Mapping Drug Overdose Demographic and Socioeconomic Characteristics in the Community.

INTRODUCTION: Drug use and drug overdose have increased at an alarming rate. OBJECTIVE: To identify demographic and neighborhood social and economic factors associated with higher risk of overdose. These findings can be used to inform development of community programs and appropriately devote resources to prevent and treat drug abuse. METHODS: The electronic health records of all patients seen in the emergency department or admitted to the hospital for a drug overdose in 2016 at Gundersen Health System in La Crosse, Wisconsin, were reviewed retrospectively. Patient data collected included age, sex, race/ethnicity, insurance type, overdose intention (intentional, unintentional), drug involved, and total charge for the episode of care. Patient residence was geocode mapped to census tract to analyze the relationship of drug overdose to neighborhood characteristics. Overdose rates were calculated by census tract and compared by several sociodemographic characteristics. RESULTS: Four hundred nineteen patients were included in this study. Forty percent of overdoses were unintentional. Patients who were older, male, nonwhite, and who had no insurance were more likely to have unintentional overdoses. Opiates and heroin were most commonly present in unintentional overdoses, whereas benzodiazepines and sedatives were more common in intentional overdoses. Patients living in census tracts with a higher percentage of residents with some college also had a higher rate of unintentional overdose. Rates of overdose at the census tract level varied and were higher in tracts with lower median income, low income inequality ratio, high percentage of college attendance, and higher percentage of nonwhite residents. The average charge per overdose was $14,771 (median = $9,497) and totaled $6,188,923 for the year. CONCLUSIONS: This study provides demographic, geographic, and socioeconomic detail about drug overdose in the community that can be used to focus future treatment and prevention interventions.

A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem.

OBJECTIVES: To determine whether outcomes have changed over time for a managed, systematic approach to advance care planning (ACP). DESIGN: Retrospective comparison of medical record and death certificate data of adults who died over a 7-month period in 2007/08 with those of adults who died over an 11-month period in 1995/96. SETTING: All healthcare organizations in La Crosse County, Wisconsin. PARTICIPANTS: Five hundred forty adults who died in 1995/96 and 400 adults who died in 2007/08. INTERVENTION: A systematic ACP approach, Respecting Choices, collaboratively implemented in 1993 and continuously improved in subsequent years. MEASUREMENTS: Demographic and cause-of-death data were collected from death certificates. Type and content of any advance directive (AD), existence and content of Physician Orders for Life-Sustaining Treatment, and medical treatment provided at the location of death in the last 30 days of life were abstracted from the medical record. RESULTS: The recent data show a significantly greater prevalence of ADs (90% vs 85%, P=.02) and of availability of these directives in the medical record at the time of death (99.4% vs 95.2%, P<.001) than the data collected over 10 years ago. The new data suggest that quality efforts have improved the prevalence, clarity, and specificity of ADs. CONCLUSION: A system for ACP can be managed in a geographic region so that, at the time of death, almost all adults have an advance care plan that is specific and available and treatment is consistent with their plan.

Social determinants of smoking among Hmong Americans residing in Wisconsin.

OBJECTIVE: This study examined correlates of tobacco use among Hmong people residing in Wisconsin. METHODS: Surveys of youth (ages 12-17) and adults (ages > or =18), available in English and Hmong, were distributed in 14 communities through Hmong Mutual Assistance Associations and analyzed centrally. Surveys assessed daily and ever use of tobacco, as well as other sociodemographic characteristics. RESULTS: Of those contacted, 2856 people completed the survey (1460 youth and 1396 adults). Among youth, 15% reported daily use (18.8% for males, 11.7% for females); 32% reported ever use (36.3% for males, 28.2% for females). Education and birth location were significant predictors of tobacco use. Youth who reported someone in their household smoked were more likely to use tobacco. The odds of ever use of tobacco increased as the percent of life lived in the United States increased (OR = 3.7). Among adults, prevalence of daily use was 20% (25.3% for males, 12.4% for females) and ever use was 35.9% (45% for males, 23.2% for females.) Adults born in the United States were 3.4 to 3.7 times more likely to use tobacco. The less education reported, the more likely they were to be a daily tobacco user. Adults who reported that someone in their household smoked were 2.8 to 3.4 times more likely to use tobacco. CONCLUSION: Overall, Hmong males are at higher risk of smoking than females, although this difference is smaller for youth than adults. Education and household exposure are strong predictors of smoking prevalence.

