Chinese Hospital Emergency Department Alternatives to Opioids (CHED-ALT) program is a patient-centered, multi-disciplinary team based, community-based organization(CBO) partners involved care model that provides proactive care and responsive care through community engagement and evidence-based, non-opioid Medication Assisted Treatment plus Cognitive Behavioral Therapy (CBT) to address unmet pain management and opioids misuse among Asian American and African American racial/ethnic minority groups reside in Chinatown and Tenderloin areas.
The program goals are to 1) increase the total number of targeted ED patients using non-opioids therapies; 2) reduce their opioid misuse or addiction risk by maintaining the opioid-prescription rate for post CHED-ALT care patients not to exceed 6.9%.
From June to December in 2022, Chinese Hospital served 839 pain-related patients around Chinatown. 142 patients received at least 1 opioid. 95% of ED population served were Asian Chinese, among which, 60% are older adults from age 65 and above, 38% were adults in age group ranging from 18 to 64,2% were age 17 and under. The top 10 pain conditions related primary diagnosis were COVID-19, dizziness, urinary tract infection, nausea/vomiting, chest pain, low back pain, headache, abdominal pain, epigastric pain and cough.
San Francisco Chinatown's total population is 10,136. 78.79% is Asian. 16% is between ages 55-64 and 17% is between ages 65-84. From literature review, Chinese American tend to have clinical characteristics of inappropriate pain management and also language issue affecting their health care outcome, we anticipate this aging population will have greater need for pain management. San Francisco Tenderloin area total residents' number is 9942. 38% is Asian, 19% is Hispanic and 7% is African American. Per data from Tenderloin Center created by Mayor London Breed, it has accommodated 124,000 visits in roughly 10-month open period. About 70% of the opioid overdose deaths in 2020 were men between age 35 and 64, and ethnically significant for African American, 5 times more than other racial groups.
Based on our ED data, population data in Chinatown and Tenderloin areas, and information from literature review and city drug crisis report. The yearly number of ED patients to be served is projected to be 1600 for year 1, 1750 for year 2 and 1950 for year 3. In another word, 5300 individuals in total will benefit from our program if awarded.
To reach our program goals, our interventions and strategies are 1) educating providers on OUD and non-opioids therapies, encouraging them to practice non-opioids therapies in ED; 2) educating patients on opioids risk and non-opioids therapies benefits through community outreach and ED service, encouraging and enrolling patients in non-opioids therapies; 3) engaging patient community, educating CBOs and recruiting them into the care model and encouraging mutual-referrals of qualified patients. Our objectives are to 1) increase number of providers trained on OUD and CHED-ALT care model; increase number of patients received CHED-ALT care; increase number of CBOs through community outreaches and collaborate with CBOs to provide health education and reach out to more targeted patient population in Chinatown and Tenderloin areas.