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MOVDRS and ESOOS An Ongoing Partnership
MOVDRS and ESOOS An Ongoing Partnership
Goals of Presentation
• Provide a general overview of both the National Violent Death Reporting System (NVDRS) and Enhanced State Surveillance for Opioid Morbidity and Mortality (ESOOS) programs.
• Share recent Missouri trends in opioid/heroin addiction.
• Present recent health statistics related to injury in Missouri.
Violent crime in Missouri
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Detroit, MI Memphis,TN
Oakland, CA St. Louis,MO
Milwaukee,WI
Baltimore,MD
Cleveland,OH
Stockton, CA Indianapolis,IN
Kansas City,MO
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Violent Crime Rates for American Cities with More than 250,000 People
Source: Federal Bureau of Investigation. Crime in the US 2014. https://ucr.fbi.gov/crime-in-the-u.s/2014/crime-in-the-u.s.-2014/cius-home
Violent crime in Missouri
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St. Louis, MO Detroit, MI NewOrleans, LA
Baltimore,MD
Newark, NJ Buffalo, NY Pittsburgh,PA
Memphis,TN
Atlanta, GA Cincinnati,OH
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Murder Rates for American Cities with More than 250,000 People
Source: Federal Bureau of Investigation. Crime in the US 2014. https://ucr.fbi.gov/crime-in-the-u.s/2014/crime-in-the-u.s.-2014/cius-home
Violent deaths in the U.S.
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Source: NVDRS (CDC), Bureau of Vital Statistics (Missouri Department of Health and Senior Services)
NVDRS
• A state-based surveillance system that collects information on violent deaths
• Where and when victims were killed
• Victim demographics
• Factors perceived to contribute to death
• Sources include: coroner/medical examiner records, law enforcement reports, and death certificates.
• The only state-based violence surveillance system that:
• Pools data on violent deaths from multiple sources
• Covers all types of violent deaths, in all settings, for all age groups
NVDRS Participants
MOVDRS
• Provides states and communities with a clearer understanding of violent deaths to guide local decisions about efforts to prevent violence and track progress over time
• Provides data to assist groups in:
• Selecting and targeting violence prevention efforts;
• Supporting evaluations of violence prevention activities;
• Improving the public's access to in-depth information on violent deaths
MOVDRS Process
Death Certificate received from Bureau of Vital
Statistics
Death Certificate data entered into NVDRS web
system
Decedent information passed to Law
Enforcement abstractor
Law Enforcement abstractor contacts investigating LEA
Decedent information passed to participating
coroners/medical examiners (CMEs)
CMEs provide reports (autopsy/ toxicology) to
CME abstractor
Investigating LEA provides copies of reports to Law Enforcement abstractor
Investigating LEA completes and returns
data elements form
Law Enforcement abstractor travels to
Investigating LEA facility and abstracts data on-site
OR OR
Complete NVDRS Case can be used to inform public health and law enforcement
decision-making
Strengths of NVDRS Data
• Standardized case definitions / Standardized data collection across states allows us to:
• Evaluate public health and law enforcement interventions to determine what does/does not work
• Look at patterns of behavior underlying violent deaths
• Improve stewardship of financial resources by identifying discrete and linked risk factors
• Information pooled about the same incident from multiple data sources / linkages can help fill gaps in the record
MOVDRS Data Dissemination
1. Data Sharing with LPHAs, Law Enforcement, and affiliated programs within DHSS and Missouri state government
• Office on Women’s Health
• Office on Minority Health
• Child Fatality Review Board
• Injury and Violence Prevention program
2. Fact-sheets
• County-level/regional
• Statewide
• Manner-specific findings
3. Stretch goal: MOVDRS PHIMS/MICA module
ESOOS- A Nationwide Epidemic
Source: CDC/NCHS, National Vital Statistics System, Mortality.
U.S. Death Rates
ESOOS Funded States
Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
Opioid-Related Mortality
0.0
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6.0
8.0
10.0
12.0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
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00
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Missouri Resident Opioid and Heroin-Specific Death Rates, 2001-2014
All Opioids
Heroin
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
ESOOS Strategy 1- Nonfatal Opioid Overdose Reporting
• Increase the timeliness of aggregate nonfatal opioid overdose reporting.
• Target area is the entire state of Missouri.
• Focus will be on emergency department records.
ESOOS Strategy 1- Nonfatal Opioid Overdose Reporting
• Two Data Sources
• ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics)
• Missouri Patient Abstract System (PAS) quarterly Emergency Room discharge files
• Three types of data collected
• Any drug overdose
• Any opioid overdose
• Any heroin overdose
ESOOS Strategy 1- Nonfatal Opioid Overdose Reporting
What is ESSENCE? • Electronic Surveillance System for the Early Notification
of Community-based Epidemics (ESSENCE)
• Web-based automated surveillance tool
• Emergency Department chief complaints
• Installed in 2006
• Data loaded hourly; available 24/7/365
• 9,000 ED visits per day
Opioid-Related Morbidity
Daily ED visits due to opioid abuse in ESSENCE
Time
Co
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ts o
f ED
vis
its
Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services
ESOOS Strategy 1- Nonfatal Opioid Overdose Reporting • DHSS receives inpatient, emergency room, and outpatient
data from approximately 132 Missouri hospitals.
