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!

MOMS Project: Algorithms

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…