Welcome to the OPQC NAS

May Action Period Call

• In the mean time; please

sign in the chat box the

names of all webinar

participants and full name of

hospital affiliation.

• Please also tell us: What

work has your hospital done

concerning changing or

improving attitudes towards

mothers of NAS babies?

Thank you for joining; our webinar will start shortly!

Neonatal Abstinence

Syndrome Project

May Action Period Call

Ohio Perinatal Quality Collaborative

May 2015

Welcome!

The line will be placed on

Group Mute To ask a question:

– Click on the Raised Hand icon

– You can type your question

into the Chat Box

– You can use *6 to come off of GROUP

MUTE (and *6 to go back on).

Time Topic Presenter

12:00 pm Welcome & Agenda Review Andrea Hoberman, MPH

12:05 pm Data Overview – April Results

Attitude Measure Results

Scott Wexelblatt, MD

12:25 pm Update from the MOMS Project Mike Marcotte, MD

12:45 pm Sharing Seamlessly - Team Discussion All teams

12:55 pm Next Steps

•Unit Comparison Tool

•Data Submission Reminder

•MPR/PDSA Reminder

Andrea Hoberman

Agenda

Promedica Toledo Children’s

Miami Valley

Mercy Anderson

Aultman

Mt. Carmel East OSU

UH Rainbow Babies & Children’s

Bethesda North Hospital

Nationwide Dublin Methodist

Akron Children’s Summa

Cincinnati Children’s

Hillcrest Hospital Fairview Hospital

Cleveland

Clinic

Dayton Children’s

Nationwide Riverside Methodist

Nationwide Grant

Nationwide Mt. Carmel St. Ann’s

UH Cincinnati

Good Samaritan Hospital

MetroHealth

Mt. Carmel West Nationwide Doctor’s

Akron Children’s

Nationwide Children’s

Mercy Children’s Hospital

Atrium Medical Center

Fort Hamilton

Mercy Hospital Fairfield

Mercy Medical Center Canton

The Christ Hospital

St. Rita’s

Medical Center

Southview Medical Center

Good Samaritan Hospital Dayton

Kettering

Mercy Health West

Southern Ohio Medical Center

Genesis Healthcare System

OhioHealth MedCentral Mansfield

Marion General

Elyria Medical Center -UH

Mercy Regional Medical Center Lorain

ProMedica Bay Park

Lima Memorial Health System

Springfield Regional Medical Center

Adena Regional

Medical Center

Soin Medical Center

Upper Valley Medical Center

Licking Memorial Health System

NAS Participating Sites 2014

1/2014 start Level 3

and Level 2 teams

Akron Children’s St. Elizabeth

Health Center/Mahoning

Valley

Trumbull Memorial

4/2014 start

Level 2 teams

We’re Changing our OPQC Learning Session Schedule…

from: Winter/Summer to: Fall/Spring

Save the Date: September 28th

Key Driver Diagram Project Name: OPQC Neonatal NAS Leader: Walsh

SMART AIM

KEY DRIVERS INTERVENTIONS

By increasing identification of and

compassionate withdrawal treatment for full-term infants born with

Neonatal Abstinence Syndrome (NAS), we will reduce length of stay by 20% across participating sites by June 30, 2015.

Improve recognition and non-judgmental support for Narcotic addicted women

and infants

Connect with outpatient support and treatment program prior to

discharge

Standardize NAS Treatment Protocol

Optimize Non-Pharmacologic Rx Bundle Initiate Rx If NAS score > 8 twice.

Stabilization/ Escalation Phase Wean when stable for 48 hrs by 10%

daily.

Swaddling, low stimulation. Encourage kangaroo care Feed on demand- MBM if appropriate

or lactose free, 22 cal formula

All MD and RN staff to view “Nurture the Mother- Nurture the Child”

Monthly education on addiction care

Attain high reliability in NAS scoring by nursing staff

Partner with Families to Establish Safety Plan for Infant

• Fulltime RN staff at Level 2 and 3 to complete D’Apolito NAS scoring training video and achieve 90% reliability.

Establish agreement with outpatient program and/or Mental Health

Utilize Early Intervention Services

Collaborate with DHS/ CPS to ensure infant safety.

Prenatal Identification of Mom Implement Optimal Med Rx Program

Engage families in Safety Planning. Partner with other stakeholders to influence policy and primary

prevention. Provide primary prevention materials to

sites.

To reduce the number of moms and babies with narcotic exposure, and

reduce the need for treatment of NAS.

GLOBAL AIM

Monthly Progress Report

Submissions

MOC

Requirements

Monthly Progress Reports

Attitudes….

Think about verbiage used to

discuss the problem….

• “The negative words we use to describe drug

addiction -- "clean" vs. "dirty," "patient" vs.

"addict" -- can drive some individuals away

from the very help they so desperately need.

To reduce that stigma, we need to start

changing the language for people struggling

with a disease.”

