MOMS Plu lus Project November Action Period Call Ohio Perinatal - PowerPoint PPT Presentation

MOMS Plu lus Project November Action Period Call Ohio Perinatal Quality Collaborative November 15, 2019 Through collaborative use of improvement science methods, reduce preterm births & improve perinatal and preterm newborn outcomes in Ohio as quickly as possible.

Welcome Please be certain you are on “mute” when not speaking to avoid background noise. Whether you have joined by phone or computer audio, you can mute and unmute yourself by clicking on the microphone icon The following shortcuts can also be used For PC: Alt + A : Mute or Unmute For Mac: Shift + Command + A: Mute or Unmute For telephone: *6 : Mute or Unmute 3

Housekeeping: Participant Code ➢ PLEASE BE CERTAIN TO USE YOUR PARTICIPANT CODE!! ➢ #participant code# This call will now be recorded 4

Housekeeping: Chat box Please add your name and organization to the chat box: (e.g.) Susan Ford, OPQC 5

Today’s Presenters Today’s Facilitators Project Management Team Cole Jackson, MS Andrea Hoberman, MPH Jalea Stowers-Grimes, BBA Mike Marcotte, MD OPQC Project Specialist OPQC QIC OPQC Project Specialist TriHealth/ OPQC Faculty Mentor 6

Agenda Time Topic Presenter 12:00 pm Welcome & Agenda Review Andrea Hoberman, MPH 12:05 pm Data Review Andrea Hoberman 12:15 pm Postpartum transitions to care Mike Marcotte, MD • OB-GYN Tri-Health Lynn Hamrich, MD • Family Practice Summa Health Anne Valeri-White, DO • Pediatrics MetroHealth Philip Fragassi, MD All Teach ~ All Learn All participants Team sharing regarding the case scenario 12:50 pm Next steps/Wrap up Andrea Hoberman 7

MOMS+ Project Key Driver Diagram (KDD) Revision Date: 8/30/2019 Project Leader: Carole Lannon (PI) Interventions Global Aim Key Drivers • Provide training in trauma informed care and addiction as chronic disease Optimize the health and well-being of Compassionate care/ for clinical practitioners pregnant women with opioid use culture change • Ongoing support for practice culture change disorder and their infants SMART Aim • Selection and use of a standardized screening tool for all OB patients to identify pregnant women with OUD (e.g. 5 P’s, NIDA Quick Screen). By January 31, 2020 we will: • At time of identification, assess need to prevent acute opiate withdrawal Optimize maternity medical home to Identification of by initiating or referring to MAT improve outcomes for pregnant pregnant women with • Establish connections for coordinated referral to maternity care from BH women with opioid use disorder OUD and MAT providers, drug courts, prisons, homeless shelters, and ERs. (OUD) as measured by : • Identify a care coordinator to provide ongoing support and assist with • Increased identification of referrals and ongoing communication among the multi-disciplinary care pregnant women with OUD team. • Use tracking system to monitor care of pregnant women with OUD • Increased % of women with OUD diagnosis (e.g.. Database, spreadsheet) during pregnancy who receive Supportive care and • Use standardized checklist for maternity care of the pregnant patient with prenatal care (PNC), Medication tracking during OUD Assisted Treatment (MAT) and pregnancy • Coordinate care among OB, BH, MAT, care navigator by regularly Behavioral Health (BH) reviewing shared patients (e.g. multi-disciplinary care conference, huddle). counseling each month • Tailor counseling and support for healthy behaviors based on patient- specific situation/need during pregnancy (sobriety, smoking cessation, • Decreased % of full-term infants stable housing and future contraception plan) with referral to community with Neonatal Abstinence resources as needed to augment medical resources. Syndrome (NAS) requiring pharmacological treatment • Ensure mom and baby have a Patient Centered Medical Home (post-delivery) • Provide a warm handoff to pediatric care provider for infant post discharge • Increased % of babies who go • Provide lactation consultation (if applicable), post partum depression screening and home with mother Connection to contraceptive counseling; and ”normalization” of postpartum transition postpartum support Population (overwhelmed) • Facilitate continuation of OUD treatment and services post-delivery occur Pregnant women with • Coordinate with Department of Job & Family Services/Child Protective Services opioid use disorder 8 regarding reporting requirements and infant plan of safe care

