Welcome To The NAS R Ti W Bi !NAS Reporting Webinar!
Welcome to theNAS ReportingRti Webinar!W bi! The webinar will begin at 2PM CST. Webinar attendees will be on mute. Use your phone’sphone s mute function as well if youwish, but please do not use the Hold function. If yyou would like to speakpor send qquestionsand comments, please use the “Chat”feature. If you experience technical difficulties duringthe webinar, please email: tim.gill@tn.gov
Neonatal Abstinence SyndromeReportingHospital WebinarMarch 19, 2013
Webinar Procedures Webinar attendees will be on mutemute. Use your phone’s mute function as well if youwish but please do not use the Hold functionwish,function. If you would like to speak or send questionsand commentscomments, please use the “Chat”Chatfeature. If you experience technical difficulties duringthe webinar, please email: tim.gill@tn.gov
Objectives for Today’sToday s Webinar Describe NAS epidemic and broaderprescription drug epidemic in TN Review key elements of the NAS reportingrequirement and online reporting system ShareShddatat receivedi d tto ddatet Listen to feedback from birthing andreporting hospitals
Opening Remarks fromCCommissioneri ioff HealthH lth John JJ. DreyzehnerDreyzehner, MD MPH FACOEM– Commissioner– Tennessee Department of Health
TN’sTNs Prescription Drug Problem In 20112011, Tennessee ranked 49th highest inthe country for the number of prescriptionsfilled per capita– 17.6 prescriptions filled per person– National average: 1212.11 KKentuckyt k anddWWestt VirginiaVi i i titiedd fforhighest (19.3 prescriptions per person)Data source: Henry J. Kaiser Family Foundation. Retail Prescription Drugs Filled at Pharmacies (Annual Per Capita), 2011.
TN’sTNs Prescription Drug ProblemPrescription Painkillers Sold By State, 2010TN: 2ndhighest incountry forkilograms ofprescriptionpainkillerssold per10 000 people10,000Data source: CDC, Policy Impact Brief: Prescription Painkiller Overdoses. Available at: ef/
Opioid Prescription Ratesb County—TN,byCTN 2007200Data source: Tennessee Department of Health; Controlled Substance Monitoring Database.
Opioid Prescription Ratesb County—TN,byCTN 2008Data source: Tennessee Department of Health; Controlled Substance Monitoring Database.
Opioid Prescription Ratesb County—TN,byCTN 2009Data source: Tennessee Department of Health; Controlled Substance Monitoring Database.
Opioid Prescription Ratesb County—TN,byCTN 2010Data source: Tennessee Department of Health; Controlled Substance Monitoring Database.
Opioid Prescription Ratesb County—TN,byCTN 2011Data source: Tennessee Department of Health; Controlled Substance Monitoring Database.
TN’sTNs Prescription Drug Problem51 pillsper everyTennesseanover age 12275.5 Million Hydrocodone Pills116.6 Million Xanax Pills113 5 Million Oxycodone Pills113.5Data source: Tennessee Department of Health; Controlled Substance Monitoring Database.22 pillsper everyTennesseanover age 1221 pillsper everyTennesseanover age 12
TN’sTNs Prescription Drug Problem Increase in TN deaths due to prescriptiondrug overdose– 422 in 2001– 1,062 in 2011 MoreMththan ddeathsth ffrom:– Motor vehicle accidents, homicide, or suicide Opioids (methadone, oxycodone, andhydrocodone) are by far the most-abusedprescription drugs
NAS Epidemiology (TN) Sharp increase in NAS incidence overpast decade NAS incidence highest in East TN Nearly all NAS births covered by Medicaid– Average cost 40 40,931931 (compared to 7 7,285285for all live births) Averagee age lengthe gt ofo stay 22.66 days NAS infants over-represented in DCSycustody
Number7Rate65005Number4004300320021001001999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Data sources: Tennessee Department of Health; Office of Health Statistics; Hospital Discharge Data System (HDDS) and Birth Statistical System.Analysis includes inpatient hospitalizations with age less than 1 and any diagnosis of drug withdrawal syndrome of newborn (ICD-9-CM 779.5).HDDS records may contain up to 18 diagnoses. Infants were included if any of these diagnosis fields were coded 779.5. Note that these aredischarge-level data and not unique patient data.Rate per 1,000 Live BBirths600NAS Hospitalizations in TN:1999 20101999-2010
TN NAS Hospitalizations (2010)Data sources: Tennessee Department of Health; Office of Health Statistics; Hospital Discharge Data System (HDDS) and Birth Statistical System.Numerator is number of inpatient hospitalizations with age less than one and any diagnosis of neonatal abstinence syndrome (ICD-9-CM 779.5).HDDS records may contain up to 18 diagnoses. Infants were included if any of these diagnosis fields were coded 779.5. Note that these aredischarge-level data and not unique patient data. Denominator is number of live births. For BSS data, county is mother’s county of residence.
