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 and to develop concrete strategies capable of providing rapid and durable solutions to the opioid crisis. This project seeks to address the overdose epidemic by working with overdose fatality review (OFR) teams. Current OFR practices rely on the case review model to make policy and programmatic recommendations. However, the continued rise in overdose rates and sheer number of preventable overdose deaths suggest a need to shift OFR teams away from case review and toward using timely population-level data to better inform their recommendations and actions. The goal of our proposed project, Fatal Overdose Review Teams – Research to Enhance Surveillance Systems (FORTRESS), is to improve standard OFR practices by equipping OFRs with a data dashboard built on real-time aggregate data, record-linked across multiple sources and presented in a way that helps identify and visualize common “overdose touchpoints,” or opportunities to deliver harm-reduction services or engage individuals at risk for overdose in evidence-based treatment. Aligning with the goals of the HEAL Data2Action Program, the FORTRESS research team will leverage available resources and expertise to help OFRs translate data to action. During the R61 Phase, the research team will strengthen established cross-sector partnerships with two state agencies, the Indiana Department of Health and the Indiana Management Performance Hub (MPH), which provide the necessary statewide data infrastructure to record-link population-level administrative data from multiple sources. MPH has also successfully developed publicly accessible data dashboards. The FORTRESS team will build on the early successes of MPH to ensure more timely collection of overdose event data and design the “Overdose Touchpoints Dashboard” (Aim 1). Our team will train OFR team members in Data-Driven Decision Making (DDDM) to effectively use the dashboard. The FORTRESS team also includes individuals involved in developing the CDC’s OFR best practice guidelines and a pilot study of OFR adherence to these guidelines, which will inform our team’s development of an “OFR Fidelity Tool” (Aim 2). This tool will be the first of its kind. For the R33 phase, we will conduct a cluster-randomized stepped-wedge trial comparing the impact of our intervention (dashboard + DDDM training) versus standard OFR practices on both implementation (Aim 3) and effectiveness outcomes (Aim 4). Implementation outcomes include implementation process fidelity (Stages of Implementation Completion), staff acceptance of harm reduction philosophies (qualitative interviews), OFR fidelity to CDC best practices (FORTRESS OFR Fidelity Tool), and usability of the Overdose Touchpoint Dashboard, (Systems Usability Scale). A statewide OFR data repository serves as a rich source of data on effectiveness outcomes, including OFR team recommendation quality and local actions to implement recommended overdose prevention strategies. We will also survey OFR team members to assess changes in their attitudes toward evidence-based overdose prevention strategies. In sum, the FORTRESS team is uniquely qualified to help OFRs use more comprehensive, available data to inform quality, action-oriented recommendations to reduce overdose.

PROJECT NARRATIVE The continued rise in overdose rates and sheer number of preventable overdose deaths suggest a need to improve practices of widely-established overdose fatality review (OFR) teams by shifting OFRs away from case review and toward using timely, population-level data to better inform their recommendations and actions. Thus, we will provide OFRs with a real time overdose-related dashboard and data-driven decision making training. We anticipate that our proposed intervention will lead to better quality, actionable OFR recommendations; increased OFR actions to implement evidence-based overdose strategies based on dashboard data; and long term reductions in both fatal and nonfatal overdoses.