welcome to the opqc nas april action period call · 2018. 4. 26. · welcome to the opqc moms+...
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Through collaborative use of improvement science methods, reduce preterm births &
improve perinatal and preterm newborn outcomes in Ohio as quickly as possible.
Welcome!
MOMS+ Project
Introductory Webinar
Ohio Perinatal Quality Collaborative
April 23, 2018
Welcome to the OPQC MOMS+
Introductory Webinar
Thank you for joining;
please sign in the chat
box with the names of
all webinar participants
and your hospital
affiliation.
The OPQC NAS Project is funded by the Ohio Department of Medicaid and administered by the Ohio Colleges of Medicine Government Resource Center. The
views expressed in this presentation are solely those of the authors and do not represent the views of the state of Ohio or federal Medicaid programs.
Objectives
• Discuss the scope of OUD among pregnant
women in Ohio
• Identify best practice developed by the
MOMS Project that will be incorporated into
the MOMS+ work
• Describe crucial activities for teams to
prepare for the MOMS+ Learning
Collaborative
Time Topic Presenter
4:00 pm Welcome & Agenda Review Susan Ford, MSN, RN
4:05 pm What is a Collaborative?
OPQC past/present projects
Susan Ford
4:15 pm Scope of the Problem
OPQC NAS Project
Initial ODMHAS MOMS Project
OPQC MOMS+ Project
Susan Ford
Dave McKenna, MD
OPQC MOMS+ Faculty
4:30 pm Questions/ Discussion All
4:55 pm Next Steps
• Team Identification Sheet
• Regional meetings
Susan Ford
Agenda
Ohio Perinatal
Quality Collaborative
Through collaborative use of improvement science methods, reduce preterm births
& improve perinatal and preterm newborn outcomes in Ohio as quickly as possible.
The Ohio Perinatal Quality Collaborative
Obstetrics
ANCS for women at risk for preterm
birth
(240/7 - 33 6/7)
39-Week Scheduled
Deliveries w/o medical
indication
Increase Birth Data Accuracy & Online modules
Spread to all maternity
hospitals in Ohio
Progesterone for Preterm Birth Risk
LARC
Neonatal
BSI: High reliability
maintenance bundle
Neonatal Abstinence Syndrome
MOMS+
Human milk in infants
22-29 week GA
NICU Grads Project
Smoke Free Families
How OPQC and teams
do this work…
• Collaborative methods –
“All Teach, All Learn”
• Improvement Science
• Data to inform change
Michele Walsh, MD, MSE
Neonatal Clinical Lead
Welcome from OPQC - MOMS+ Project
Susan Ford MSN, RNQuality Improvement
Consultant
Carole Lannon, MD, MPH
Quality Improvement Lead
Missy Page, MPHProject Management-Senior Specialist
Heather Kaplan, MD, MSCE
Neonatal & QI Faculty
Mike Marcotte, MDOB Faculty, MOMS+ Mentor
Jennifer Bailit, MD, MPHOB Faculty, MOMS+ Mentor
Mona Prasad, DO, MPHOB Faculty, MOMS+ Mentor
Dave McKenna, MDOB Faculty, MOMS+ Mentor
Maurizio Macaluso, MD, DPH
Biostatistics/Data Analytics
Jay Iams, MD
Obstetrical Clinical Lead
Melanie Glover, MDOB Faculty, MOMS+ Mentor
Age-adjusted drug overdose death rates,
by state: United States, 2016
NOTES: Deaths are classified using the International Classification of Diseases, Tenth Revision. Drug-
poisoning (overdose) deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85,
and Y10–Y14.
SOURCE: NCHS, National Vital Statistics System, Mortality
0
1,000
2,000
3,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
# o
f c
as
es
Year
Marijuana
Opioid
Cocaine
Other Drugs (Amphetamines, Hallucinogens and Sedatives)
Drug Abuse or Dependence
Diagnosis at Time of DeliverySource: Ohio Hospital Association
Number of cases, Ohio, 2004-2015
• Women with a marijuana-related dx increased 107% -- from 994 in 2004 to 2,061 in 2015.
• Dx of opioid abuse or dependence grew 1,039%.
• Dx of cocaine abuse or dependence fell 41% among delivering mothers.
