1. (Abbreviated) Data Projects Overview
MDH Behavioral Health Administration
Office of Prevention
Statewide Epidemiological Outcomes Workgroup
November 7, 2017

2. Current Initiatives
Predictive Risk Evaluation to Combat Overdose Grant (PRECOG)
CRISP Opioid Indicators Dashboards
Prescription Drug Monitoring Program (PDMP) analyses: active buprenorphine prescribers
Overdose Fatality Review data collection system
Overdose Response Program: naloxone training & use reports

3. PRECOG $750k, 3-year Harold Rogers PDMP grant from US DOJ
Goal: develop predictive risk model (PRM) to identify Maryland-specific risk factors for overdose, potential points of intervention
Method: create linked, de-identified database of multiple state agency datasets
Project partners:
Chesapeake Regional Information System for our Patients (CRISP)
Johns Hopkins Bloomberg School of Public Health, Center for Population Health Information Technology (CPHIT)

4. Datasets Maryland Prescription Drug Monitoring Program
Includes dispense data for all controlled dangerous substances (CDS) dispensed in Maryland
Information on prescription as well as recipient, dispenser and prescriber utilized
Office of the Chief Medical Examiner
OCME investigates all deaths in the state of Maryland that occur outside of hospitals: includes homicides, suicides, unintentional and undetermined deaths
Includes information on decedent, location of death, and cause and manner of death
For unintentional and undetermined overdose deaths, added validated county of residence and coded toxicology information from our Vital Statistics Administration

5. Datasets Health Services Cost Review Commission
Hospitalizations and emergency department visits at MD hospitals
Discharge file including ICD-9/10-CM codes
Interested in the hospitalization histories of those identified as having fatal overdoses, both for non-fatal overdoses and for other conditions
Beacon Health Options
MDH-contracted ASO for publicly-funded behavioral health services
Includes mental health & substance use disorder services paid by Medicaid & grant funds
Depts. Public Safety & Correctional Services & Juvenile Services
Includes offender criminal history (offense/complaint), community supervision (parole & probation) & state correctional facilities

6. Timeline for Model Development
Phase I: Project Development
Identify data sets of interest
Initial conversations with other agencies about project and data usage
Legal frameworks to exchange data (MOUs/DUAs)
Phase II: Data Linkage and Transfer
Coordinated between CRISP, data provider, and BHA
CPHIT compiles linked, de-identified data set
Phase III: Predictive Risk Model Development

7. CRISP Opioid Indicators Dashboard
Partnership b/t BHA Prevention & CRISP
Goal: provide public health authorities & others with access to timely, automatically updated data on opioid indicators statewide
Web-based Tableau dashboards w/ interactive reports:
PDMP Dashboard: Rx controlled substances dispensed in MD
Overdose Dashboard: Acute drug/alcohol poisoning-related hospital encounters (HSCRC data)
State & local users trained/credentialed for access October 2017
Working to develop fatal overdose dashboard based on OCME data

8. PDMP Dashboard

9. Overdose Hospital Events Dashboard

10. PDMP Analysis: Active Buprenorphine Prescribers
Initial aim: Leverage state Prescription Drug Monitoring Program data to quantify number of active buprenorphine prescribers outside of opioid treatment programs in the state, stratified by “waiver” status (patient cap)
16 month timeframe: dispenses from January 1, 2016 to April 30, 2017
Specific brand names and formulations of drugs designated as either pain or OUD treatment after review of FDA indication on drug labels
DEA Waiver information obtained from DEA Registrant File
Crosslinked information to PDMP data using SAS and Excel (manual deduplication of prescribers)

11. Buprenorphine Prescribers Ctd.
Buprenorphine accounted for 5.4% of all captured controlled substance prescriptions in this time period
97% of buprenorphine fills for OUD treatment formulations: Suboxone (60.2%), Zubsolv (15.08%), generic buprenorphine tablets (10.78%)
2,448 unique providers prescribed buprenorphine at least once
70.2% wrote only for OUD treatment formulation
23.5% wrote only for pain treatment formulation
6.25% wrote at least one of each formulation

12. Buprenorphine Prescribers Ctd.
Of n= 2,448 prescribers:
Missing/invalid DEA Number (including X-codes in DEA field): 193 (7.88%)
Waivered at 30 patients, any state: 428 (17.48%)
Waivered at 100 patients, any state: 528 (21.53%)
Waivered at 275 patients, any state: 299 (12.21%)
No waiver found, any state: 1000 (40.85%)

13. Overdose Fatality Review (OFR)
Structure:
Modeled after existing mortality review programs (Child Fatality Review)
Multi-agency/multi-disciplinary team assembled at local level to conduct confidential reviews of overdose death cases
State provides technical assistance & OCME/VSA overdose death records to local OFR teams
Team members bring info about decedents from respective agencies for review
Goal to prevent future deaths by:
Identifying missed opportunities for prevention and gaps in system
Building working relationships b/t local stakeholders on OD prevention
Recommending policies, programs, laws, etc. to prevent OD deaths
Informing local overdose prevention strategy

14. OFR Data System Funded by 2016 Harold Rogers PDMP grant
BHA/CRISP partnership
Goal: develop data collection/reporting system to support local OFR teams and state administrators
BHA provides death data to CRISP to populate database
OFR teams retrieve death data to support case review and report information about decedent into the system
Interface allows OFR teams streamlined access to hospital records & PDMP data through CRISP
Centralized respository of OFR case review findings statewide

15. Overdose Response Program
Orgs authorized to conduct overdose education and naloxone distribution under ORP required to report monthly training statistics to BHA
Bystander naloxone use/administration in response to opioid OD reported to BHA, training organizations and Maryland Poison Center (MPC)
BHA historically compiles naloxone training and use data for analysis at jurisdiction and training org level
New partnership w/ MPC to consolidate naloxone use reporting methods and disseminate standardized reports to state agencies, LHDs and training orgs
Updated evaluation of hundreds of naloxone use reports to MPC planned

17. In closing…
Other programmatic/admin data collected by Office of Prevention
BHA generates reports on publicly-funded behavioral health services, including linkage with overdose deaths
BHA recently established Office of Applied Research & Evaluation (Jay Yoe, Director)
MDH overdose death reports available online:
Additional analysis/dissemination of overdose-related ED visits (ESSENCE) and EMS responses (MIEMSS) being conducted in support of Opioid Operational Command Center (OOCC) activities