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The illicit drug supply is rapidly evolving. Equally important to gathering drug supply data for monitoring is timely sharing of information with people who use drugs, the providers who care for them, law enforcement partners, and public health stakeholders so that efforts to avoid harmful substances, take preventive actions, and better target interventions can occur. PROGRAM: The Massachusetts Drug Supply Data Stream (MADDS) is the country's first statewide community drug checking program. Founded on public health-public safety partnerships, MADDS collects remnant drug packaging and paraphernalia with residue from people who use drugs and noncriminal samples from partnering police departments. MADDS tests samples using simultaneous immunoassay fentanyl test strips, Fourier-transform infrared spectrometry (FTIR), and off-site laboratory testing by gas chromatography-mass spectrometry (GC/MS). Results are accessible to community programs and municipalities, while trend analyses inform public health for cross-site alerts and informational bulletins. IMPLEMENTATION: MADDS was launched statewide in 2020 and rapidly expanded to a multisite program. Program staff approached communities and met with municipal police and community partners to secure written agreements to host drug checking. Community partners designed sample collection consistent with their pandemic era workflows. Consultations with stakeholders gathered feedback on design and deliverables. EVALUATION: The program tests sample donations on-site from community agencies and police departments, incorporates review by a medical toxicologist for health and safety concerns, crafts stakeholder-specific communications, and disseminates English, Spanish, and Portuguese language materials. For 2020, a total of 427 samples were tested, of which 47.1% were positive for fentanyl. By early 2021, MADDS detected shifts in cocaine purity, alerted communities of a new toxic fentanyl analogue and a synthetic cannabinoid contaminant, and confirmed the increase of xylazine (a veterinary sedative) in Massachusetts. DISCUSSION: Community drug checking programs can be collaboratively designed with public health and public safety to generate critical health and safety information for people who use drugs and the communities where they live.

Background: Physicians have unparalleled access to smokers. It is estimated that over 70% of smokers visit a physician every year, which provides a powerful opportunity to promote tobacco cessation by asking about smoking behaviors and providing cessation advice and counseling to tobacco users at every visit. In general, smokers consider a physician’s advice to quit an important motivator to make a quit attempt. We adapted our Quitxt program to the patient population attending the Mays Cancer Center at UT Health San Antonio. Every patient is screened for tobacco use; if the patient is a tobacco user, healthcare providers (HCPs) advise them to quit, offer nicotine replacement therapy if needed, and recommend enrollment in the Quitxt program. Purpose: We present the development process and implementation of Quitxt, our evidence-based, bilingual mobile cessation service tailored to the patient population of the Mays Cancer Center (MCC). Methods: Tobacco screening was integrated into EPIC, and the Quitxt program was added to the BestPractice Advisories Banner. All patients are screened for tobacco use. If a tobacco-using patient is identified, the BestPractice Advisories Banner will appear, prompting HCPs to counsel patients to quit and encourage them to enroll in Quitxt. Selecting referral to Quitxt will activate our Patient Navigator (PNs) follow-up. PNs contact patients and provide support, positive reinforcement, and encouragement. They continue with monthly follow-ups for the duration of the program. The EPIC system also places instructions on how to enroll in Quitxt in the patients’ after-visit summary. The Quitxt library of messages was adapted to the patient population of the MCC. We also developed a news-style video for HCPs with peer modeling on how to approach patients and enroll them in Quitxt. Results: The program will be launched at the MCC on August 1st, 2022. We will present the development and implementation process and preliminary results related to patient enrollment characteristics, stages of change, smoking abstinence, and patient navigation support. Conclusion: This project will greatly increase the accessibility and utilization of a bilingual evidence-based smoking cessation service among primary care and cancer patients. Quitxt will also serve as a model that can be easily adapted and replicated by any organization or network interested in serving their patients with an evidence-based cessation program. Quitxt represents an affordable approach to reach tobacco-using patients, produce a public health impact, reduce health service costs, and reduce tobacco-related diseases and mortality. Citation Format: Patricia Chalela, Vivian Cortez, Armida Flores, Sandra Sivak, Ysabel Lew, Edgar Munoz, Cliff Despres, Sarah Ruiz, Ramon Cancino, Mio Kitano, Rahul Mundlamuri, Ganesh Gunnam, David Akopian, Ruben Mesa, Amelie Ramirez. Quitxt Mobile Cessation Service for Cancer Patients: Development and Implementation Process [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-20.