– John F. Kelly, MD, associate professor of psychiatry at

Harvard Medical School

Instead of: Try:

Addict Person with a substance use disorder

Person with a serious substance use disorder

Addicted to X Has an X use disorder

Has a serious X use disorder

Has a substance use disorder involving X (if more than one substance is involved)

Addiction Substance use disorder

Serious substance use disorder • Note: Addiction is appropriate when quoting findings or research that used the term or if it is a

proper name of an organization. It is also appropriate when speaking of the disease process

that leads to someone developing a substance use disorder that includes compulsive use (for

example: “the field of addiction medicine” or “the science of addiction”.

Clean Abstinent

Clean Screen Substance-free

Testing negative for a substance use

Dirty Actively using

Positive for substance use

Dirty Screen Testing positive for substance use

Drug Habit Substance use disorder

Compulsive or regular substance use

Drug/Substance

Abuser

Person with a substance use disorder

Person who uses drugs (if not qualified as a disorder)

Former Addict Person in recovery

Opioid Replacement Medication assisted treatment

Medication assisted recovery Source: White House Office of National Drug Control Policy

“Better” Language

• The White House Office of National Drug Control

Policy has drafted a preliminary glossary of

suggested language: “dirty” replaced with

“actively using”; “clean” replaced

with “abstinent”.

Michael Botticelli

Director of Office of National Drug Control Policy

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.

Mike Marcotte, MD

May 27, 2015

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• In 2011, Medicaid was the payer for approximately

84% of NAS inpatient hospitalizations • In 2011, treating newborns with NAS was associated

with over $70 million in charges and nearly 19,000 days in Ohio’s hospitals

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Source: Massatti, R., Falb, M., Yors, A., Potts, L., Beeghly, C. & Starr, S. (2013, November). Neonatal abstinence syndrome and drug use among pregnant women in Ohio, 2004-2011. Columbus, OH: Ohio Department of Mental Health and Addiction Services Data Source: Ohio Hospital Association

Neonatal Abstinence Syndrome (NAS) in Ohio

Project Partners

State Sponsors

• Office of Health Transformation • Department of Mental Health and Addiction Services • Department of Medicaid Pilot Sites • CompDrug • First Step Home • Health Recovery Services • MetroHealth Medical Center Clinical Advisory Panel Project Management and Data Infrastructure • Ohio Colleges of Medicine Government Resource Center Quality Improvement Vendor • Health Services Advisory Group

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Maternal Opiate Medical Supports

• In August 2013, the Kasich Administration announced plans to address the epidemic of NAS

• Maternal Opiate Medical Supports (MOMS) project is a two-year quality improvement initiative that seeks to: • Improve maternal and fetal outcome • Improve family stability • Reduce costs of Neonatal Abstinence Syndrome (NAS)

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Project Details

• $4.2 million program over two years

• Goal is to support interventions and prenatal treatments that improve outcomes for 300 women and babies

• Funds clinical (e.g., MAT) and non-clinical services (e.g., housing vouchers, transportation, brief babysitting)

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Community Resources

• Crisis Intervention

• Detoxification

• Medication Assisted Treatment

• Residential

• Financial

• Health

• Legal

• Food assistance

• Education

• Housing

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ADAMHS Boards

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Detoxification Services

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Methadone Services

32

Outpatient Services

33

Residential Services

34

Project Aims • Identify best practices to develop and implement a clinical and

patient toolkit to guide process improvement work

• Implement the Maternal Care Home (MCH) model, a patient-centered and team based healthcare delivery mode to engage/empower expecting mothers in coordinated care and wrap-around services including pre-and post-natal care, addiction treatment, counseling, Medication Assisted Treatment (MAT), recovery support, and care management

• Implement a quality improvement structure involving monthly technical assistance calls to share and discuss best practices, quarterly clinical learning sessions, and individual coaching calls

• Develop and implement rapid cycle quality improvement feedback 35

36 36

SMART Aims

• Improve maternal and fetal outcomes and family stability

• 30% improvement in 12 month treatment retention rates of pregnant mothers who are dependent or addicted to opioids

• 30% reduction the rate in low birth weight (LBW) infants

• 30% reduction in average Neonatal Intensive Care Unit (NICU) length of stay (LOS)

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Collaborative Model

38

Learning and community collaborative approach

• The Institute for Healthcare Improvement (IHI) Rapid Cycle Quality Improvement Model

• Patient-centered and population-based

• Design, test, and implement evidence-based quality interventions in four pilot sites

• Spread the community-tested strategy and success statewide

39

Use of IHI Breakthrough Series Collaborative Model • Monthly customized performance measure data

feedback focusing on: • Early engagement and retention • Coordination of prenatal care, medication

assisted treatment, and counseling • Clinical best practices • Ancillary social supports (safe and stable housing)

• Use of Plan Do Study Act (PDSA) to test improvement strategies and support MCH model fidelity

Quality Improvement

Maternal Care Home Model

Adaptation of the Patient Centered Medical Home Model

Basic Tenets of a Maternal Care Home Model (MCH):

