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

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.

Maternal Substance Use Disorders and Infant Outcomes in the First Year of Life among Massachusetts Singletons, 2003-2010

“…5,8 For maternal SUD identification, we used a sex-specific tool/algorithm tested in our prior studies (REF). 9,10 This new algorithm, the Explicit Mention Substance Abuse need for Treatment (EMSANT) in Women, uses a variety of means to establish maternal SUDs, conceived as a (longitudinal) chronic condition. First and foremost, EMSANT developed a new (International Classification of Diseases, Ninth Revision, Clinical Modification) SUD diagnostic code-based groupers that can be applied to hospital-based administrative discharge data.…”

“…The EMSANT algorithm is described in detail elsewhere. 9,10 Mothers were also considered to have SUDs based on birth certificate record mention of a positive toxicology screen, or a record of BSAS treatment within 1 year before delivery. All other women were considered as not having SUDs.…”

“…Compared with other methods of identifying maternal substance abuse on a population-basis, this algorithm allows for a more robust approach given that it draws upon multiple sources of maternal and infant records. 9,10 All MA resident mothers who delivered a live-born singleton infant in a MA hospital during 2003-2009 were included in this study (N = 509 548). Mothers were classified as having SUDs or not per the EMSANT algorithm, described above.…”

The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts

“…EMSANT-W is more fully described elsewhere (Derrington et al, 2015). Women who appeared in the dataset with no evidence of SUD from any source were classified as “non-SUD.”…”

No official identity: a data linkage study of birth registration of Aboriginal children in Western Australia

“…The Supplementary Information (available online) lists the codes of the International Classification of Diseases, 9 th and 10 th Revisions (ICD‐9‐CM, ICD‐10‐AM) used. For alcohol and drug use, we modified the diagnoses used by Derrington et al, excluding codes for chronic diseases associated with long‐term, past abuse, as we were interested in ongoing use around the time of birth 4 . For mental health, we used the diagnoses used by O'Donnell et al, excluding the alcohol and drug‐related codes 5 …”