Cook County Medical Examiner/Clinical Data Linkage to Inform Overdose Prevention Strategy (1.5 CME)

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(1.5 CME) In this conference recording from the 2019 Annual Conference, you will learn:

Background: Over 49,000 individuals in the U.S. died from opioid overdose in 2017 [1]. In Illinois half of all opioid fatalities occurred in Cook County in 2016 [2]. Buprenorphine and methadone have been shown to reduce mortality among individuals surviving an opioid overdose [3]. Naloxone is a safe and effective medicine for opioid overdose reversal [4]. Cook County Health (CCH) is a large safety-net healthcare system based in Chicago IL. It comprises a 464-bed tertiary-care hospital, an emergency department with over 120,000 visits annually, a network of 14 community health centers, Cermak Health Services (providing healthcare to detainees at Cook County Jail), the public health department for suburban Cook County, and a Medicaid Managed Care Community Network. CCH serves a vital role for many patients at highest risk of fatal illicit opioid overdoses. Recognizing increased health care utilization preceding overdoses [5], we characterized all CCH community- and corrections-based clinical encounters that preceded fatal opioid overdoses in 2017 to help inform novel prevention strategies. Methods: All 2017 cases of illicit opioid fatalities in the Cook County medical examiner’s database were merged with CCH electronic health records. For matching records of decedents we obtained encounter history and ICD10 diagnosis codes. We characterized decedents and their CCH clinical encounters within 12 months of their fatality. Separately for ED visits, hospitalizations, clinic encounters, and detentions in jail, we assessed time between encounter and death, whether or not opioid use disorder was identified as a contributory diagnosis, and co-morbid conditions. Results: Cook County Medical Examiner data revealed 1017 overdose deaths in 2017 attributed to heroin and/or fentanyl.  There were 663 overdose deaths attributed to fentanyl.  Sixty-nine percent (n = 706) of all decedents had a documented CCH encounter within 15 years of fatal overdose, and 18% (n=181) had a documented encounter within 12 months. Of these 181, 49% died within 100 days of their final encounter, and 25% within 30 days.  Among decedents with a CCH encounter within 12 months of death, 133 (73%) were associated with �-1 ICD10 diagnosis codes; 57% and 32% with substance use disorder and opioid use disorder, respectively.  The two most common diagnosis codes were hypertension and “encounter for issue of repeat prescription refill”.  Among diagnoses recognized in the ED, “encounter for issue of repeat prescription refill” accounted for 20% of encounters. Conclusions/Discussion: Our analysis highlights important questions for a healthcare system seeking to improve its approach to opioid overdose prevention.  Where are the missed opportunities for intervention?  Does screening effectively recognize patients with opioid use disorder and enable care teams to implement overdose prevention systematically? What revisions to current care processes would improve access to proven overdose prevention interventions?  How accessible are treatment and overdose prevention resources for patients at highest risk of overdose?  During this session, we will introduce system improvement efforts identified and supported by this research across the domains of screening, risk stratification, and transitions of care. Practical implications will be reviewed for application to other healthcare systems.  



Learning Objectives:

1.) Describe the key findings from clinical and medical examiner opioid overdose data integration in Cook County, IL and its application to other jurisdictions. 
2.) Identify potential healthcare system improvements and process changes informed by the clinical/medical examiner overdose data integration.
3.) Demonstrate understanding of the opportunity and limitations related to medical examiner overdose and clinical data integration. 



James Raspanti

DO

James Raspanti, DO is a second year family medicine resident at Cook County Health in Chicago, IL.  On top of an interest in full-spectrum family medicine, he has focused on acquiring skills in substance use treatment to better meet the needs of his patients.  His research interests include understanding healthcare utilization by patients with substance use disorder, creating structure for resident participation in MAT, and integrated care teams.

Juleigh Nowinski Konchak

MD, MPH

Juleigh Nowinski Konchak MD MPH is a physician leader for the medication-assisted treatment (MAT) Collaborative at Cook County Health.  Juleigh is also core faculty for the Preventive Medicine Residency Program at CCH.   Juleigh recently served as Medical and Community Health Lead for Addiction Services at Heartland Health Outreach, a healthcare for the homeless federally-qualified health center in Chicago.  She has a master in public health degree from Northwestern University, completed her preventive medicine and public health residency at CCH in conjunction with Northwestern University, and attended the University of Illinois at Chicago College of Medicine.  Prior to her medical training, Juleigh held several public sector roles in policy and public health including Director of Health Systems Integration with the Chicago Department of Public Health,  Special Assistant to the Assistant Secretary for Health at the U.S. Department of Health and Human Services, and Health Policy Legislative Assistant at the Office of then-U.S. Senator Barack Obama. 

ACCME Accredited with Commendation

ACCME Accreditation Statement

The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement

The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABPM Maintenance of Certification (MOC)

The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.

ABAM Transitional Maintenance of Certification (tMOC)

This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.

ABIM Maintenance of Certification (MOC)

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn 1.5 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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Session Recording
Open to view video.
Open to view video. This session was recorded on 4/7/19 in Orlando, FL
CME Quiz
3 Questions  |  10 attempts  |  2/3 points to pass
3 Questions  |  10 attempts  |  2/3 points to pass Complete the quiz to claim CME.
CME Evaluation
15 Questions
15 Questions Please complete the evaluation to claim CME.
CME Credit and Certificate
Up to 1.50 medical credits available  |  Certificate available
Up to 1.50 medical credits available  |  Certificate available 1.5 AMA PRA Category 1 Credits