• Continuity of care from a primary clinician who accepts responsibility for providing and/or coordinating all health care and related social services during a woman’s pregnancy, childbirth, and postpartum period

• Commitment to utilize highest standards of care for newborns and provide appropriate pediatric/specialist referrals to ensure achievement of all developmental milestones

• Commitment to continuous quality improvement, patient/child safety, and evidence-based practice

• Commitment to patient-centeredness and a positive experience of care

• Timely access to appropriate care and information

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Maternal Care Home Model

Adaptation of the Patient Centered Medical Home Model

Basic Tenets of a Maternal Care Home Model (MCH):

• Continuity of care from a primary clinician who accepts responsibility for providing and/or coordinating all health care and related social services during a woman’s pregnancy, childbirth, and postpartum period

• Commitment to utilize highest standards of care for newborns and provide appropriate pediatric/specialist referrals to ensure achievement of all developmental milestones

• Commitment to continuous quality improvement, patient/child safety, and evidence-based practice

• Commitment to patient-centeredness and a positive experience of care

• Timely access to appropriate care and information

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Implementation

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• Four Pilot sites selected implementing MCH model

• Maternal Care • MAT • Behavioral healthcare (AoD and MH) • Social services and supports

• 72 women enrolled as of 2/1/2015 • Goal is total enrollment of 300 by project end • Pilot Sites

First Step Home

Terry Schoenling, BBA

Vice President

CompDrug

Dustin Mets

Pilot Sites and Principal Investigators

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Health Recovery Services

Joe Gay, PhD, LICDC

MetroHealth Medical Center

Jennifer Bailit, MD

Early Adopter Site Activities

• Weekly phone conferences with MHAS and Medicaid staff regarding program implementation

• Monthly calls for all sites, with specific training focus: • October 2014: Motivational Interviewing • November 2014: MAT in Pregnancy • December 2014: Maternal Care Home Model • January 2015: Trauma Informed Care

Retaining Patients in Prenatal Care • February 2015: Toolkit Review and Feedback • March 2015: Engagement Strategies for Early

Enrollment And many ad hoc discussions…..

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Role of Clinical Advisory Panel

• Academic and clinical experts in opiate addiction treatment in behavioral health and maternity and fetal medicine.

• Roles and Responsibilities • Develop technical resources that integrate evidence-

based/informed clinical decision support (toolkit). • Provide clinical guidance to the Project Team. • Serve as faculty resource in clinical decision support

training/seminar for clinicians.

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Recognition of CAP Members

‣ Daniel Brown, DO

‣ Margaret Chisolm, MD

‣ Christopher Croom, MD

‣ Sara Dugan, PharmD, BCPP

‣ Melanie Glover, MD

‣ Karol Kaltenbach, PhD

‣ Steven Matson, MD

‣ David McKenna, MD

Meridian Community Care

Johns Hopkins University

Premier Health Specialists

Northeast Ohio Medical University

Premier Health Specialists

Thomas Jefferson University

Nationwide Children’s Hospital

Premier Health Specialists

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MOMS Toolkit Development

Developed by subject matter experts and MOMS clinical advisory panel

Tested by pilot sites

Development

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Toolkit

Toolkit: Almost Ready!!!!

• The MOMS Project will have a web portal that s

• The MOMS Project will have a web portal that serves as a resource for MOMS pilot sites and all health professionals in the state of Ohio.

r MOMS pilot sites and all health professionals in the

state of Ohio.

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Resource Audiences

• Prescribers

• Clinicians

• Patients

• Community Agencies

Resource Topics

• Readiness Lists

• Care Coordination

• Assessment

• M.A.T. Services

• Psychosocial Services

• Prenatal and Postnatal Care

• Labor and Delivery

• Outpatient Care

Resource Types

• Decision Trees

• Evidence-based Guidelines and Resources

• Fact Sheets

• Shared Decision-Making Module

Toolkit

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Questions and

Discussion

• Questions for Dr. Marcotte or Dr. Massatti?

• What work has your hospital done

concerning changing or improving attitudes

towards mothers of NAS babies?

Courtesy of:njms.rutgers.edu

Still in need of Unit Protocol

Comparison Surveys for the

following teams…

Akron Children’s Summa Mount Carmel West

Fort Hamilton Hospital OhioHealth MedCentral Mansfield

Mercy Children’s Hospital (St. V) ProMedica Bay Park

Next Steps • Save the date: September 28th OPQC Fall

Learning Session in Columbus. Be certain to

have Lead MD’s and Key Contacts in attendance

on one of the June webinars for further information.

• Please respond to any data queries you have received.

• Please submit NAS Data by May 30th. Remember to

please submit and check “No Eligible Babies for the

Month” if there were no NAS patients at your site.

• Monthly Progress Report was be sent to Key Contacts

last Wednesday; due May 30th.

The OPQC NAS Project is

funded by The Ohio

Department of Medicaid