• This data includes a variety of demographic information, as well as variables about the visit itself.
• Each healthcare record has 23 diagnoses fields (containing ICD codes, not literals), though rarely are all of these used.
• DX1= Chief Complaint
• Data is received quarterly and converted into an annual file.
• Missouri has an agreement with the Hospital Industry Data Institute (HIDI) to download data monthly in the early period of the grant in order to establish methodology.
Opioid-Related Morbidity
Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
Time and Space Trends in Opioid-Related ER Diagnoses
Opioid-Related Morbidity
Missouri Heroin versus Other Opioid Diagnoses- ER Setting
Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
ESOOS Strategy 2- Fatal Opioid Overdose Reporting • Increase the timeliness of fatal opioid overdose and
associated risk factor reporting.
• Target area will be a subset of Missouri counties.
• DHSS will partner with medical examiner and coroner offices across the state to integrate Missouri Death Certificates with Medical Examiner/Coroner (ME/C) reports in cases of suspected opioid overdoses.
• Time Period: July 1, 2016 through December 31, 2018
ESOOS Strategy 2 Reporting Timetable
ESOOS Strategy 2 Target Area
Per grant requirements, DHSS reached out to ME/C offices with high frequencies of overdose deaths. •The counties shown in orange represent just over 75% of 2014 unintentional and undetermined drug overdoses (UUDO) statewide.
Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
Opioid-Related Mortality
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
Percent change values compare the 2008-2014 rates to the 2001-2007 rates.
Demographic Differences in Missouri Heroin Deaths, 2001-2014
Opioid-Related (Non-Heroin) Mortality Death Rates (per 100,000), 2008-2014
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
Heroin-Specific Mortality Death Rates (per 100,000), 2008-2014
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
Missouri and St. Louis Area Zip Codes
ESOOS Strategy 3- Data Dissemination • Disseminate opioid surveillance findings to key
stakeholders working to prevent or respond to opioid overdoses.
• Data dissemination unit housed within BHCADD will continually revise dissemination strategies based on stakeholder feedback.
• Activities include: • New opioid overdose website
• Annual report
• Development of Fact Sheets for areas with high rates/increases
• Presentations to local stakeholders
• Respond to data requests
NVDRS Mental Health
• Nationally, NVDRS data has been harnessed most often to look at patterns in suicide incidence
• LGBT+
• Military veterans
• Chronic pain
• Geographic patterns
• Which populations are most at-risk?
• Suicide patterns in different demographic groups?
• Where are increases occurring?
• What circumstance factors are most strongly associated with a successful suicide attempt?
• How can LPHAs and others help?
DHSS Opioid Dashboard
• The Division of Community and Public Health is in the process of developing a web-based dashboard to communicate data related to opioid abuse.
• Maps, charts, and other graphics will tell the story of the opioid epidemic in Missouri.
• COMING SOON!
DHSS Opioid Dashboard- Preview
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2010 2011 2012 2013 2014
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Neonatal Abstinence Syndrome (NAS) in Missouri 2010-2014
Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
DHSS Opioid Dashboard- Preview
Governmental $38,384,003
Self Pay/No Charge $36,291,099
Commercial $19,926,517
Other $713,518
Insurance Payers Missouri Resident Opioid-Involved Emergency Room
Discharges 2010-2014
Governmental insurance payers include: Medicare, Medicaid, Workman's Compensation, CHAMPUS, Veteran's Administration, TriCare, and all other government insurance.
Estimated Emergency Room Charge Total:
$95,315,137
Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
DHSS Opioid Dashboard- Preview
Counts
Quarters
DHSS Opioid Dashboard- Preview
Partners • 23+ county Medical Examiner and Coroner offices • DHSS
• Bureau of Community Health and Wellness and the Injury Prevention Program • Bureaus of Reportable Disease Informatics and Communicable Disease Control
and Prevention • Bureau of Vital Statistics • Office of Minority Health • Office of Primary Care and Rural Health • Office on Women’s Health
• Hospital Industry Data Institute (HIDI), The Data Company of the Missouri Hospital Association
• Midwest HIDTA • Missouri Department of Mental Health, Division of Behavioral Health • Missouri State Registrar • National Council on Alcoholism and Drug Abuse- St. Louis Area • Regional Heroin and Opiates Steering Committee • Missouri Foundation for Health • Missouri Injury and Violence Prevention Advisory Committee • Missouri State Highway Patrol • Missouri Child Fatality Review Board
Contact Information
• MOVDRS
Rebecca Lander
Injury Epidemiologist
573/522-4839
• ESOOS
Whitney Coffey
Interim Project Manager
573/751-6285
QUESTIONS/CONCERNS
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