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Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (EMSANT-W) Algorithm

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Abstract

Substance use disorder (SUD) in women of reproductive age is associated with adverse health consequences for both women and their offspring. US states need a feasible population-based, case-identification tool to generate better approximations of SUD prevalence, treatment use, and treatment outcomes among women. This article presents the development of the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), a gender-tailored tool based upon existing International Classification of Diseases, 9th Edition, Clinical Modification diagnostic code-based groupers that can be applied to hospital administrative data. Gender-tailoring entailed the addition of codes related to infants, pregnancy, and prescription drug abuse, as well as the creation of inclusion/exclusion rules based on other conditions present in the diagnostic record. Among 1,728,027 women and associated infants who accessed hospital care from January 1, 2002 to December 31, 2008 in Massachusetts, EMSANT-W identified 103,059 women with probable SUD. EMSANT-W identified 4,116 women who were not identified by the widely used Clinical Classifications Software for Mental Health and Substance Abuse (CCS-MHSA) and did not capture 853 women identified by CCS-MHSA. Content and approach innovations in EMSANT-W address potential limitations of the Clinical Classifications Software, and create a methodologically sound, gender-tailored and feasible population-based tool for identifying women of reproductive age in need of further evaluation for SUD treatment. Rapid changes in health care service infrastructure, delivery systems and policies require tools such as the EMSANT-W that provide more precise identification methods for sub-populations and can serve as the foundation for analyses of treatment use and outcomes.

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Acknowledgments

This work was supported by two R21 grants from National Institute on Alcohol Abuse and Alcoholism (grant R21 AA018395) and the National Institute on Drug Abuse (grant R21 DA027181) of the National Institutes of Health. PELL is currently administered and funded by the Massachusetts Department of Public Health. From its inception in 2001 to 2012, it was a university–government partnership between the Boston University School of Public Health, the Massachusetts Department of Public Health, and the Centers for Disease Control and Prevention (CDC) and was funded by the CDC (PELL Data System Expansion and Associated Analyses Contract No. 200-2009-31671). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health or the Massachusetts Department of Public Health. Dr. William McAuliffe provided many hours of invaluable assistance to the study team, explaining the rationale behind the inclusion and exclusion criteria used in the SNI, and challenging investigators to examine assumptions and support them with evidence. While his index was designed with another purpose in mind, it forms the foundation that made it possible to undertake this work.

Conflict of interest

The authors have indicated they have no financial relationships relevant to this article to disclose. The authors report no conflict of interest related to the design and conduct of the study or in the data analysis and manuscript preparation.

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Correspondence to Taletha Mae Derrington.

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Derrington, T.M., Bernstein, J., Belanoff, C. et al. Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (EMSANT-W) Algorithm. Matern Child Health J 19, 2168–2178 (2015). https://doi.org/10.1007/s10995-015-1730-1

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