the time of death. We constructed a multinomial logistic regression model to identify factors associated with three mutually exclusive overdose death groups based on toxicological results: opioid-related deaths with (1) opioids only present, (2) opioids and other substances not including stimulants, and (3) opioids and stimulants with or without other substances. Results Between 2014 and 2015, there were 2,244 opioid-related overdose deaths in Massachusetts that had accompanying toxicology results. Toxicology reports indicated that 17% had opioids only, 36% had opioids plus stimulants, and 46% had opioids plus another non-stimulant substance. Persons older than 24 years, non-rural residents, those with comorbid mental illness, non-Hispanic black residents, and persons with recent homelessness were more likely than their counterparts to die with opioids and stimulants than opioids alone. Conclusions Polysubstance opioid overdose is increasingly common in the US. Addressing modifiable social determinants of health, including barriers to mental health services and homelessness, is important to reduce polysubstance use and overdose deaths.

Introduction Massachusetts developed and used bidirectional electronic referrals to connect clinical patients across the state to interventions run by community organizations. The objective of our study was to determine whether the use of Massachusetts's electronic referral system (MA e-Referral) reached racial/ethnic groups experiencing health disparities and whether it was associated with improved health outcomes. Methods We assembled encounter-level medical records from September 2013 through June 2017 for patients at Massachusetts clinics funded by the Clinical Community Partnerships for Prevention into 2 cohorts. First, all patients meeting program eligibility guidelines for an e-Referral (N = 21,701) were examined to assess the distribution of e-Referrals among populations facing health disparities; second, a subset of 3,817 people with hypertension were analyzed to detect changes in blood pressure after e-Referral to an evidence-based community intervention. Results Non-Hispanic black (OR, 1.4; 95% confidence interval [CI], 1.2-1.6) and Hispanic patients (OR, 1.3; 95% CI, 1.1-1.4) had higher odds than non-Hispanic white patients of being referred electronically. Patients completing their hypertension intervention had 74% (95% CI, 1.2-2.5) higher odds of having an in-control blood pressure reading than patients who were not electronically referred. Conclusion Clinical to community linkage to interventions through MA e-Referral reached non-Hispanic black, Hispanic, and Spanish-speaking populations and was associated with improved blood pressure control.

Because quality improvement metrics and treatment guidelines are used to conduct research, evaluate care quality, and assess population health, they should, ideally, align. We used electronic medical record data to analyze variation between blood pressure control estimates calculated by using thresholds derived from National Quality Forum 0018 (NQF 0018) and Joint National Committee (JNC) treatment guidelines in a cohort of patients with hypertension. Percentage of patients with controlled blood pressure derived from each quality improvement or treatment guideline cutoff varied up to 16.1 percentage points. This variance demonstrates that discrepancies in blood pressure thresholds produce considerable variation in estimates; thus, treatment guidance and metrics should be selected carefully.

Older adult falls continue to be a public health priority across the United States, and Massachusetts (MA) is no exception. The MA Prevention and Wellness Trust Fund (PWTF) program within the MA Department of Public Health aims to reduce the physical and economic burdens of chronic health conditions by linking evidence-based clinical care with community intervention programs. The PWTF partnerships that focused on older adult falls prevention have integrated the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Death and Injuries toolkit into clinical settings. Partnerships also offer referrals for home safety assessments, Tai Chi and Matter of Balance (1) programs. This paper describes the PWTF program implementation process involving 49 MA organizations, while highlighting the successes achieved and lessons learned. With the unprecedented expansion of the U.S. Medicare beneficiary population, and the escalating incidence of falls, widespread adoption of effective prevention strategies will become increasingly important for both public health and for controlling healthcare costs. The lessons learned from this PWTF initiative offer insights and recommendations for future falls prevention program development and implementation.

Inconsistencies between the United States Air Force Hearing Conservation Program's quarterly reports and local base records were generated by rule changes made to the Defense Occupational and Environmental Health Readiness System Hearing Conservation/Data Repository (DOEHRS-HC/DR) in 2009. These changes resulted in the usage of older baseline audiograms to calculate significant threshold shifts if the most current baseline audiogram was incorrectly labeled. Records in DOEHRS-DR between January 2009 and February 2013 were reviewed to determine what percent of all records had the most current baseline audiogram incorrectly labeled. Approximately 15% of the 338,760 individuals had incorrect baseline records; from that 15% with incorrect baseline records, 27% (14,171 individuals) developed a positive shift that could have been the result of the baseline audiogram error. However, since 2009, the prevalence and incidence of incorrect baselines have been decreasing; efforts should continue to educate on proper baseline test management.