Racial equity in linkage to inpatient opioid use disorder treatment in patients that received emergency care

Lessons Learned from Implementation of a Post-opioid Overdose Outreach Program in a Rural Massachusetts Community

Post-overdose outreach programs can play a key role in reducing opioid overdose deaths and increasing access to healthcare services. The design and implementation of these programs, especially in rural communities, remains a gap in knowledge. We aimed to understand the lessons learned from the implementation experiences of the Community, Opportunity, Network, Navigation, Exploration, and Connection Team (CONNECT), a post-overdose outreach program based in a rural community in Massachusetts. We conducted semi-structured focus groups and interviews with 21 community partners after the first year of implementation in 2022. Participants included behavioral health, medical, public health, and public safety personnel involved in the design and implementation of CONNECT. Using a combination of thematic and rapid qualitative analysis methods, we inductively coded transcripts for salient themes. Themes were mapped onto the Health Equity Implementation Framework to better understand implementation and health-equity factors. Facilitators to implementation of this innovation included efficient inter-partner data sharing and coordination, and ability to offer numerous health services to clients to meet their needs. Key partners identified that CONNECT serves clients who use opioids, have previous involvement with the legal system, and reside in low-income areas within this rural region. Unhoused individuals and individuals who do not call 9-11 after an overdose were identified as populations of need that CONNECT was missing due to structural barriers. Partners shared how the context of this rural community came with challenges related to limited access to health services and pervasive stigma towards substance use, while it was also perceived to foster a culture of collaboration and unity among multidisciplinary key partners. Post overdose outreach programs serve clients with complex health needs. The ability to access services for these health needs is shaped by the post overdose outreach program and its key partners, and by the broader community context. As post-overdose outreach programs continue to expand as a promising strategy to address the opioid overdose crisis, there exists a need to contextualize implementation strategies to inform adaptations and develop best-practices.

2022 consensus conference on diversity, equity, and inclusion: Developing an emergency medicine research agenda for addressing racism through health care research

Racism in emergency medicine (EM) health care research is pervasive but often underrecognized. To understand the current state of research on racism in EM health care research, we developed a consensus working group on this topic, which concluded a year of work with a consensus-building session as part of the overall Society for Academic Emergency Medicine (SAEM) consensus conference on diversity, equity, and inclusion: "Developing a Research Agenda for Addressing Racism in Emergency Medicine," held on May 10, 2022. In this article, we report the development, details of preconference methods and preliminary results, and the final consensus of the Healthcare Research Working Group. Preconference work based on literature review and expert opinion identified 13 potential priority research questions that were refined through an iterative process to a list of 10. During the conference, the subgroup used consensus methodology and a "consensus dollar" (contingent valuation) approach to prioritize research questions. The subgroup identified three research gaps: remedies for racial bias and systematic racism, biases and heuristics in clinical care, and racism in study design, and we derived a list of six high-priority research questions for our specialty.

Implications of missingness in self-reported data for estimating racial and ethnic disparities in Medicaid quality measures

OBJECTIVE

To assess the feasibility and implications of imputing race and ethnicity for quality and utilization measurement in Medicaid.

DATA SOURCES AND STUDY SETTING

2017 Oregon Medicaid claims from the Oregon Health Authority and electronic health records (EHR) from OCHIN, a clinical data research network, were used.

STUDY DESIGN

We cross-sectionally assessed Hispanic-White, Black-White, and Asian-White disparities in 22 quality and utilization measures, comparing self-reported race and ethnicity to imputed values from the Bayesian Improved Surname Geocoding (BISG) algorithm.

DATA COLLECTION

Race and ethnicity were obtained from self-reported data and imputed using BISG.

PRINCIPAL FINDINGS

42.5%/4.9% of claims/EHR were missing self-reported data; BISG estimates were available for >99% of each and had good concordance (0.87-0.95) with Asian, Black, Hispanic, and White self-report. All estimated racial and ethnic disparities were statistically similar in self-reported and imputed EHR-based measures. However, within claims, BISG estimates and incomplete self-reported data yielded substantially different disparities in almost half of the measures, with BISG-based Black-White disparities generally larger than self-reported race and ethnicity data.

CONCLUSIONS

BISG imputation methods are feasible for Medicaid claims data and reduced missingness to <1%. Disparities may be larger than what is estimated using self-reported data with high rates of missingness.