Oregon's Approach To Demonstrating The Value Of A Modern Public Health System Through Accountability Metrics.

Oregon's public health system uses accountability metrics to improve health, eliminate inequities, and practice stewardship. First enacted into law during the 2015 legislative session, with additions and clarifications made in the 2017 session, these metrics promote collective action across sectors, bring attention to the root causes of health inequities, and hold public health authorities accountable for performance improvement as they carry out core public health functions. This article describes the development of Oregon's accountability metrics and implications for future practice. In 2023, Oregon's public health leaders adopted a new set of health outcome indicators and process measures for communicable disease control and environmental health, with performance tied to financial incentives. Oregon's process is a model for other states developing an accountability framework in their pursuit of public health transformation. Oregon's work contributes to legislative and other policy decisions for measuring the success of approaches to eliminating health inequities and for applying performance-based incentives within the public health system.

Population-based trends in hospitalizations due to injection drug use-related serious bacterial infections, Oregon, 2008 to 2018.

BACKGROUND: Injection drug use has far-reaching social, economic, and health consequences. Serious bacterial infections, including skin/soft tissue infections, osteomyelitis, bacteremia, and endocarditis, are particularly morbid and mortal consequences of injection drug use. METHODS: We conducted a population-based retrospective cohort analysis of hospitalizations among patients with a diagnosis code for substance use and a serious bacterial infection during the same hospital admission using Oregon Hospital Discharge Data. We examined trends in hospitalizations and costs of hospitalizations attributable to injection drug use-related serious bacterial infections from January 1, 2008 through December 31, 2018. RESULTS: From 2008 to 2018, Oregon hospital discharge data included 4,084,743 hospitalizations among 2,090,359 patients. During the study period, hospitalizations for injection drug use-related serious bacterial infection increased from 980 to 6,265 per year, or from 0.26% to 1.68% of all hospitalizations (P<0.001). The number of unique patients with an injection drug use-related serious bacterial infection increased from 839 to 5,055, or from 2.52% to 8.46% of all patients (P<0.001). While hospitalizations for all injection drug use-related serious bacterial infections increased over the study period, bacteremia/sepsis hospitalizations rose most rapidly with an 18-fold increase. Opioid use diagnoses accounted for the largest percentage of hospitalizations for injection drug use-related serious bacterial infections, but hospitalizations for amphetamine-type stimulant-related serious bacterial infections rose most rapidly with a 15-fold increase. People living with HIV and HCV experienced increases in hospitalizations for injection drug use-related serious bacterial infection during the study period. Overall, the total cost of hospitalizations for injection drug use-related serious bacterial infections increased from $16,305,129 in 2008 to $150,879,237 in 2018 (P<0.001). CONCLUSIONS: In Oregon, hospitalizations for injection drug use-related serious bacterial infections increased dramatically and exacted a substantial cost on the health care system from 2008 to 2018. This increase in hospitalizations represents an opportunity to initiate substance use disorder treatment and harm reduction services to improve outcomes for people who inject drugs.

Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR.

BACKGROUND: Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However, in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex are limited. METHODS: In 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and, assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes, HIV screening, and knowledge and uptake of HIV pre-exposure prophylaxis (PrEP) between women who did and did not report transactional sex. RESULTS: Of 334 women, 13.6% reported transactional sex (95% confidence interval [CI]: 6.8, 20.5%). Women who reported transactional sex were older, more likely to identify as black, to identify as lesbian or bisexual, to experience childhood trauma and recent sexual violence, and to have been homeless. Six percent (95% CI: 1.8, 10.5%) of women with no adverse childhood experiences (ACEs) reported transactional sex compared to 23.8% (95% CI: 13.0, 34.6%) of women who reported eleven ACEs (P <  0.001). Transactional sex was strongly associated with combination methamphetamine and opiate use as well as condomless sex. Women who reported transactional sex were more likely to report being diagnosed with a bacterial STI and hepatitis C; however, HIV screening and pre-exposure prophylaxis knowledge and use were low. CONCLUSIONS: In a sample of women of low socioeconomic status in Portland, Oregon, transactional sex was characterized by marginalized identities, homelessness, childhood trauma, sexual violence, substance use, and sexual vulnerability to HIV/STI. Multi-level interventions that address these social, behavioral, and trauma-related factors and increase access to biomedical HIV prevention are critical to the sexual health of women who engage in transactional sex.

Partner notification for gonococcal and chlamydial infections in men who have sex with men: success is underestimated by traditional disposition codes.

BACKGROUND: Recent reports evaluating partner notification (PN) efforts among men who have sex with men (MSM) have observed relatively poor outcomes. However, the validity of traditional PN disposition codes is not known, possibly leading to overly pessimistic assessments of PN outcomes. OBJECTIVES: To evaluate PN practices among MSM with gonococcal or chlamydial infection, assess the utility of offering MSM PN assistance and compare patient self-reported PN outcomes with those recorded using Disease Intervention Specialist (DIS) disposition codes. STUDY DESIGN: We reviewed the records of all MSM with gonococcal or chlamydial infection interviewed by Public Health-Seattle and King County for purposes of PN in 2004. Men were asked to indicate whether each of their sex partners were already notified or treated at time of interview and were offered PN assistance. RESULTS: DIS interviewed 409 of 628 (65%) MSM reported with gonococcal or chlamydial infection. Three hundred thirteen of the 409 (76%) interviewed men provided information about their number of sex partners in the 60 days before diagnosis and specific information about 1 or more of their potentially exposed partners. These index cases reported a total of 1037 sex partners, but provided information about only 634 (61%). Two hundred thirteen of the 313 (68%) index cases reported notifying at least 1 partner. Index cases reported that 295 of all 1037 (28%) reported partners had been notified, and that 170 (16%) were treated; DIS disposition codes documented the treatment of 111 (11%) partners. Only 18 (6%) index cases requested DIS assistance contacting a partner; DIS notified and assured the treatment of 24 of the 35 (69%) partners reported by these 18 men. CONCLUSIONS: Although MSM with gonorrhea or chlamydia seldom accept assistance notifying partners, they report higher levels of partner treatment than suggested by DIS disposition codes, with 68% indicating that they had notified at least 1 sex partner and 46% reporting that at least 1 of their partners received treated.