The COVID-19 pandemic has fueled growing concerns about the long-term impacts on outcomes in older adults including social isolation and declines in cognitive health. Prior to the pandemic, the Administration for Community Living (ACL) released a nationwide request for information to understand how community-based organizations monitor changes in cognitive status for homebound older adults. This Perspective describes strategies reported by community-based organizations to monitor cognitive status in homebound older adults and notes the potential for technology to mitigate the risk of social isolation and delays in observing cognitive decline, considerations that are especially relevant during COVID-19 amid social distancing requirements.

A significant gap remains between existing evidence-based care coordination techniques for the general population and those that have been successfully translated for people with intellectual and developmental disabilities (IDD). Two models funded through the Health Care Innovation Awards have dedicated resources to the translation of evidence-based practices in community or clinical settings. This study analyzes quasi-experimental mixed-methods evaluation data, including Medicaid/Medicare claims on more than 600 beneficiaries who participated in the two models and survey data, site visits, and focus groups with participants and caregivers. Qualitative data suggest that both models address key contextual factors, considering residential setting, health disparities, and heterogeneity of the population. We identify key improvements in health care quality related to timeliness, patient safety, and medication reconciliation. In addition, both models show some evidence of reduced claims utilization. This study represents the first step to understand the potential of care coordination to improve the lives of adults aging with IDD. As health systems continue to struggle to manage the cost of their most expensive users and deliver high quality care, these models hold promise as vehicles to reduce utilization and cost among adults who have lived long-term with disability by addressing their unique health care and social needs.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. \ud \ud \ud METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. \ud \ud \ud FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. \ud \ud \ud INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. \ud \ud \ud FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.

Background Opioid overdose is a significant public health problem. Collaborative programs between local public health and public safety agencies have emerged to connect overdose survivors and their personal networks with harm reduction and addiction treatment services following a non-fatal overdose event. This study explored the prevalence of these programs in Massachusetts and the different ways they have been structured and function. Methods We sent an online screening questionnaire to police and fire departments in all 351 communities in Massachusetts to find instances in which they collaborated with a community-based public health agency to implement a post-overdose outreach and support program. We conducted telephone interviews with communities that implemented this type of program and categorized programs based on their structure, outreach approach, and other key characteristics. Results Police and fire personnel from 110 of the 351 communities in Massachusetts (31% response rate) completed the screening survey. Among respondents, 21% (23/110) had implemented a collaborative, community-based, post-overdose program with a well-defined process to connect overdose survivors and their personal networks with support services or addiction treatment services. Using data from the interviews, we identified four types of programs: (1) Multi-Disciplinary Team Visit , (2) Police Visit with Referrals , (3) Clinician Outreach , and (4) Location-Based Outreach . Conclusions This study represents the first attempt to systematically document an emerging approach intended to connect opioid overdose survivors and their personal networks with harm reduction and addiction treatment services soon after a non-fatal overdose event. These programs have the potential to increase engagement with the social service and addiction treatment systems by those who are at elevated risk for experiencing a fatal opioid overdose.

