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1. Geospatial analysis of emergency department visits for targeting community-based responses to the opioid epidemic.

Author

Daniel A Dworkis, Lauren A Taylor, David A Peak, and Benjamin Bearnot

Subjects
Medicine, Science
Abstract

The opioid epidemic in the United States carries significant morbidity and mortality and requires a coordinated response among emergency providers, outpatient providers, public health departments, and communities. Anecdotally, providers across the spectrum of care at Massachusetts General Hospital (MGH) in Boston, MA have noticed that Charlestown, a community in northeast Boston, has been particularly impacted by the opioid epidemic and needs both emergency and longer-term resources. We hypothesized that geospatial analysis of the home addresses of patients presenting to the MGH emergency department (ED) with opioid-related emergencies might identify "hot spots" of opioid-related healthcare needs within Charlestown that could then be targeted for further investigation and resource deployment. Here, we present a geospatial analysis at the United States census tract level of the home addresses of all patients who presented to the MGH ED for opioid-related emergency visits between 7/1/2012 and 6/30/2015, including 191 visits from 100 addresses in Charlestown, MA. Among the six census tracts that comprise Charlestown, we find a 9.5-fold difference in opioid-related ED visits, with 45% of all opioid-related visits from Charlestown originating in tract 040401. The signal from this census tract remains strong after adjusting for population differences between census tracts, and while this tract is one of the higher utilizing census tracts in Charlestown of the MGH ED for all cause visits, it also has a 2.9-fold higher rate of opioid-related visits than the remainder of Charlestown. Identifying this hot spot of opioid-related emergency needs within Charlestown may help re-distribute existing resources efficiently, empower community and ED-based physicians to advocate for their patients, and serve as a catalyst for partnerships between MGH and local community groups. More broadly, this analysis demonstrates that EDs can use geospatial analysis to address the emergency and longer-term health needs of the communities they are designed to serve.

Published
2017
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2. Geospatial analysis of emergency department visits for targeting community-based responses to the opioid epidemic

Author

Lauren A. Taylor, Benjamin Bearnot, Daniel A. Dworkis, and David A. Peak

Subjects
Male, Critical Care and Emergency Medicine, Social Sciences, lcsh:Medicine, computer.software_genre, Geographical locations, Drug Abuse, 0302 clinical medicine, Outpatients, Health care, Medicine and Health Sciences, Psychology, Public and Occupational Health, 030212 general & internal medicine, lcsh:Science, Analgesics, education.field_of_study, Multidisciplinary, Drugs, Census, Substance abuse, Research Design, Female, Medical emergency, Behavioral and Social Aspects of Health, Emergency Service, Hospital, Research Article, medicine.medical_specialty, Geospatial analysis, Patients, Population, Addiction, Research and Analysis Methods, Hospitals, General, 03 medical and health sciences, Age Distribution, medicine, Pain Management, Humans, Sex Distribution, Epidemics, education, Psychiatry, Pharmacology, Behavior, Survey Research, business.industry, Public health, lcsh:R, Biology and Life Sciences, 030208 emergency & critical care medicine, Emergency department, Opioid-Related Disorders, medicine.disease, United States, Local community, Opioids, Health Care, North America, lcsh:Q, People and places, business, computer
Abstract

The opioid epidemic in the United States carries significant morbidity and mortality and requires a coordinated response among emergency providers, outpatient providers, public health departments, and communities. Anecdotally, providers across the spectrum of care at Massachusetts General Hospital (MGH) in Boston, MA have noticed that Charlestown, a community in northeast Boston, has been particularly impacted by the opioid epidemic and needs both emergency and longer-term resources. We hypothesized that geospatial analysis of the home addresses of patients presenting to the MGH emergency department (ED) with opioid-related emergencies might identify "hot spots" of opioid-related healthcare needs within Charlestown that could then be targeted for further investigation and resource deployment. Here, we present a geospatial analysis at the United States census tract level of the home addresses of all patients who presented to the MGH ED for opioid-related emergency visits between 7/1/2012 and 6/30/2015, including 191 visits from 100 addresses in Charlestown, MA. Among the six census tracts that comprise Charlestown, we find a 9.5-fold difference in opioid-related ED visits, with 45% of all opioid-related visits from Charlestown originating in tract 040401. The signal from this census tract remains strong after adjusting for population differences between census tracts, and while this tract is one of the higher utilizing census tracts in Charlestown of the MGH ED for all cause visits, it also has a 2.9-fold higher rate of opioid-related visits than the remainder of Charlestown. Identifying this hot spot of opioid-related emergency needs within Charlestown may help re-distribute existing resources efficiently, empower community and ED-based physicians to advocate for their patients, and serve as a catalyst for partnerships between MGH and local community groups. More broadly, this analysis demonstrates that EDs can use geospatial analysis to address the emergency and longer-term health needs of the communities they are designed to serve.

Published
2017

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