Population Health

Data Source: Department of Human Services, Division of Mental Health and Addiction Services (DMHAS). Substance Abuse Overview Statistical Reports (https://www.state.nj.us/humanservices/dmhas/publications/statistical/#1).

Definitions:

• First Time Clients:First time clients are those who are new to the New Jersey substance use disorder treatment system based on a search of all historical NJSAMS data since 2006.
• Unmet Demand:Average Proportion of NJ Household Surveys (2003, 2009 & 2016) estimated adult population who did not receive treatment in the 12 months prior to the interview but who felt they needed and wanted treatment times the adult resident population for the selected year.
• Met demand: The number of unduplicated counts of adults admitted for drug treatment in selected year.
• Population Data Source: U.S. Census Bureau.

Race/ethnicity groupings:

• White non-Hispanic
• Black non-Hispanic
• Hispanic
• Other

Data Source: New Jersey Department of Health, New Jersey Hospital Discharge Data Collection System (NJDDCS).

Case Definition: Neonatal abstinence syndrome (NAS) cases were identified by a diagnosis (first 13 diagnosis fields) of:
-ICD-9-CM: 779.5 Drug withdrawal syndrome in newborn
-ICD-10-CM: P96.1 Neonatal withdrawal symptoms from maternal use of drugs of addiction

Denominator:

1. a) Birth records under ICD-10-CM are identified by any diagnosis of:
   Z38 Series: Liveborn infants according to place of birth and type of delivery
2. b) Birth records under ICD-9-CM are identified by any diagnosis of:
   V30-V39 Series: Liveborn infants according to type of birth
   • Ending in 00 or 01: Indication of birth inside hospital
   • Ending in 1: Indication of birth before admission to hospital

NAS Rate per 10,000 Births: (Number of NAS cases/number of live births for the selected year) * 10,000

Race/ethnicity groupings:

• White non-Hispanic
• Black non-Hispanic
• Hispanic
• Asian non-Hispanic
• Other non-Hispanic

Inclusion and Exclusion Criteria:

• Out-of-state residents were excluded
• Newborns over 29 days old were excluded

Transition from ICD-9-CM to ICD-10-CM - The International Classification of Diseases (ICD) is a coding system maintained by the World Health Organization and the U.S. Centers for Disease Control and Prevention. It is used to classify causes of death on death certificates and diagnoses, injury causes, and medical procedures for hospital and emergency department visits. These codes are updated every decade or so to account for advances in medical technology. The U.S. is currently using the 10th revision (ICD-10-CM). The 9th revision (ICD-9-CM) was used for hospital and emergency department visits through September 30, 2015. New Jersey's October 1 - December 31, 2015 records have been back-coded to ICD-9-CM, so all 2008-2015 hospital discharge data in NJSHAD are coded using ICD-9-CM. All data for 2016 forward are coded using ICD-10-CM. Caution should be used when examining trends. See the NJSHAD (NJ State Health Assessment Data) for more information: https://www-doh.state.nj.us/doh-shad/query/UBQueryTechNotes.html

Suppression Rules:  NAS cases were suppressed if there were less than five cases in a category; furthermore, county rates based on counts less than twenty cases were also suppressed. Suppressed values are labeled with asterisks.

Data Source: New Jersey Department of Health, New Jersey Hospital Discharge Data Collection System (NJDDCS).

Case Definitions: Drug-related hospital visits were identified using the first twenty-five diagnosis fields and were categorized into the following drug types as perCDC Overdose Data to Action Grant Technical Guidance: https://www.cdc.gov/drugoverdose/nonfatal/case.html .