NAS—ReportableNASReportable Disease Previous estimates of NAS incidencecame from:– Hospital discharge data (all payers but 18month lag)– Medicaid claims data (only 99 month lag butonly includes Medicaid) Need more real-time estimation ofincidence in order to drive policy andprogram efforts
NAS—ReportableNASReportable Disease NAS added to state’sstate s Reportable Diseases& Events list as of January 1, 2013 Reporting hospitals/providers submitelectronic report (SurveyMonkey)
NAS—ReportableNASReportable Disease Reporting Elements– Case Information Birth hospital, Reporting hospital, Gender, DOB,Maternal county of residence, last 4 digits of MR #– Diagnostic Information Screening/confirmatory test(s) usedused, presence ofclinical signs– Source of Maternal Exposure Maternal substance if known
Poll Question Have you (or has someone at yourhospital) submitted a report of NAS usingthe Tennessee Department of Healthonline system?
NAS Identification NAS is a clinical diagnosis NAS diagnosis based on:– History of exposure– Evidence of exposure:– Maternal drug screen– Infant urine, meconium, hair, or umbilical samples– Clinical signs of withdrawal (symptom ratingscale)
Poll Question In your hospitalhospital, who submits the report ofan NAS case through the TennesseeDepartment of Health’sHealth s online system?
Neonatal Abstinence Syndrome Surveillance SummaryFor the Week of March 11-March 17, 2013(W k 11)1(WeekCumulative Cases NAS Reported2013 CasesReporting Summary (Year-to-date)Cases Reported: 146Male: 80Female: 66Unique Hospitals Reporting: .8%North East2013.7%yShelby32.1%South Central96.1%South East10.7%Sullivan2315.8%Upper Cumberland1812.3%West4Total146Nuumber of CasesMaternal County ofResidence(By Health DepartmentRegion)g )Estimated 415#Cases*%CasesSupervised replacement therapy5839.7%SSupervisedi d paini ththerapy3624 7%24.7%Therapy for psychiatric or neurological condition85.5%Prescription substance obtained WITHOUT a prescription5235.6%Non-prescription substance4128.1%2.7%No known exposure but clinical signs consistent with NAS42.7%100%No response53.4%Source of Maternal Substance (if known)21. Summary reports are archived weekly at: http://health.tn.gov/MCH/NAS/NAS Summary Archive.shtml2. Multiple maternal substances may be reported; therefore the total number of cases in this table may not match the total number of cases reported.
NAS—ReportableNASReportable Disease Through Week 11 (March 11-1711 17, 2013)– 146 cases 80 male, 66 female– 28 uniqueireportingti hhospitalsit l
NAS—ReportableNASReportable DiseaseCumulative Cases NAS Reported2013 CasesEstimated 2011180160146Number oof 5
NAS—ReportableNASReportable DiseaseMaternal County of Residence(By HD Region)65% ofcases inEast andNortheastTN# Cases% CasesDavidson96 2%6.2%East3423.3%Hamilton00%J kJackson/Madison/M di00%Knox1812.3%Mid-Cumberland74.8%North East2013.7%Shelby32.1%South Central96.1%South East10.7%Sullivan2315.8%Upperpp Cumberland1812.3%West42.7%Total146100%23% ofcases inMiddle TNandPlateau
NAS—ReportableNASReportable Disease#CCases**%CCasesSupervised replacement therapy5839.7%Supervised pain therapy3624.7%Therapy for psychiatric or neurological condition85.5%Prescription substance obtained WITHOUT a prescription5235.6%Non-prescription substance4128.1%No known exposure but clinical signs consistent with NAS42.7%No response53.4%SSourceoff MMaternaltl SubstanceS b t(if known)k)*Multiple maternal substances may be reported; therefore the total number of cases in this table may not match the total number of casesreported.
NAS—ReportableNASReportable Disease Important caveat:– Reporting is for surveillance purposes only.– Does not constitute a referral to anyy agencygyother than the Tennessee Department ofHealth.– Does not replace requirement to reportsuspected abuse/neglect.
Poll Question If you have reported a case of NAS to theTennessee Department of Health onlinesystem how easy was it to submit thesystem,report?
NAS Reporting:IIssuestot DateD t Drug exposed infant vsvs. infant with NAS– Requirement only to report infant withwithdrawal symptomsy p– Excluded if answer “No” to “Clinical SignsConsistent with NAS” Concern re: TDH reporting info to DCS– Surveillance to TDH DCS Report FFew reportst tot dated t fromfHamiltonH ilt orSoutheast Region– 2011:2011 HHamilton-13ilt 13 cases, SEROSERO-1111 cases
NAS Reporting:F db k fromFeedbackfHospitalsHit l We want to hear from you! What is working well? Not working well? How can we help this work better for you?To submit a question:Click on the icon of the person with raisedhand. Select “Raise Hand” on the dropdown menu.menu Your phone line will be ununmuted so that you can ask a question.you can:Or yType a question into the “Chat” window.
Next Steps Each hospital: Please email one primarycontact (name and e-mail address) toWanda Benson at wanda.benson@tn.govwanda benson@tn gov Contact list will be used to distribute:– Important announcements about NASreportingpg– Notifications about changes in reportingsystem– Answers to frequently asked questions
Conclusion Thank you again for your NAS reportingefforts! For questions or assistance, pleasecontact:– Michael D. Warren, MD MPH FAAP Director, Division of Familyy Health and Wellness 615-741-0310 Michael.d.warren@tn.gov
Welcome to the NAS R ti W bi !NAS Reporting Webinar! The webinar will begin at 2PM CST.The webinar will begin at 2PM CST. Webinar attendees will be on mute. Use your phoneUse your phones’s mute function as well if you mute function as w
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