Introduction and Aims. The Massachusetts Department of Public Health Overdose Education and Naloxone Distribution Program provides overdose education and naloxone rescue kits to people at risk for overdose and bystanders, including family members. Using Massachusetts Department of Public Health data, the aims are to: (i) describe characteristics of family members who receive naloxone; (ii) identify where family members obtain naloxone; and (iii) describe characteristics of rescues by family members. Design and Methods. We conducted a retrospective review using program enrollee information collected on a standardised form between 2008 and 2015. We calculated descriptive statistics, including demographics, current substance use, enrolment location, history of witnessed overdoses and rescue attempt characteristics. We conducted a stratified analysis comparing family members who used drugs with those who did not. Results. Family members were 27% of total program enrollees (n = 10 883/40 801). Family members who reported substance use (n = 4679) were 35.6 years (mean), 50.6% female, 76.3% non-Hispanic white, 75.6% had witnessed an overdose, and they obtained naloxone most frequently at HIV prevention programs. Family members who did not report substance use (n = 6148) were 49.2 years (mean), 73.8% female, 87.9% non-Hispanic white, 35.3% had witnessed an overdose, and they obtained naloxone most frequently at community meetings. Family members were responsible for 20% (n = 860/4373) of the total rescue attempts. Discussion and Conclusions. The Massachusetts experience demonstrates that family members can be active participants in responding to the overdose epidemic by rescuing family members and others. Targeted intervention strategies for families should be included in efforts to expand overdose education and naloxone in Massachusetts. [Bagley SM, Forman LS, Ruiz S, Cranston K, Walley AY. Expanding access to naloxone for family members: The Massachusetts experience. Drug Alcohol Rev 2017;00:000-000]

A growing number of new smart, internet-enabled technologies from smart phone applications, to teleconferencing, to the Internet of Things (IoT), provide great promise and potential to support successful aging-in-place for people with long-term disabilities. This symposium highlights ongoing research at the TechSAge Rehabilitation Engineering Research Center to identify technology needs and develop/adapt new technologies to promote independence, health, and participation of this population. To understand user needs, Harris et al. will present findings from a large-scale interview study with older adults with long-term vision and mobility disabilities (N=120) that explored specific task-based challenges with community activities (e.g., going to entertainment events, volunteering) as well as solutions and strategies to overcome them. Koon et al. will present findings on perceived facilitators and barriers to using digital assistants (e.g., Amazon Alexa) to facilitate a variety of everyday tasks at home, from shopping to communicating with others, among adults aging with mobility disabilities. Levy et al. will discuss findings from research driving the creation of augmented reality tools that can enable individuals to experience how IoT devices, such as smart thermostats and lightbulbs, could be used within the context of one’s own abilities and home. Mitzner et al., will describe the development of a Tele Tai Chi intervention for older adults with long-term mobility disabilities that employs teleconferencing software to translate an in-person, evidence-based class to an online, social experience. TechSAge Program Officer, Sarah Ruiz (National Institute on Disability, Independent Living, and Rehabilitation Research), will serve as the discussant.

Many neurodegenerative disorders have lysosomal impediments, and the list of proposed treatments targeting lysosomes is growing. We investigated the role of lysosomes in Alzheimer&rsquo, s disease (AD) and other age-related disorders, as well as in a strategy to compensate for lysosomal disturbances. Comprehensive immunostaining was used to analyze brains from wild-type mice vs. amyloid precursor protein/presenilin-1 (APP/PS1) mice that express mutant proteins linked to familial AD. Also, lysosomal modulation was evaluated for inducing synaptic and behavioral improvements in transgenic models of AD and Parkinson&rsquo, s disease, and in models of mild cognitive impairment (MCI). Amyloid plaques were surrounded by swollen organelles positive for the lysosome-associated membrane protein 1 (LAMP1) in the APP/PS1 cortex and hippocampus, regions with robust synaptic deterioration. Within neurons, lysosomes contain the amyloid &beta, 42 (A&beta, 42) degradation product A&beta, 38, and this indicator of A&beta, 42 detoxification was augmented by Z-Phe-Ala-diazomethylketone (PADK, also known as ZFAD) as it enhanced the lysosomal hydrolase cathepsin B (CatB). PADK promoted A&beta, 42 colocalization with CatB in lysosomes that formed clusters in neurons, while reducing A&beta, deposits as well. PADK also reduced amyloidogenic peptides and &alpha, synuclein in correspondence with restored synaptic markers, and both synaptic and cognitive measures were improved in the APP/PS1 and MCI models. These findings indicate that lysosomal perturbation contributes to synaptic and cognitive decay, whereas safely enhancing protein clearance through modulated CatB ameliorates the compromised synapses and cognition, thus supporting early CatB upregulation as a disease-modifying therapy that may also slow the MCI to dementia continuum.