The value of a web-based interactive regional health scorecard in setting public health priorities.

INTRODUCTION: Community-based health improvement efforts sometimes focus on emerging health issues rather than following a more proactive planning process. Although there is an abundance of easily accessible data on state and national websites, community leaders frequently don't know where to find data that will help them to prioritize local efforts. METHODS: The La Crosse Medical Health Science Consortium (LMHSC) is a formal collaborative of the 2 major health care providers and 3 higher education institutions in La Crosse, Wisconsin, and covers 20 counties in western Wisconsin, southeastern Minnesota, and northeastern Iowa. To help prioritize regional health improvement efforts, we developed an interactive scorecard for each county, which allows for tracking indicators (ie, leading causes of death, accidents, cancer, health and behaviors, heart disease, infectious diseases, maternal and child health, sexually transmitted infections, and substance use/abuse) and monitoring health improvement efforts. The website www.communityscorecard.com allows the user to examine a county's statistics over time (as far back as 1998) and compare data among LMHSC's 20 counties, the state, and the nation as a whole. To aid prioritization, a grading schema allows each county to grade itself compared with selected health indicator benchmarks, like the Healthy People 2010 goals. RESULTS: Since going public in March 2007, the website has received more than 10,500 visits by more than 2300 unique users from 48 states and 46 countries. CONCLUSIONS: Prioritization and engagement of the community in health promotion activities requires quick access to accurate data that have been translated into information. We describe the development of a web-based population health scorecard for this purpose.

Quit and Win smoking cessation contest for Wisconsin college students.

OBJECTIVE: To determine effectiveness of smoking cessation contests at 3 Wisconsin colleges. DESIGN: Pre-post program evaluation, with 6-month follow-up. SETTING: Two-year technical college, private 4-year college, and state university in spring and fall of 2000. SUBJECTS: One hundred fifty-two college smokers. INTERVENTIONS: Students participated in 7-week stop-smoking contests. Successful quitters were eligible for prizes. Smoking status was assessed at 6-month follow-up by telephone survey. RESULTS: The cessation rate for 18- to 24-year-olds was 30% at the end of the contests. At the 6-month followup, 12% of participants were not smoking. Participants who smoked fewer cigarettes per month were more likely to quit smoking at the end of the contests. Although no difference was found between 2- and 4-year college participants, heavier smokers from 4-year colleges were more likely to quit. CONCLUSIONS: Because of their similarity to effective smoking promotions, contests should be considered a cost-effective strategy for this age group.

Ultrasound assessment of first-trimester bleeding.

OBJECTIVE: To assess the outcome (to the end of the first trimester) of pregnancies with vaginal bleeding and the influence of ultrasound-acquired information on care and cost of care. METHODS: A chart review was performed of 1,240 patients receiving care at an integrated medical center for threatened abortion from 1998-2000. Records from 715 patients with adequate follow-up data were reviewed and outcomes studied. Charges for outpatient and inpatient care were obtained from the data warehouse. RESULTS: Main findings include that on endovaginal ultrasonography, 44% of the pregnancies were viable, of which 86% continued to the end of the first trimester and that of the 33% of pregnancies that were nonviable, 74% successfully miscarried without intervention. Charges for the care varied significantly, based on outcome and choice of site of care. CONCLUSION: Endovaginal ultrasonography for the evaluation of early pregnancy bleeding has a significant effect on care decisions and costs. LEVEL OF EVIDENCE: II-3.