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
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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
25
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
26
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
29
ADAMHS Boards
30
Detoxification Services
31
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)
37
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
40
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
41
Implementation
42
• 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
43
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…..
44
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.
45
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
46
MOMS Toolkit Development
Developed by subject matter experts and MOMS clinical advisory panel
Tested by pilot sites
Development
47
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