Background Caregivers are essential for assisting people with disabilities to fully participate in their communities. Past research has primarily focused on family caregivers in the U.S. providing care to older adults rather than children and adults with disabilities. Objective This paper examines the demographic and health characteristics of caregivers of children and adults with disabilities across the lifespan using data from the 2017 Health Information National Trends Survey (HINTS). Methods Chi square, t-test, linear and logistic regression analyses show differences between caregivers and non-caregivers related to gender, age, employment, and specific health outcomes. Results Of 3285 respondents, 18% self-identified as caregivers of children or adults with disabilities (n = 546). Almost one-third of all caregivers reported being diagnosed with depression or an anxiety disorder as compared to one-fifth of non-caregivers. Psychological distress was associated with an increased risk for a diagnosis of depression/anxiety. We also found that distress decreased with age when controlling for other factors. Conclusion This paper increases knowledge of a growing segment of family caregivers providing care for members with disabilities across the lifespan. Research and policy needs are discussed.

Background Community overdose responders do not always seek help from emergency services when administering naloxone. We aimed to identify responder, overdose event, and community characteristics associated with help seeking from emergency services during overdoses reported by Massachusetts Overdose Education and Naloxone Distribution (OEND) enrollees, and to assess trends in help seeking over time. Methods We analyzed overdose reports submitted between 2007 and 2017 to the Massachusetts Department of Public Health. We used logistic regression, stratified by responder drug use status, to assess associations of characteristics with help seeking during an overdose. Results From January 2007 through December 2017, there were 69,870 OEND enrollees. 5,588 enrollees reported 10,246 overdoses. Help seeking was more likely among responders who did not use drugs. Among responders who did not use drugs, help seeking was more likely when: the responder was older or female, the victim was a stranger or client, and when naloxone did not work. Among responders who used drugs, help seeking was more likely when: the responder was female or had not previously reported responding to an overdose, the victim was a stranger or client or did not use fentanyl, naloxone took a longer time to work, and when the overdose was public or occurred more recently. The percentage of overdoses where help seeking occurred reached a maximum in 2016 at 50%. Conclusions Help seeking by OEND enrollees was significantly associated with several responder, victim, and event characteristics. Targeted interventions to promote help seeking are warranted, particularly as the lethality of opioid supplies rises.

As federal, state, and local governments continue to test innovative approaches to health care delivery, the ability to produce timely and reliable evidence of what works and why it works is crucial. There is limited literature on methodological approaches to rapid-cycle qualitative research. The purpose of this article is to describe the advantages and limitations of a broadly applicable framework for in-depth qualitative analysis placed within a larger rapid-cycle, multisite, mixed-method evaluation. This evaluation included multiple cycles of primary qualitative data collection and quarterly and annual reporting. Several strategies allowed us to be adaptable while remaining rigorous; these included planning for multiple waves of qualitative coding, a hybrid inductive/deductive approach informed by a cross-program evaluation framework, and use of a large team with specific program expertise. Lessons from this evaluation can inform researchers and evaluators functioning in rapid assessment or rapid-cycle evaluation contexts.

