Ohio’s Multi-Pronged Approach to Addressing the Opioid Crisis
Since 2007, the Ohio Perinatal Quality Collaborative (OPQC)—a statewide consortium of perinatal clinicians, hospitals, policy makers and governmental entities—has leveraged quality improvement (QI) science to significantly improve birth outcomes for moms and babies across Ohio. Their achievements include reducing early elective deliveries by 75 percent across the state and a statewide progesterone program that reduced preterm birthrates before 32 weeks by 20 percent in at-risk women. The OPQC’s successful projects illustrate the potential of leveraging the QI framework and powerful statewide partnerships to drive population level improvement. In its efforts, the OPQC has partnered with a number of stakeholders, including the Ohio Department of Medicaid, the Ohio Department of Health, the Ohio Department of Mental Health and Addiction Services, and the Ohio Chapter of the March of Dimes.
In recent years, the OPQC has started addressing the thousands of families affected by the opioid crisis and is testing innovative strategies for improvement.
The OPQC is one of 47 state and multi-state PQCs working with the National Network of Perinatal Quality Collaboratives (NNPQC), a Centers for Disease Control and Prevention-funded initiative seeking to improve maternal and infant health outcomes by advancing evidence-informed clinical practices. More than a quarter of NNPQC teams are working on projects that address maternal opioid use disorder and neonatal opiate withdrawal syndrome, reflecting an urgent national need for improvement.
“As one of the first PQCs, Ohio is an invaluable mentor for states who are earlier in development,” says NICHQ NNPQC Executive Project Director Pat Heinrich, RN, MSN, CLE. “Their innovative work around Opioid Use Disorder (OUD) illustrates the effectiveness of their QI approach, and their lessons-learned and strategies can and should be spread to hospitals, communities, and states across the country. We need to do more to help mothers and babies affected by this national public health crisis.”
OUD among pregnant mothers in Ohio has dramatically increased, growing by 491 percent between 2004 and 2011. This escalation corresponds to a spike in babies born with neonatal abstinence syndrome (NAS), which can cause babies to experience painful drug withdrawal symptoms resulting in prolonged hospitalizations and can potentially adversely affect their long-term health outcomes.
Recognizing that the crisis had reached epidemic proportions, the OPQC worked with state partners to develop a multipronged improvement strategy focused on providing comprehensive care for the mother-infant dyad. Below, the OPQC shares four core elements of their approach so that state and hospital improvement teams can learn alongside them.
Standardize identification and treatment for opioid exposed infants in Neonatal Intensive Care Units (NICUs)
Between 2014 and 2018, the OPQC collaborated with more than 50 NICUs across the state (96 percent of all Ohio NICUs). Over the course of the project, participating hospitals cared for 9,600 babies born exposed to opiates.
“When we started this work, there was significant variation in how these infants were treated in the NICU—because there was no standardized protocol for NAS treatment—and there were large differences in length of stay,” explains Carole Lannon, MD, MPH, the Collaborative Science Lead for the OPQC. “We built on work done by the six children’s hospitals of the Ohio Children’s Hospital Association, and supported the hospital NICUs in adopting a set of straightforward evidence-based practices, called bundles; standardizing care; and then helping people understand that it was safe and effective.”
Breastfeeding, which has numerous benefits for mothers and babies, is an important part of the nonpharmacological approach. But not all mothers could immediately breastfeed. Hospitals were uncertain about which formula would work best for babies with NAS who could not get mom’s milk, so they used an innovative quality improvement method to test the different formulas across four different groups of hospitals. The OPQC discovered that a high calorie formula had the best outcomes in terms of reducing NAS symptoms. The non-pharmacologic bundle was updated to recommend high calorie formula when breastmilk is unavailable, and the new bundle was implemented widely across the collaborative.
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The Maternal and Child Environmental Health Collaborative Improvement and Innovation Network (MCEH CoIIN), a national initiative led by the Association of Maternal and Child Health Programs developed the MCH Lead Poisoning Toolkit to share innovative practices and methods that nine different state teams tested out to improve access to systems and services that address the needs for pregnant women, infants, children, and families that are exposed to lead. NICHQ provided quality improvement expertise and technical assistance for the MCEH CoIIN—offering state teams guidance on using data and measurement to determine where improvements have been made and areas that still require change. Read tips and take-aways from the three-year CoIIN for data collection and using data for Improvement.
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Exploring a Nonbinary Approach to Health
NICHQ is not abandoning the traditional use of the terms “mother” and “maternal.” We are embracing the inclusive language of “birthing person/people” across our work. A move toward inclusive language does not force us to stop using language that so many people identify with; at its core, inclusion is about creating more space for one another. We are taking care to expand the use of these terms in our communications, on our website, in our resources, and eventually, in all our projects.