Developing and Using an Opioid Continuum of Care Model to Improve Patient Care
By Dean McEwen, MBA, Manager, Data Science and Informatics, Denver Public Health
Denver Public Health serves the residents of the City and County of Denver and provides many services to the entire Denver metro community of 3.2 million people. Denver is the largest city in Colorado, with beautiful mountains to the west and spacious views of the plains to the east. The race and ethnicity of Denver is varied, with 55% White, 29% Hispanic, 9% Black, 4% Asian, and 3% comprising multiple races. The median age, 34.7 years, is slightly lower than that of Colorado and the rest of the United States. Almost 12% of the Denver population has an income level below poverty level, which is slightly lower than the national average. Denver Public Health is a department within the larger Denver Health organization. Denver Health, the parent organization, provides an integrated safety net healthcare system that serves one in three Denver residents and 40% of Denver’s children. Integration of Denver Public Health within Denver Health is unique, in that it allows integration and coordination of public health and personal health activities. The work across the spectrum of public health, including the connection to Denver Health and its comprehensive health system, enables Denver Public Health to innovate and implement public health improvements, along with using local health data to drive actionable steps to improve the health of Denver’s diverse communities.
Several years ago, Denver Public Health recognized that the opioid epidemic was an increasing public health concern within the community. Between the years 2000 and 2014, the number of overdose deaths due to opioids in the U.S. has more than tripled. These numbers have continued to increase during the past five years. In 2018, the U.S. experienced more than 46,800 opioid overdose deaths.
In Colorado, there were 1,012 drug overdose deaths in 2017, 1,004 in 2018, and 1,100 in 2019. In Denver County, there were 158 drug overdose deaths in 2017, 172 deaths in 2018, and 192 deaths in 2019. The number of drug overdose deaths nationally, and in Colorado and Denver, were all continuing to rise.
In addition to the opioid overdose deaths, the opioid crisis includes a large population of residents who are either misusing prescription opioids or using illicit opioids. Clearly, this was a critical health issue that needed to be addressed. Denver Public Health knew that the opioid issue could not be addressed alone, and collaborating among partners was necessary. One vital partner was the Centers for Disease Control and Prevention (CDC), which provided fellows; together; a plan was initiated to address the opioid crisis. The organizational integration with Denver Health was also a critical partnership as Denver Public Health began addressing the opioid epidemic. One service that Denver Health provides within the Outpatient Behavioral Health Services (OBHS) department is a methadone clinic. At the beginning of this collaborative effort, OBHS was already providing treatment to more than 1,000 patients experiencing opioid use disorder (OUD). Unfortunately, the resources for patient enrollment were very limited, even though the number of patients seeking treatment was increasing. Our first task was to determine how best to create measurements related to individuals experiencing OUD. Using the well-established HIV Care Cascade Model as a framework, we developed an initial Opioid Continuum of Care Model, designed to quantify the number of individuals who need treatment, initiate treatment, and remain in care.
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