Cancer patients often present to the emergency department (ED) and hospital for symptom management, but many of these visits are avoidable and costly.We assessed the impact of 2 Health Care Innovation Awards that used an oncology medical home model [Community Oncology Medical Home (COME HOME)] or patient navigation model [Patient Care Connect Program (PCCP)] on utilization and spending.Participants in COME HOME and PCCP models were matched to similar comparators using propensity scores. We analyzed utilization and spending outcomes using Medicare fee-for-service claims with unadjusted and adjusted difference-in-differences models.In the adjusted models, both COME HOME and PCCP were associated with fewer ED visits than a comparison group (15 and 22 per 1000 patients/quarter, respectively; P0.01). In addition, COME HOME had lower spending ($675 per patient/quarter; P0.01), and PCCP had fewer hospitalizations (11 per 1000 patients/quarter; P0.05), relative to the comparison group. Among patients undergoing chemotherapy, fewer COME HOME and PCCP patients had ED visits (18 and 28 per 1000 patients/quarter, respectively; P0.01) and fewer PCCP patients had hospitalizations (13 per 1000 patients/quarter; P0.05), than comparison patients.The oncology medical home and patient navigator programs both showed reductions in spending or utilization. Adoption of such programs holds promise for improving cancer care.

Background and Objectives Care coordination and palliative care supports are associated with reduced anxiety, fewer hospital admissions, and improved quality of life for patients and their families. Early palliative care can result in savings in the end-of-life period, but there is limited evidence that larger-scale models can improve both utilization and the cost of care. Three models that received Health Care Innovation Awards from the Centers for Medicare & Medicaid Services aimed to improve quality of care and reduce cost through the use of innovative care coordination models. This study explores the total cost of care and selected utilization outcomes at the end-of-life for these innovative models, each of which enrolled adults with multiple chronic conditions and featured care coordination with advance care planning as a component of palliative care. These included a comprehensive at-home supportive care model for persons predicted to die within a year and two models offering advance care planning in nursing facilities and during care transitions. Research Design and Methods We used regression models to assess model impacts on costs and utilization for high-risk Medicare beneficiaries participating in the comprehensive supportive care model (N = 3,339) and the two care transition models (N = 587 and N = 277) who died during the study period (2013–2016), relative to a set of matched comparison patients. Results Comparing participants in each model who died during the study period to matched comparators, two of the three models were associated with significantly lower costs in the last 90 days of life ($2,122 and $4,606 per person), and the third model showed nonsignificant differences. Two of the three models encouraged early hospice entry in the last 30 days of life. For the comprehensive at-home supportive care model, we observed aggregate savings of nearly $19 million over the study period. One care transition model showed aggregate savings of over $500,000 during the same period. Potential drivers of these cost savings include improved patient safety, timeliness of care, and caregiver support. Discussion and Implications Two of the three models achieved significant lower Medicare costs than a comparison group and the same two models also sustained their models beyond the Centers for Medicare & Medicaid Services award period. These findings show promise for achieving palliative care goals as part of care coordination innovation.

This paper describes the key outputs of the INTEGRID project related to the impact of the new Grid Codes and the implementation of new technologies on the electrical systems and equipment of Nuclear Power Plants (NPPs). The project is funded by the European Commission under the NUGENIA+ umbrella as a pilot project, and carried out by EDF (leader), the University of Manchester, Areva GMBH, and TECNATOM. INTEGRID investigates the increased stresses on the equipment of NPPs that could result from the newly proposed modifications of the Grid Codes by the ENTSO-E, specifically the impacts of wider voltage and frequency ranges. In particular, this paper discusses the impact of these new frequency and voltage operating ranges, and the corresponding code modifications, on different aspects related to the regulation of machines, overheating and vibrations of the equipment, and the appearance of electrical transients in the plant distribution network. The implementation of new technologies, replacing the existing equipment, is also discussed.