Data outcomes for HOPE Program Fetal/neonatal demise – 2% Adoption - 4% Data from 544 women in the Foster care -10.5% Home w/family-1.5% HOPE Program over a three- CPS safety plan - 17% year period for No CPS- home with mom - 65% the years of 2016-2017-2018 no CPS-home with mom requires CPS saftety plan home with family 17 foster care adoption fetal/neonatal demise

Data • Questions or comments?? – Does this differ from what you are seeing in your region or at your site? • It is likely the data does not represent the reality for the entire population of currently pregnant patients with OUD in Ohio. – What can we do to get this registry to better reflect the population of patients? – What are the barriers? – What can we do to overcome some of them before the end of the year? 18

Postpartum transitions to care Mike Marcotte, MD 19

Case Scenario: “JS” returns for postpartum visit 4 weeks after having an uncomplicated vaginal • delivery. – She entered prenatal care at 20 weeks and last used illicit opiates 24 weeks ago. – She is on buprenorphine she receives from the OB provider. – She is living with the FOB who is also in a treatment program. Her sister is her main support. – “JS” was started on an antidepressant after delivery for a high depression screening. The baby spent the required number of days in the hospital following delivery to • monitor for signs of possible withdrawal and has been seen once by her provider. – Hospital staff notified local CPS of the infant born with prenatal substance exposure. CPS investigated the case and interviewed mom at the hospital. – The plan of safe care was found to be appropriate and baby was discharged home with mom. – She has been slow to gain weight. She is receiving both breastmilk and formula. 20

Polling Question #1 • After delivery, when is the next OB team member visit with the patient at your site: • 1 week • 2 - 3 weeks • 4 – 5 weeks • 6 weeks • Other (use chat box) 21

Postpartum checklist ❑ Reproductive life plan/birth control ❑ MAT provider transition ❑ Ongoing Behavioral Health support ( specific to post-partum period ) ❑ Mental health follow up ❑ Referral to primary care provider ❑ HCV treatment ❑ Follow up vaccinations (HBV third dose) ❑ Nutritional support ❑ Smoking cessation ❑ Inquiry of parental stress & coping “how are you doing” ❑ Social work/case management hand off 22

Pediatric care ❑ Routine preventative care for the first year of life ❑ Vaccines ❑ Well child visits ❑ Special follow up for opiate exposed infant ❑ Parenting support ❑ Other 23

Transitions to care - initial visit components • Family Practice • Pediatrics 24

Summa Health Nursery Transitions Anne Valeri, DO, FAAFP Lynn Hamrich, MD, FAAFP 25

Summa Family Medicine Center Approach • The FMC of Akron has been running Centering Parenting groups since late 2016 • Special population- moms in opiate recovery and their newborns • Monthly group visits for well-baby care and social/medical support for up to 6 dyads through the first year of life • Dyads identified from Summa WHC Centering Pregnancy group • Recruiting: • Variable success d/t limited personnel resources • Some moms are established FMC patients • Some establish for primary care prior to delivery • Many are identified by WHC case manager at/after delivery • Established FMC patients are more likely to participate 26

Newborn Hospital Care- Family Medicine Inpatient Service (FMIS) • If identified prior to delivery, the FMIS team cares for baby in the nursery • NAS monitoring • Breastfeeding support • Behavioral health support • If discharged from normal newborn nursery, follow up is facilitated • Most are transferred to our on- site Akron Children’s NICU for NAS • Due to capacity issues, some are transferred to Akron Children’s main campus • Both transfer types present a large barrier for FMC care management 27

Ideal Follow Up • Infant is discharged from newborn nursery by FMIS, if NAS remains at goal and CSB approves discharge plan • 24-48 hour follow up in office • Dyad is scheduled for the next CenteringParenting session • Acute issues are handled on the regular FMC schedule 28

Major Points of Attrition • CSB takes custody • Infant is followed by a contracted pediatric group • NICU transfer • Lost to follow up, referred to pediatric group affiliated with Akron Children’s • Lack of timely communication regarding discharge • CSB takes custody • Mom has other children who see a private pediatrician • Maternal relapse • Scheduling conflicts 29

Metro Health Philip A. Fragassi, MD 30 Department of Pediatrics

Primary Care Provider Role As in other health conditions, self- management, with mutual support, is very important in recovery from addiction . MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching. 31