NAS Statewide Rate per 1,000 Live Births
Source: Ohio Hospital Association
1.4 1.9 2.1 2.5 3.35.0
7.08.8
10.912.6
14.115.9
0
20
40
60
80
100
120
140
160
180
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ra
te p
er
1,0
00
Year
OPQC NAS Project
54 sites:
• 26 Level III NICU’s
• 26 Level II Special Care Nurseries
• 2 Normal Newborn Nurseries
A Guide for Families
Improve recognition and non-judgmental support
for Narcotic addicted women and infants
• Addiction = Chronic Illness Addiction is a chronic and treatable disease
Opioid maintenance therapy with methadone or
buprenorphine may play an important role in
treatment of pregnant women struggling with
addiction
Opioid maintenance therapy improves outcomes
for both pregnant women and their infants
Providing non-judgmental, compassionate care
can be rewarding and beneficial for the patients
and the providers
• Attitude Measures Survey
This resource is focused on people’s attitudes
towards alcohol and other drug use and is designed
to encourage health professionals to explore and
evaluate their attitudes towards drug users -
particularly perceptions about a client’s or patient’s
deservingness of medical care.
OPQC NAS Recommendations
Non-pharmacological treatment:• All infants are treated with decreased stimulation, swaddling, continuous holding,
and frequent feedings.
• Encourage breastfeeding if mother is in treatment program.
• If breast milk not used, give 22 kcal/oz formula. Low-lactose formula may be used
at the discretion of the unit.
Pharmacologic Treatment:
MATERNAL OPIATE MEDICAL
SUPPORTS: “MOMS PROJECT”
Identified Best Practices –
We’ll help you get there!
Potential benefits to your patients in
MOMS+
0%
20%
40%
60%
80%
Received Medication Assisted Treatment
MOMSParticipants(N=247)
MedicaidComparisonCohort (N=846)
Notes:
Chi-square analyses conducted , ***p<.001
Medication Assisted Treatment (MAT) determined using claims of buprenorphine, methadone,
Naltrexone or Suboxone Rx or administration.
Source: Medicaid Claims
0%20%40%60%80%
100%
Received Behavioral Health Services
MOMSParticipants(N=252)
MedicaidComparisonCohort (N= 846)
Family Stability
0%
10%
20%
30%
40%
50%
60%
Out-of-HomePlacements
Child Maltreatment
MOMS Participants(N=252)
Medicaid ComparisonCohort (N= 846)*
Notes:
Chi-square analysis , * p<.05
Source: Ohio Statewide Automated Child Welfare System Database (SACWIS)
Key Lessons from MOMS Project
• A window of treatment opportunity opens
when a woman with opioid use disorder
becomes pregnant:
– her goals are sobriety and parenting her
newborn
• Importance of safe and stable housing
• Need for post-partum support for mother-
infant dyad
“MOMS+ FRAMEWORK”
Coordination of Obstetric (OB), Medication Assisted Treatment (MAT)/Opioid
Treatment Program (OTP),Behavioral Health (BH) and Neonatal/Pediatric
providers to deliver:
• Compassionate and coordinated clinical and community based services
• Support for mother/infant dyad post delivery
4 Faculty Mentor Sites
20+
Partner Sites
SMART Aim
Key Drivers Interventions
Optimize maternity medical
home to improve outcomes
for pregnant women with
opioid use disorder(OUD) as
measured by:• Increased identification of pregnant
women with OUD
• Increased % of women with OUD
during pregnancy who receive
prenatal care (PNC), Medication
Assisted Treatment (MAT) and
Behavioral Health (BH) counseling
each month
• Decreased % of full-term infants
with Neonatal Abstinence
Syndrome (NAS) requiring
pharmacological treatment
• Increased % of babies who go
home with mother
Project Leader: Carole Lannon (PI)
Optimize the health and well-
being of pregnant women with
opioid use disorder and their
infants
Global Aim
Pregnant women with
opioid use disorder who
intend to carry to term
Population
Revision Date: 04/9/2018
MOMS+ Project
DRAFT Key Driver Diagram (KDD)
Timely identification and
tracking of pregnant
women with opioid use
disorders
Compassionate and
coordinated clinical and
community based
services
Legend
Empowerment of women
Supported mother/infant
dyad post delivery
• Track pregnant women with OUD history/diagnosis
• Connect with community resources serving women with OUD,
including MAT providers, drug courts, homeless shelters, and ERs