Opioid overdose deaths in Massachusetts increased 150% from 2012 to 2015 (1). The proportion of opioid overdose deaths in the state involving fentanyl, a synthetic, short-acting opioid with 50-100 times the potency of morphine, increased from 32% during 2013-2014 to 74% in the first half of 2016 (1-3). In April 2015, the Drug Enforcement Agency (DEA) and CDC reported an increase in law enforcement fentanyl seizures in Massachusetts, much of which was believed to be illicitly manufactured fentanyl (IMF) (4). To guide overdose prevention and response activities, in April 2016, the Massachusetts Department of Public Health and the Office of the Chief Medical Examiner collaborated with CDC to investigate the characteristics of fentanyl overdose in three Massachusetts counties with high opioid overdose death rates. In these counties, medical examiner charts of opioid overdose decedents who died during October 1, 2014-March 31, 2015 were reviewed, and during April 2016, interviews were conducted with persons who used illicit opioids and witnessed or experienced an opioid overdose. Approximately two thirds of opioid overdose decedents tested positive for fentanyl on postmortem toxicology. Evidence for rapid progression of fentanyl overdose was common among both fatal and nonfatal overdoses. A majority of interview respondents reported successfully using multiple doses of naloxone, the antidote to opioid overdose, to reverse suspected fentanyl overdoses. Expanding and enhancing existing opioid overdose education and prevention programs to include fentanyl-specific messaging and practices could help public health authorities mitigate adverse effects associated with overdoses, especially in communities affected by IMF.

While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population.

Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) and fewer hospitalizations in the last thirty days of life (fifty-seven and forty per 1,000 people, respectively). The patient navigation model was also associated with fewer emergency department visits in the last thirty days of life and increased hospice enrollment in the last two weeks of life. These promising results can inform new initiatives for cancer patients, such as the CMS Oncology Care Model.

PURPOSE An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding impor- tant contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS Key contextual factors involve complementary perspectives across mul- tiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flex - ible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care pro- viders, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, phil- anthropic organizations, and the business community. CONCLUSION Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multi- method approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life.

Objective To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs. Data Sources Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations. Study Design NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews. Data Collection/Extraction Methods We used qualitative thematic coding for data from 21 programs actively engaging physicians as part of HCIA interventions. Principal Findings Establishing physician champions and ensuring an innovation-values fit between physicians and programs, including the strategies programs employed, facilitated engagement. Among engagement practices identified in this study, tailoring team working styles to meet physician preferences and conducting physician outreach and education were the most common successful approaches. Conclusions We describe engagement strategies derived from a diverse range of programs. Successful programs considered physicians' values and engagement as components of process and policy, rather than viewing them as exogenous factors affecting innovation adoption. These types of approaches enabled programs to accelerate acceptance of innovations within organizations.

This presentation will discuss how aging policies influence people with disability, and how the disability research community can influence aging policy. The Program for All-Inclusive Care of the Elderly (PACE) Innovation Act of 2015 has expanded the program’s reach to people with disabilities under age 55 who are nursing home eligible. We will discuss the current empirical support for PACE and people with disabilities in the context of an ongoing trial funded by NIDILRR. Specifically, we will discuss dignity of risk and the challenges of adapting PACE for people with disabilities. Second, we will examine how innovative behavioral health programs design for people with disabilities can benefit older adults. Since 2012, community wellness programs receiving Administration on Aging funding must meet criteria to be evidence-based. We will examine the potential for Wellness Recovery Action Program (WRAP) to serve older adults in community settings with dual diagnosis of behavioral health challenges.

The Massachusetts Department of Public Health Overdose Education and Naloxone Distribution Program provides overdose education and naloxone rescue kits to people at risk for overdose and bystanders, including family members. Using Massachusetts Department of Public Health data, the aims are to: (i) describe characteristics of family members who receive naloxone; (ii) identify where family members obtain naloxone; and (iii) describe characteristics of rescues by family members.We conducted a retrospective review using program enrollee information collected on a standardised form between 2008 and 2015. We calculated descriptive statistics, including demographics, current substance use, enrolment location, history of witnessed overdoses and rescue attempt characteristics. We conducted a stratified analysis comparing family members who used drugs with those who did not.Family members were 27% of total program enrollees (n = 10 883/40 801). Family members who reported substance use (n = 4679) were 35.6 years (mean), 50.6% female, 76.3% non-Hispanic white, 75.6% had witnessed an overdose, and they obtained naloxone most frequently at HIV prevention programs. Family members who did not report substance use (n = 6148) were 49.2 years (mean), 73.8% female, 87.9% non-Hispanic white, 35.3% had witnessed an overdose, and they obtained naloxone most frequently at community meetings. Family members were responsible for 20% (n = 860/4373) of the total rescue attempts.The Massachusetts experience demonstrates that family members can be active participants in responding to the overdose epidemic by rescuing family members and others. Targeted intervention strategies for families should be included in efforts to expand overdose education and naloxone in Massachusetts.