An inpatient hospitalization is one in which the patient was admitted to the hospital directly or through the emergency department or other department. The Emergency Department Database contains information on ED visits that do not result in admission to the same hospital (i.e., "treated and released," which includes patients who were discharged home, transferred to another health care facility, left against medical advice, left without being seen, transferred to another hospital, or died). See NJ State Health Assessment Data (NJSHAD) for more information: https://www-doh.state.nj.us/doh-shad/query/UBQueryTechNotes.html

Denominator

1. Number of NJ Residents stratified by year and county
2. Number of NJ Residents stratified by year, county, and pre-defined age group

Computations:

The crude rate of hospital visits was adjusted by age groups of interest to compensate for differences in age distribution in NJ populations.

Crude Rate per 100,000 Residents: (Number of drug-related diagnoses/Population Denominator(1))*100,000

Age-adjusted Rate per 100,000 Residents: (Number of drug-related diagnoses/ Population Denominator(2))*100,000. Each age-specific rate was weighted by multiplying it by the proportion of the standard population in the respective age group. Thus, the age-adjusted rate is the sum of the weighted age-specific rates.

95% Confidence Interval (CI): Standard error (SE) was approximated by SE=R / square root of N, where R is the age-adjusted rate and N is the number of drug-related diagnoses. The estimated SE was used to compute a 95% CI for the rate, producing an equation of the age-adjusted rate(s) plus or minus (1.96* SE): CI= age-adjusted rate ± 1.96*SE

Race/ethnicity groupings:

• White non-Hispanic
• Black non-Hispanic
• Hispanic
• Asian non-Hispanic
• Other non-Hispanic

Inclusion and Exclusion Criteria:

• Out-of-state residents were excluded
• Fatal drug overdoses were excluded
• Assault, adverse effects, underdosing, and subsequent hospitalizations were all excluded using ICD-9-CM and ICD-10-CM to ensure only intentional drug use was captured Furthermore, where ICD-10-CM was used, only initial encounters were included to ensure that repeat patients did not inflate the case number

Suppression rules: Counts less than 5 and rates based on counts less than 20 have been suppressed and/or represented by an asterisk.

Transition from ICD-9-CM to ICD-10-CM - The International Classification of Diseases (ICD) is a coding system maintained by the World Health Organization and the U.S. Centers for Disease Control and Prevention. It is used to classify causes of death on death certificates and diagnoses, injury causes, and medical procedures for hospital and emergency department visits. These codes are updated every decade or so to account for advances in medical technology. The U.S. is currently using the 10th revision (ICD-10-CM). The 9th revision (ICD-9-CM) was used for hospital and emergency department visits through September 30, 2015. New Jersey's October 1 - December 31, 2015 records have been back-coded to ICD-9-CM, so all 2008-2015 hospital discharge data in NJSHAD are coded using ICD-9-CM. All data for 2016 forward are coded using ICD-10-CM. Caution should be used when examining trends. See the NJSHAD (NJ State Health Assessment Data) for more information: https://www-doh.state.nj.us/doh-shad/query/UBQueryTechNotes.html

Data Source: New Jersey Division of Consumers Affairs, New Jersey Prescription Monitoring Program (NJPMP). The NJPMP is statewide database that collects prescription data on controlled dangerous substances and human growth hormone dispensed in outpatient settings in New Jersey, and by out-of-State pharmacies dispensing into New Jersey.

Case Definition: Number of prescriptions dispensed to state residents within the state. Drug class definitions were modeled after the CDC Prevention for States Indicator Support Toolkit. It is difficult to identify medication misuse and diversion using only the PMP database. The PMP data do not include detailed information such as provider specialty, patient medical history, or diagnosis to determine if prescriptions are for active cancer pain, palliative care, or end-of-life care.

Denominator: Number of New Jersey residents by year and county. Population estimates were obtained from the U.S. Census Bureau.

Inclusion and Exclusion Criteria:

• Drugs administered to patients by substance abuse treatment programs are usually excluded from PMP files and therefore will not be captured by this indicator.
• Additional exclusion criteria are: (1) drugs not typically used in outpatient settings or otherwise not critical for calculating dosages in morphine milligram equivalents (MME), such as cough and cold formulations including elixirs, and combination products containing antitussives, decongestants, antihistamines, and expectorants; (2) buprenorphine products indicated for medication assisted treatment (MAT) to treat opioid use disorder.

