1. National Sobering Collaborative 10/25/15 Melanie Lippmann MD Otis Warren MD

2. Mission To advance Advocacy, Research and Policy to improve the care of the Intoxicated Person.

3. The Problems and the Paradoxes Intoxicated (predominantly ETOH) brought to attention of the public. Homeless Irony of where this intoxication presents Hospital vs. Jail Incredible burden on society Cities EMS Hospitals Payers Jails Courts Value=Quality/Cost We suffer as our fellow citizen suffers

4. Problem: No National Data! Literature exists on individual communities. No pooled data, consensus, overview, practice guidelines. Little collaboration between centers.

5. Our Initial Findings Sobering practices across the country. As varied as the communities they serve. Police vs Hospital vs Shelter Robust diversion in areas with “County Hospitals” Who’s problem is it? Funding/Operations Cities Sheriff Dept Hospitals Non-Profits Religious Institutions Housing No Medicaid Funding

6. 2012 2014 >5 ETOH Payer, Pre and Post ACA

7. Our Goal: Creating Value Economic Problem High Cost Low Quality Care Economic Questions How Much Is It Costing (real cost)? How Much Does an Alternative Cost? Does It Improve The Lives Of Those We Serve? How Do We Do It Safely (triage)? Economic Solution

8. National Sobering Collaborative Agenda Phase 1 Website Development Collaboration, informal data sharing Phase 2 Fundraising Formal Data Sharing- Standardized Reporting Development of Database Phase 3 Robust economic research Comparative study Triage Phase 4 Reporting: Communities Toolkit

9. Hurdles Heterogeneity Communities Population Complexity Population Cooperation of programs