This article explores how rebalancing efforts can support the needs of individuals aging with a lifelong disability. The National Balancing Indicator project examined the overall long-term supports and services system (LTSS) progress in five indicators within the Sustainability, Coordination and Transparency, and Prevention principles toward a balanced LTSS system for those aging with a lifelong disability. In assessing state efforts to create a balanced participant-directed LTSS system with the National Balancing Indicators, the findings suggest states are better equipping the system to handle a burgeoning population of individuals aging with a lifelong disability, but more progress is still needed. Overall, states need to continue to create a seamless system that allows individuals with lifelong disabilities to transition smoothly through the life course.

Naloxone is a medication that reverses respiratory depression from opioid overdose if given in time. Paramedics routinely administer naloxone to opioid overdose victims in the prehospital setting, and many states are moving to increase access to the medication. Several jurisdictions have expanded naloxone administration authority to nonparamedic first responders, and others are considering that step. We report here on policy change in Massachusetts, where several communities have equipped emergency medical technicians, law enforcement officers, and firefighters with naloxone.

We investigated whether and under what family conditions young adult grandchildren psychologically benefit from having close and supportive grandparent relations. Relying on parental absence and family systems perspectives, we hypothesized that grandparents will be most effective in reducing depressive symptoms and increasing self-esteem of grandchildren who were raised in single-parent and step-parent families, as well as those with poorer quality relations with their parents. We analyzed data from a sample of grandchildren aged 18–23 years who were surveyed in the 1992–1994 wave of the National Survey of Families and Households (n = 925). Hierarchical multiple regressions with interaction terms found that greater cohesion with grandparents decreased depressive symptoms, particularly among grandchildren raised in single-parent families. However, cohesive grandparent relations reduced depressive symptoms more in the presence of stronger ties to parents. The model partially supports the long reach of grandparents as compensatory resources for mature grandchildren whose families of origin were absent a parent. Implications for future research on the role of grandparents in family systems are discussed.

Medical advancements have extended the life of individuals with long-term disability into later life, also known as aging with disability. The paucity of evidence-based programs demonstrating effectiveness represents a gap for this unique group. This study analyzes quasi-experimental mixed-methods evaluation data on two programs in California (N=211) and Minnesota (N=124) funded under CMMI’s Health Care Innovation Award (HCIA) program, including Medicare and Medicaid claims data on over 800 patients, administrative comparison groups, survey data, site visits, and focus groups with patients and caregivers. All programs show evidence of improved quality of care and some support for reduced utilization. In addition to self-management education and motivational interviewing, mechanisms driving these favorable findings include enhanced access, supportive care, and avoidance of acute exacerbations of chronic conditions. Individuals aging with disability are not traditional consumers and often require careful tailoring and adaptations of existing programs.

A significant gap remains between existing evidence-based care coordination techniques in medical homes for the general population and those that have been successfully translated for people with intellectual and developmental disabilities (ID/DD). Two programs funded by CMMI have dedicated resources to the translation of existing evidence-based practices for the ID/DD population in community or clinical settings. Across New York, New Jersey, and Rhode Island, these programs have served over 2,200 individuals and demonstrated improved quality of care and limited evidence of reduced health care claims utilization. A greater-than-expected investment was needed to retrain clinicians and other staff to understand the unique needs of people with ID/DD and cater approaches based on person-centered planning. Establishing a medical home faced several barriers, such as administrative delays due to changes in State Medicaid offices and issues regarding health plan reimbursement. Additionally, community-based organizations often encountered difficulties in targeting their services to a population with the appropriate risk level for a successful intervention.

