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.
NICHQ Employee Spotlight: Nathaniel Ray Pickett, Ph.D.
Each month, we’re shining a spotlight on a NICHQ employee, asking them to share their memories, advice, and goals. This month, NICHQ Web & Product Manager Nathanial Ray Pickett, Ph.D., shares his untraditional path to working in MCH, while highlighting his passion for equity, resisting oppression, and giving voice to the voiceless.
TRANSCRIPT | Connecting Infant and Maternal Health Outcomes – Prematurity Awareness Month
Our main story this episode highlights he links between maternal and infant health, and the impacts of preterm birth on health outcomes for mothers, birthing people, and babies. Hear from NICHQ VP of Equity and Innovation Dr. Stacy Scott, Ph.D. D, MPA, who shares some equity considerations regarding disparate rates of preterm birth, infant mortality, and maternal mortality. Dr. Zsakeba Henderson, MD, FACOG, NICHQ’s senior health advisor, also connects the impact of maternal health on infant health outcomes while shining a light on the U.S. maternal mortality crisis and current policy initiatives that can help reverse maternal mortality trends.
NICHQ Employee Spotlight: Callie Rowland
Each month, we’re shining a spotlight on a NICHQ employee, asking them to share their memories, advice, and goals. This month, NICHQ Project Manager Callie Rowland, MPH, shares her passion for working to affect change in the system, serving all mothers and children, and working for an organization that aims to help create more equitable systems.
4 Strategies for Transitioning from Pediatric to Adult Care for People Living with Sickle Cell Disease
Whether transitioning to college or a full-time job, it's a time when young adults are going to be establishing their independence from their nuclear family and taking responsibility for their own needs. For a young person with special healthcare needs such as SCD, the responsibilities are compounded by the additional need to begin transitioning from pediatric to adult care. Read more for four helpful strategies for transitioning from pediatric to adult care for people living with sickle cell disease and other special health conditions.
TRANSCRIPT | Sickle Cell Awareness Month: Transitioning to College, Equity Considerations, and Resource Sharing
Our main story this episode highlights the need for resources for people living with sickle cell disease and strategies for transitioning from pediatric to adult care. We also reflect on National Infant Mortality Awareness Month and hear from NICHQ team member about connecting their personal and professional passion for equity. Thanks for joining us!
For our main story in this episode we are joined by Summer 2023 NICHQ Communications & Digital Strategy interns Amalia Hirschhorn-Martinez and Katie McCormick. They speak with members of the NICHQ team about our upcoming webinar focused on infant safe sleep and breastfeeding messaging and NICHQ’s continued work to ensure health professionals and the communities they serve are supported with the necessary tools and resources to create safe sleeping environments and improve breastfeeding and chestfeeding rates.