System for Opioid Overdose Surveillance (S.O.S.)
PI: Mahshid Abir, MD, MSc
“The increasing number of deaths from opioid overdose is alarming. The opioid epidemic is devastating American families and communities.” Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH.
In 2015, a record number of Americans died of an opioid-involved overdose, bringing devastation to families and communities in urban and rural communities alike. Now more people in America die from drug overdoses than car accidents.
In response to this alarming public health crisis, the Office of National Drug Control Policy is supporting the development of opioid overdose monitoring systems in High Intensity Drug Trafficking Areas (HIDTA).
In collaboration, the University of Michigan Injury Center and the Acute Care Research Unit are developing and piloting a real-time System for Opioid Overdose Surveillance (S.O.S.) in the Michigan HIDTA.
Through connecting overdose and mortality data from regional emergency departments, the Medical Examiner, and Emergency Medical Services (EMS) agencies, the S.O.S. project aims to increase the timeliness and quality of overdose reporting so that regional strategies to reduce fatal and non-fatal overdoses may be developed.
Medical Control Authority (MCA) Assessment Project
PI: Mahshid Abir, MD, MSc
A mixed method study funded by the Michigan Department of Health and Human Services (MDHHS), this project seeks to determine the characteristics of successful MCAs, the oversight entities for emergency medical services in Michigan.
The specific objectives of the project are to:
- Evaluate the quality of MI-EMSIS data, the quality reporting database for pre-hospital EMS care in the state.
- Identify MCA structure, processes, and resources that correlate with successful MCAs.
- Identify community-specific quality measures across Michigan based on regional/local needs and challenges.
- Provide policy recommendations to the MDHHS regarding MCA structure and performance measures.
Investigating Patient-Centered Interventions to Reduce Asthma-Related Pediatric Hospitalizations
PI: Mahshid Abir, MD, MSc
A mixed method study funded by the Emergency Medicine Foundation (EMF), this community-based participatory research (CBPR) project was initiated by community stake-holders in Camden, New Jersey, who recognized that lack of access to timely, effective ambulatory care is contributing to poor care management for asthmatic children and increasing pediatric asthma-related hospitalizations.
In response to this community need, the Camden Coalition of Health Care Providers (CCHP)—an organization dedicated to improving the health of the residents of Camden by increasing the capacity, quality, and accessibility of care—is partnering with the University of Michigan and the RAND Corporation to investigate evidence-based interventions to reduce potentially avoidable asthma-related pediatric hospitalizations by improving the quality of and access to ambulatory pediatric care.
The objective of this project is to support parents and other caregivers of children in obtaining healthcare in ways that work for them and that improve outcomes they care about.
The specific objectives of this project are to:
- Identify geographic clusters of children with distinct patterns of asthma-related emergency department visits and hospitalizations.
- Identify promising interventions thought to be effective in reducing potentially avoidable pediatric asthma-related hospitalizations through eliciting the views of patients, parents, and other caregivers of children about the perceived effectiveness and acceptability of candidate interventions.
- Arrive at a consensus set of patient-centered interventions to reduce potentially avoidable pediatric asthma-related emergency department visits and hospitalizations.
Identifying, Comparing, and Disseminating Best Practices to Address the Needs of “Super-Utilizer” Patients
Co-PIs: Paula Lantz, PhD; Mahshid Abir, MD, MSc; Peter D. Jacobson, JD, MPH; and David Mendez, PhD
A subset of people with serious health care and social needs—referred to as “super-utilizers”— account for the majority of public health care expenditures in the United States. Although there recently has been increased attention to this subpopulation of patients, the existing evidence regarding the impact of interventions on health care intentions by this group is limited.
This project investigates Medicaid super-utilizers of health care in Michigan. The research approach includes:
- A statewide survey of strategies currently employed by Michigan acute-care hospitals and Medicaid managed care plans to target the medical and social needs of super-utilizer patients.
- Medicaid claims data analysis to examine patterns of super-utilizer health care experiences for enrollees of all ages.
- Quasi-experimental analysis of the associations between the super-utilizer interventions/strategies in effect at acute-care hospitals, Medicaid managed care plans and the super-utilizer health care experiences for Medicaid beneficiaries.
This is part of a joint effort, funded by the Robert Wood Johnson Foundation (RWJF) as part of the Policies for Action Research Hub at the University of Michigan, which includes the following projects:
- The Role of Pay for Success in Building a Culture of Health, PI: Paula Lantz, PhD.
- Building the Evidence for Health in All Policies, PI: Peter D. Jacobson, JD, MPH.
- Best Practices for Addressing the Medical and Social Needs of “Super-Utilizer” Patients, PI: Mahshid Abir, MD, MSc.
- Advancing the Utility of Policy Simulation Models, PI: David Mendez, PhD.
The Effect of Inpatient Occupancy on Outcomes for Elderly Medicare Patients
PI: Mahshid Abir, MD, MSc
This project is funded by the National Institute on Aging (R21) and includes researchers from the University of Michigan and RAND Corporation. Hospital crowding is a fundamental challenge confronting the U.S. healthcare systems. Most studies on crowding focus on the emergency department (ED), showing increased mortality, reduced care quality, and impaired access to care during periods of crowding. Few studies have examined the effect of a surge in admissions, high inpatient occupancy, and increased demand for resources on outcomes in the inpatient setting, and these showed mixed results.
To fill this knowledge gap this ongoing project evaluates the impact of increasing inpatient occupancy on outcomes for older Medicare patients discharged from acute care facilities in California (CA) with a primary diagnosis of myocardial infarction, congestive heart failure, and pneumonia over the years 1998-2012. Past research has shown that annual bed reports, which do not account for day-to-day variation in patient volume and within-year changes in bed supply, are not a reliable measure of hospital capacity. Therefore, we constructed a novel measure of hospital occupancy to evaluate the impact of inpatient occupancy on outcomes.
We found that increasing hospital occupancy is associated with decreased in-hospital mortality, increased 30-day out-of-hospital mortality, and decreased 30-day readmissions and ED visits. Furthermore, we found significant variation in the occupancy-outcome relationship at the hospital level.
The long-term goal of this work is to inform hospital administrators and policymakers about the potential adverse effects of hospitals operating at high occupancy levels and the need to identify areas where interventions may be implemented to promote safer clinical practice, improved quality of care, and better patient outcomes.
National Health Security Strategy Development Implementation, and Evaluation Support Services
PIs: Jeffrey Wasserman, Ph.D.; and Jeanne Ringel, Ph.D.
Dr. Abir has been an integral part of teams of RAND researchers who developed the hospital and healthcare coalition surge tools, tools that measure hospital and healthcare coalition capabilities to surge in response to large mass casualty incidents (MCIs) and disasters. She also contributed to the development of the Peer Assessment of Preparedness Activities (PAPA) Tool – a tool that evaluates the responses to MCIs as a way to identify those preparedness activities that are most effective to a successful community response to inform federal preparedness policy and investments.