Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study.

摘要: Study objective Persons with substance use disorders frequently utilize emergency department (ED) services, creating an opportunity for intervention and referral to addiction treatment harm-reduction services. However, EDs may not have the appropriate tools distinguish which patients are at greatest risk negative outcomes. We link hospital ED medical examiner mortality databases in one state identify individual-level factors associated overdose death among substance-related encounters. Methods This retrospective cohort study linked Maryland statewide claims records adults nonfatal or substance disorder encounters 2014 2015 2016. Logistic regression was used of opioid death. Predicted probabilities death were calculated hypothetical different combinations diagnostic histories. Results A total 139,252 had 2015. Of these patients, 963 later experienced death, indicating a case fatality rate 69.2 per 10,000 6 times higher than that who any cause. Factors most strongly included having both another (adjusted odds ratio 2.88; 95% confidence interval 2.04 4.07), greater or equal 3 previous overdoses 2.89; 1.54 5.43), involving heroin 2.24; 1.64 3.05). Conclusion These results highlight important differences receiving care conditions. The findings demonstrate potential utility incorporating routine data from patient assess future outcomes primary targets initiation linkage lifesaving care.