Predicting fatal and non-fatal overdose in Los Angeles County with Rapid Overdose Surveillance Dashboard to target street-based addiction treatment and harm reduction services

利用快速过量用药监测仪表板预测洛杉矶县的致命和非致命用药过量，以针对街头成瘾治疗和减少伤害服务

• 批准号: 10589518
• 负责人: David Goodman
• 金额: $ 162.41万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589518
• 关键词: Accident and Emergency department; Acquired Immunodeficiency Syndrome; Acute; Address; Area; Awareness; California; Censuses; Centers for Disease Control and Prevention (U.S.); Cessation of life; Cities; Clinical; Code; Communities; Complex; Coroner; Coroners and Medical Examiners; County; Data; Data Sources; Dose; Electronic Health Record; Emergency medical service; Epidemiology; Fire - disasters; Geographic Locations; Geography; Goals; Government Agencies; Harm Reduction; Health; Health Personnel; Health Policy; Health Services; Helping to End Addiction Long-term; Homelessness; Injecting drug user; International Classification of Disease Codes; Intervention; Local Government; Los Angeles; Machine Learning; Measures; Medical Examiners; Medical emergency; Medicine; Methods; Modeling; Monitor; National Institute of Drug Abuse; Natural Language Processing; Needle-Exchange Programs; Opioid; Outcome; Overdose; Persons; Pharmaceutical Preparations; Play; Policies; Population; Prevalence; Process; Public Health; Reaction Time; Receiver Operating Characteristics; Records; Research; Resources; Services; Source; Speed; Stimulant; Strategic Planning; Substance Use Disorder; Surveys; Syringes; Text; Time; United States; Work; addiction; authority; base; biomedical informatics; computerized data processing; dashboard; data acquisition; design; diverse data; evidence base; experience; improved; injection drug use; innovation; interest; mortality; mortality statistics; opioid epidemic; opioid use; opioid use disorder; outreach; overdose prevention; predictive modeling; response; stem; surveillance data; tool; treatment services

PROJECT SUMMARY (ABSTRACT) Street medicine teams play a key role in the local overdose response, yet existing data sources lag and are no more granular than the county- or zip code level. Geolocated data exist from various sources that could be used to identify hotspots and inform street-based overdose prevention and addiction treatment, but the data sources are not harmonized or available to the public. One geographic area where these concerns are particularly acute is Los Angeles County (LAC), California, with a population of over 10 million, and which had the largest number of fatal overdoses of any U.S. county in 2020. A rising share of fatal overdoses in LAC occur among unhoused people and involve both stimulants and opioids. The objective of the project is to develop tools and processes to improve timely data acquisition from, rapid processing and integration of diverse data sources, geospatial anal- ysis of overdose hotspots (fatal and non-fatal), and nowcasting of overdose, opioid use disorder (OUD), and injection drug use in LAC. Building on our research team's work in mobile overdose prevention and treatment of OUD in LAC, we will collaborate with five local government agencies with interest and experience in improving local overdose response. Our partners span public health, medicine, emergency medical services (EMS), med- ical examiner and coroner, syringe services programs, and street-based harm reduction. Together, we propose to develop a publicly available Rapid Overdose Surveillance Los Angeles online dashboard that can provide local, granular data and more timely estimates of countywide metrics. To establish the dashboard, we pursue two specific aims. In Aim 1, we will establish data flows to collate geolocated fatal overdose data from the coroner and non-fatal overdose from EMS, adapting natural language processing (NLP) methods to classify free-text data that characterize the specific drugs involved. We then employ geostatistical methods to identify hotspots at the census tract level, providing localization to inform placement of mobile and street-based services. Finally, we will develop nowcasting models to “predict the present” of fatal and non-fatal overdose at the county-level based on incomplete surveillance data. In Aim 2, we will develop further NLP strategies to identify upstream outcomes of overdose (i.e., OUD and injection drug use) in electronic health record data. We will then incorporate metrics from substance use disorder treatment, syringe services, and street medicine to improve our estimates of OUD, injection drug use, and overdose at the county-level. We will visualize these data and nowcasting results through Rapid Overdose Surveillance Los Angeles online dashboard. Findings from these efforts will serve as a model for other jurisdictions to leverage and combine data from diverse stakeholders to improve local situational awareness of overdose. Ultimately, the goal is to produce tools and processes that can speed up the time from data to action to better provide overdose prevention and addiction treatment services.

项目概要（摘要） 街头医疗队在当地药物过量应对中发挥着关键作用，但现有数据来源滞后且无法 可以使用的各种来源的地理定位数据比县或邮政编码级别更精细。 识别热点并为街头过量预防和成瘾治疗提供信息，但数据来源 这些问题特别严重的一个地理区域没有得到协调或公开。 是加利福尼亚州洛杉矶县（LAC），人口超过1000万，是人口最多的县 2020 年美国所有县因吸毒过量致死的人数。在拉美和加勒比地区，无家可归者中吸毒过量致死的比例不断上升 该项目的目标是开发工具和流程来实现这一目标。 提高不同数据源的及时数据采集、快速处理和集成、地理空间分析 药物过量热点（致命和非致命）的分析，以及药物过量、阿片类药物使用障碍 (OUD) 和即时预测 以我们的研究团队在移动药物过量预防和治疗方面的工作为基础。 在拉美和加勒比地区的 OUD，我们将与五个有兴趣并有经验的当地政府机构合作，以改善 我们的合作伙伴涵盖公共卫生、医学、紧急医疗服务 (EMS)、医疗服务等领域。 我们共同建议，包括法医检查员和验尸官、注射器服务计划以及减少街道伤害。 开发一个公开可用的快速过量监测洛杉矶在线仪表板，可以提供 本地、精细的数据和对全县指标的更及时的估计为了建立仪表板，我们追求。 在目标 1 中，我们将建立数据流来整理来自验尸官的地理定位致命过量数据。 EMS 中的非致命过量用药，采用自然语言处理 (NLP) 方法对自由文本进行分类 然后，我们采用地统计方法来识别所涉及的特定药物的数据。 人口普查区层面，提供本地化信息以告知移动和基于街道的服务的位置。 我们将开发临近预报模型来“预测县级致命和非致命用药过量的现状” 基于不完整的监测数据，我们将制定进一步的 NLP 策略来识别上游。 然后，我们将在电子健康记录数据中纳入过量用药的结果（即 OUD 和注射毒品使用）。 来自物质使用障碍治疗、注射器服务和街头医疗的指标，以改进我们的估计 我们将可视化这些数据和临近预报结果。 通过洛杉矶快速过量监测在线仪表板，这些工作的结果将作为一个。 其他司法管辖区利用和结合来自不同利益相关者的数据来改善当地情况的模型 最终的目标是生产可以加快药物过量的时间的工具和流程。 将数据转化为行动，以更好地提供过量预防和成瘾治疗服务。