• Complete a standardized screening tool on each patient to
accurately identify and diagnose pregnant women with OUD
• Coordinate care between OB, BH, MAT, NICU
• Implement a standardized process for referral of women with a
positive screen for OUD
• Provide immediate support/counseling at time of identification
• Promote healthy behaviors during pregnancy (e.g. sobriety,
smoking cessation, stable housing and birth spacing (LARC)
• Consider a Centering Pregnancy© program
• Provide non-judgmental support for pregnant women with OUD
(training regarding trauma informed care and addiction as a chronic
illness)
• Connect women to vocation training opportunities
• Involve community partners including faith-based organizations to
support pregnant women with OUD
• Utilize shared decision making and motivational interviewing to
encourage healthy behaviors
• Prenatal consultation from neonatology/pediatrics regarding NAS
• Ensure mom and baby have a PCMH (post-delivery)
• Warm handoff to pediatric care provider for infant post discharge
• Provide lactation consultation (if applicable), post partum
depression screening and contraceptive counseling
• Support from Community Health Workers and/or home visitation
• Referral or consideration for parenting classes
• Continuation and retention of services during pregnancy and post-
delivery, to include maintenance of MAT services
• Coordinate with DJFS and CPS regarding (possible) safety plan for
infant
The Model for Improvement
AIM
Optimize maternity medical home to improve outcomes for
pregnant women with opioid use disorder(OUD) as measured by:
• Increased identification of pregnant women with OUD
• Increased % of women with OUD during pregnancy who
receive prenatal care (PNC), Medication Assisted Treatment
(MAT) and Behavioral Health (BH) counseling each month
• Decreased % of full-term infants with Neonatal Abstinence
Syndrome (NAS) requiring pharmacological treatment
• Increased % of babies who go home with mother
OPQC MOMS+ AIM Statement
Measures
The Model for Improvement
Why measure?
If you don’t measure your performance, how would youknow if you improved?
Measures• % of pregnant women identified with Opioid Use Disorder (OUD)
• % of women identified with tobacco use
• % of women who receive Prenatal Care (PNC), Medication Assisted
Treatment (MAT) and Behavioral Health Counseling(BH)
• % of women receiving a toxicology screen during pregnancy
• % of women with stable housing
• % of women maintaining sobriety
• % of women receiving a toxicology screen at delivery
• % of infants with Neonatal Abstinence (NAS) Syndrome diagnosis
• % of full-term infants with NAS requiring pharmacological treatment
• % of babies who go home with mother without needing CPS Safety Plan
MOMS+ Data System
Patient
Registry
Reports:
Patient Dashboard (key data)
Visit planning tool
Patient population statistics
Quality Improvement Charts
Information sources:
Prenatal Care
Provider
MAT provider
BH provider
Birth hospital record
Patient data:
Registration/initial visit
Follow-up visits
MAT visits
BH visits
Post-partum assessment
Changes
The Model for Improvement
What do we do to get Ready?
• Identify your team
• Review Readiness Documents
and complete Systems Inventory
• Prepare to collect data
ACOG AIM Project
MOMS+ Project:
Team Identification Worksheet
To make sure your team members are receiving the right communications in a timely manner, please take a few moments to list your site's team
members and their contact information below. Please complete this worksheet and return to info@opqc.net by 5/10/2018.
Questions/Discussion
Next Steps
MOMS+ Project
• Team Worksheet submission:• Please complete and send to Missy Page
at opqc.net by May 10th
• Review ACOG AIM Patient Safety Bundle and MOMS
Decision Trees and assess your team’s readiness
• Regional meetings will take place throughout May and June
– NE OH: May 22nd; Corporate College East , Warrensville Heights
– Central OH: May 24th; OSU Eye & Ear Institute, Columbus
– SW OH: June 4th, Cincinnati Children’s Hospital, Cincinnati
– Dayton, OH: June 13th; Upper Valley Medical Center, Troy
– NW OH: June 25th; ProMedica Steam Plant, Toledo
It takes a village…
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