Prescription Rate per 100 Residents: (Number of prescriptions dispensed to state residents within the state/ Population Denominator) *100.

Limitations of the prescription rate indicator: Prescription numbers represent only one measure of prescription opioids in a state. Dosage and duration of prescriptions are not captured by the measure. The indicator does not capture whether the dispensed medications were taken as prescribed or taken by prescribed patient. The indicator does not capture opioids used outside of medical care. The indicator does not capture prescriptions of state residents when they are filled in other states.

Limitations of the data resource: The accuracy of indicators based on PMP data is limited by the completeness and quality of the data. Numbers of prescriptions captured by a PMP will vary based on the schedule of controlled substances (schedules II-V) required to be reported to the PMP. Types of pharmacies required to enter into the PDMP (Veterans Affairs, Indian Health Service, mail-order, online/Internet, resident prescriptions dispensed at out-of-state pharmacies) will also affect the number of prescriptions captured. Rescheduling and upscheduling of specific drugs (e.g., tramadol, hydrocodone) will affect trends over time.

Data Source: New Jersey Department of Health, Communicable Disease Reporting Surveillance System (CDRSS).

Inclusion and Exclusion Criteria:

• The hepatitis categories presented in this dashboard are: Hepatitis B-Acute, Hepatitis B-Chronic, Hepatitis C-Acute and Hepatitis C-Chronic.
• All confirmed cases are reported for Hepatitis B-Acute and Hepatitis B- Chronic.
• Probable and confirmed cases are reported for Hepatitis C-Acute and Hepatitis C-Chronic.

Hepatitis Rate per 100,000 residents: (Total number of cases/population) *100,000. Population estimates were obtained from the U.S. Census Bureau.

Suppression Rules: Charts showing categories with counts less than 5 cases have been suppressed.

Resources:

For more information on hepatitis, go to https://www.cdc.gov/hepatitis/index.htm

For New Jersey dataset queries and health reports on hepatitis, go to NJSHAD https://www.nj.gov/health/chs/njshad/

Data Source: New Jersey Department of Health, Office of Emergency Medical Services (EMS) and New Jersey State Police. Data from EMS is collected from the State EMS Data Repository, (housed by vendor: ImageTrend).  Under N.J.S.A26:2K-67 all EMS agencies, regardless of licensure or volunteer status, must report EMS data to the Department.  Law Enforcement (LE) data is received in a manual format (spreadsheet), which is then entered into the (ImageTrend) State Data Repository.

Case Definitions: A naloxone incident is defined as a patient who received at least one dose of Naloxone in one encounter by Emergency Medical Services or law enforcement. Naloxone is administered by EMS to patients presenting with three keys signs of a possible opioid overdose: respiratory depression/arrest, altered consciousness/delirium, and pinpoint pupils.

Types of Disposition (Patient outcome following an encounter with EMS or LE):

• Treated and Transported: Patient was administered naloxone and transported to the hospital by EMS.
• Patient Refusal: Patient was administered naloxone by EMS or LE and subsequently refused further treatment or transport to the hospital by EMS. Please note, this refusal count does not include patients with suspected overdose/opioid intoxication that did not receive naloxone by  EMS or LE.
• Pronouncements (Expired/Deaths): Patient was administered naloxone and died at the scene. The patient was not transported by EMS.
• Not Reported: The patient was administered naloxone; however, the patient disposition was not reported by EMS.
• Other: Includes not reported and any other categories such as missing or none etc.

Inclusion/Exclusion Criteria: Incidents where naloxone was administered by family/layperson are not included on this dashboard.

Suppression Rules: The number of naloxone incidents have been suppressed if there were less than 5 incidents reported in a category.