The impact of an emergency department peer navigator (EDPN) program in improving clinical outcomes and healthcare utilization in an urban setting.

INTRODUCTION: Emergency Department Peer Navigator Programs (EDPN) have been shown to increase the prescribing of medications for opioid use disorder (MOUD) and improve linkage to addiction care. However, what is not known is whether it can improve overall clinical outcomes and healthcare utilization in patients with OUD. METHODS: This is a single-center, IRB approved, retrospective cohort study using patients with OUD enrolled in our peer navigator program from 11/7/19 to 2/16/21. On an annual basis, we determined MOUD clinic follow-up rates and clinical outcomes in those patients who utilized our EDPN program. Finally, we also looked at the social determinants of health factors (e.g., race, status of medical insurance, lack of housing, access to phone and/or internet, employment, etc.) that impact our patients clinical outcomes. ED and inpatient provider notes were reviewed to determine causes of ED visits and hospitalizations one year before and after enrollment into the program. The clinical outcomes of interest were number of ED visits from all-causes, number of ED visits from opioid-related causes, number of hospitalizations from all-causes, and number of hospitalizations from opioid-related causes one year after enrollment into our EDPN program, subsequent urine drug screens, and mortality. Demographic and socioeconomic factors (age, gender, race, employment, housing, insurance status, access to phone) were also analyzed to determine if any were independently associated with clinical outcomes. Death and cardiac arrests were noted. Clinical outcomes data were described using descriptive statistics and compared using t-tests. RESULTS: 149 patients with OUD were included in our study. 39.6% had an opioid-related chief complaint at their index ED visit; 51.0% had any recorded history of MOUD and 46.3% had history of buprenorphine use. 31.5% had buprenorphine given in the ED with individual doses ranging from 2 to 16 mg and 46.3% were provided with a buprenorphine prescription. The average number of ED visits 1-year pre vs post enrollment, respectively, for all-causes was 3.09 vs 2.20 (p < 0.01); for opioid related complications 1.80 vs 0.72 (p < 0. 01). The average number of hospitalizations 1-year pre and post enrollment, respectively, for all-causes was 0.83 vs 0.60 (p = 0.05); for opioid related complications 0.39 vs 0.09 (p < 0.01). ED visits from all-causes decreased in 90 (60.40%) patients, had no change in 28 (18.79%) patients, and increased in 31 (20.81%) patients (p < 0.01). ED visits from opioid-related complications decreased in 92 (61.74%) patients, had no change in 40 (26.85%) patients, and increased in 17 (11.41%) (p < 0.01). Hospitalizations from all causes decreased in 45 (30.20%) patients, had no change in 75 patients (50.34%), and increased in 29 (19.46%) patients (p < 0.01). Lastly, hospitalizations from opioid-related complications decreased in 31 (20.81%) patients, had no change in 113 (75.84%) patients, and increased in 5 (3.36%) patients (p < 0.01). There were no socioeconomic factors that had a statistically significant association with clinical outcomes. Two patients (1.2%) died within 1 year after study enrollment. CONCLUSIONS: Our study found that there was an association between implementation of an EDPN program and decreases in ED visits and hospitalizations from both all-causes as well as from opioid-related complications for patients with opioid use disorder.

The Risk of Nosocomial Transmission of Rift Valley Fever.

In 2000, we investigated the Rift Valley fever (RVF) outbreak on the Arabian Peninsula-the first outside Africa-and the risk of nosocomial transmission. In a cross-sectional design, during the peak of the epidemic at its epicenter, we found four (0.6%) of 703 healthcare workers (HCWs) IgM seropositive but all with only community-associated exposures. Standard precautions are sufficient for HCWs exposed to known RVF patients, in contrast to other viral hemorrhagic fevers (VHF) such as Ebola virus disease (EVD) in which the route of transmission differs. Suspected VHF in which the etiology is uncertain should be initially managed with the most cautious infection control measures.

Outbreak of W135 meningococcal disease in 2000: not emergence of a new W135 strain but clonal expansion within the electophoretic type-37 complex.

In 2000, >400 cases of disease caused by Neisseria meningitidis serogroup W135 (MenW135), the largest MenW135 outbreak reported to date, occurred worldwide among Hajj pilgrims and their contacts. To elucidate the origin of the outbreak strains and to investigate their relatedness to major clonal groups, genotypic and phenotypic subtyping was performed on 26 MenW135 outbreak-associated isolates and 50 MenW135 isolates collected worldwide from 1970 through 2000. All outbreak-associated isolates were members of a single clone of the hypervirulent electrophoretic type (ET)-37 complex, designated the "(W)ET-37 clone"; 19 additional MenW135 strains were also members of this clone, and the remaining 31 MenW135 strains were clearly distinct. The 2000 MenW135 outbreak was not caused by emergence of a new MenW135 strain but rather by expansion of the (W)ET-37 clone that has been in circulation at least since 1970; the strains most closely related to those causing the 2000 outbreak have been isolated in Algeria, Mali, and The Gambia in the 1990s.