Identifying Suspected Drug Overdose Deaths in Near Real-Time Using Data Collected by Death Investigators

这项研究是NIH帮助结束成瘾长期(Hear)倡议的一部分，该倡议旨在加快科学解决国家阿片类药物公共健康危机的速度。NIH Hear Initiative支持整个NIH的研究，以改善阿片类药物滥用和成瘾的治疗。吸毒过量的死亡率已经达到了历史最高水平。有效应对药物过量流行需要准确和及时的药物过量监测数据。死亡证明是过量死亡监测的基础；然而，对疑似与毒品有关的死亡发放最终死亡证明的周转时间较长，阻碍了监测活动，并阻碍了公共卫生项目的快速反应。 验尸官和法医(C/MES)在为死亡证明的医学证明部分生成数据方面发挥着关键作用。这些数据通常是在服药过量死亡发生后立即收集的，为迅速检查死亡情况并为应对致命服药过量而采取的对时间敏感的活动提供了机会。纽约市(NYC)首席验尸官办公室(OCME)开发了一种工具，它使用死亡调查期间产生的数据来近乎实时地识别药物过量死亡。这个名为疑似潜在过量追踪器(SPOT)的工具使用了少量由Death常规收集的变量 研究人员在一种严谨和可重复性的算法中快速预测死亡是否为无意服药过量。虽然初步调查结果显示，Spot在近乎实时地识别致命过量方面非常有希望，但仍有必要进一步增强该工具，检查其在不同人群中的表现，并评估其在纽约市以外的表现和可用性。因此，本研究旨在(1) 通过来自NYC OCME的额外数据优化SPOT，以改进工具的性能并利用自然语言处理开发高级功能；(2)通过与SPOT数据的主要和次要用户进行半结构化访谈，评估采用SPOT为其部署做准备的障碍和促进者；以及(3)评估SPOT在纽约州各地的C/ME办公室的可用性和性能， 包括参与NIDA资助的治愈社区研究的县。 采用这一工具对公共卫生的影响是重大的：1)它允许近乎实时地监测过量死亡水平和检测非典型模式；2)它提供了一种机制，可以加快与可能有过量用药高风险的过量死者的家人和朋友的接触；3)它允许识别过量反应准备和数据驱动的公众决策方面的差距。 卫生和公共安全机构；以及4)它为评价和持续交流过量预防干预措施、方案和政策提供了机会。如果发现成功，SPOT方法可以很容易地传播到其他州，以加强对药物过量死亡的监测。该项目高度响应了NIDA的首要研究重点，并直接解决了美国最具挑战性的公共卫生危机之一。

This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. Drug overdose death rates have reached a record high. Effective responses to the overdose epidemic require accurate and timely drug overdose surveillance data. Death certificates are the foundation of overdose mortality surveillance; however, long turnaround times for issuing finalized death certificates in suspected drug-related deaths hinders surveillance activities and prevents rapid responses by public health programs. Coroners and medical examiners (C/MEs) play a critical role in generating data for the medical certification section of death certificates. These data are routinely collected immediately after the overdose fatality occurs and provide an opportunity to rapidly examine the circumstances of death and inform time-sensitive activities in response to fatal overdoses. The New York City (NYC) Office of Chief Medical Examiner (OCME) developed a tool that uses data generated during death investigations to identify drug overdose deaths in near real-time. This tool, named the Suspected Potential Overdose Tracker (SPOT), uses a small number of variables routinely collected by death investigators in a rigorous and reproducible algorithm to rapidly predict whether a death was an unintentional drug overdose. While preliminary findings show that SPOT is highly promising for identifying fatal overdoses in near real-time, there is a need to further enhance the tool, examine its performance across different subpopulations, and assess its performance and usability outside of NYC. Thus, this study aims to (1) Optimize SPOT through additional data from the NYC OCME to improve performance of the tool and develop advanced features using natural language processing; (2) Assess barriers and facilitators of adopting SPOT in preparation for its deployment through semi-structured interviews with primary and secondary users of SPOT data; and (3) Evaluate the usability and performance of SPOT in C/ME offices across New York State, including counties involved in the NIDA-funded HEALing Communities Study. The public health implications of adopting this tool are significant: 1) it allows for near real-time monitoring of overdose fatality levels and detection of atypical patterns; 2) it provides a mechanism for expedited outreach to family and friends of overdose decedents who may be at high risk for overdose; 3) it allows for identification of gaps in overdose response preparedness and data-driven decision making of public health and public safety agencies; and 4) it affords opportunities for evaluation and consistent information exchange of overdose prevention interventions, programs and policies. If found successful, the SPOT methodology can be readily disseminated to other states to enhance surveillance of drug overdose mortality. This project is highly responsive to a top NIDA research priority, and directly addresses one of the nation’s most challenging public health crises.