Introduction The rapid growth in chronic disease prevalence, in particular the prevalence of multiple chronic conditions, poses a significant and increasing burden on the health of Americans. Maximizing the use of proven self-management (SM) strategies is a core goal of the US Department of Health and Human Services. Yet, there is no systematic way to assess how much SM or self-management support (SMS) is occurring in the United States. The purpose of this project was to identify appropriate concepts or measures to incorporate into national SM and SMS surveillance. Methods A multistep process was used to identify candidate concepts, assess existing measures, and select high-priority concepts for further development. A stakeholder survey, an environmental scan, subject matter expert feedback, and a stakeholder priority-setting exercise were all used to select the high-priority concepts for development. Results The stakeholder survey gathered feedback on 32 candidate concepts; 9 concepts were endorsed by more than 66% of respondents. The environmental scan indicated few existing measures that adequately reflected the candidate concepts, and those that were identified were generally specific to a defined condition and not gathered on a population basis. On the basis of the priority setting exercises and environmental scan, we selected 1 concept from each of 5 levels of behavioral influence for immediate development as an SM or SMS indicator. Conclusion The absence of any available measures to assess SM or SMS across the population highlights the need to develop chronic condition SM surveillance that uses national surveys and other data sources to measure national progress in SM and SMS.

Objective To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts. Design Interrupted time series analysis of opioid related overdose death and acute care utilization rates from 2002 to 2009 comparing community-year strata with high and low rates of OEND implementation to those with no implementation. Setting 19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006. Participants OEND was implemented among opioid users at risk for overdose, social service agency staff, family, and friends of opioid users. Intervention OEND programs equipped people at risk for overdose and bystanders with nasal naloxone rescue kits and trained them how to prevent, recognize, and respond to an overdose by engaging emergency medical services, providing rescue breathing, and delivering naloxone. Main outcome measures Adjusted rate ratios for annual deaths related to opioid overdose and utilization of acute care hospitals. Results Among these communities, OEND programs trained 2912 potential bystanders who reported 327 rescues. Both community-year strata with 1-100 enrollments per 100 000 population (adjusted rate ratio 0.73, 95% confidence interval 0.57 to 0.91) and community-year strata with greater than 100 enrollments per 100 000 population (0.54, 0.39 to 0.76) had significantly reduced adjusted rate ratios compared with communities with no implementation. Differences in rates of acute care hospital utilization were not significant. Conclusions Opioid overdose death rates were reduced in communities where OEND was implemented. This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention.

Honeybee colonies are declining in some parts of the world. This may have important consequences for the pollination of crops and native plant species. In Spain, as in other parts of Europe, land abandonment has led to a decrease in the number of non professional beekeepers, which aggravates the problem of honeybee decline as a result of bee diseases In this study, we investigated the effects of honeybees on the pollination of three native plant species in northern Spain, namely wildcherry Prunus avium L., hawthorn Crataegus monogyna Jacq., and bilberry Vaccinium myrtillus L. We quantified fruit set of individuals from the target species along transects established from an apiary outwards. Half the samples were bagged in a nylon mesh to avoid insect pollination. Mixed-effects models were used to test the effect of distance to the apiary on fruit set in non-bagged samples. The results showed a negative significant effect of distance from the apiary on fruit set for hawthorn and bilberry, but no significant effects were detected for wild cherry. This suggests that the use of honeybees under traditional farming practices might be a good instrument to increase fruit production of some native plants. This may have important consequences for wildlife conservation, since fruits, and bilberries in particular, constitute an important feeding resource for endangered species, such as the brown bear Ursus arctos L. or the capercaillie Tetrao urogallus cantabricus L.