Through collaborative use of improvement science methods, reduce preterm births & improve
perinatal and preterm newborn outcomes in Ohio as quickly as possible.
Welcome!
MOMS Plus ProjectSeptember Action Period Call
Ohio Perinatal Quality Collaborative
September 20, 2019
Through collaborative use of improvement science methods, reduce preterm births & improve perinatal and preterm newborn outcomes in Ohio as quickly as possible.
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Welcome to the OPQC
MOMS Plus Action Period Webinar
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3
Time Topic Presenter
12:00 pm Welcome & Agenda Review Susan Ford, MSN, RN
12:05 pm Data Updates and Review Susan Ford
12:15 pm Revised & Renewed Key Driver Diagram Mike Marcotte, MD
OPQC faculty; Good Samaritan Tri-Health
12:30 pm Team Discussion• What tools that align with the drivers have
been helpful in providing care for the
pregnant woman with OUD?
All Teams
12:55 pm Next Steps Susan Ford
Agenda
5
SMART Aim
Key Drivers Interventions
By June 30, 2019 we will:
Optimize maternity medical home to
improve outcomes for pregnant
women with opioid use disorder
(OUD) as measured by:
• Increased identification of
pregnant women with OUD
• Increased % of women with OUD
during pregnancy who receive
prenatal care (PNC), Medication
Assisted Treatment (MAT) and
Behavioral Health (BH)
counseling each month
• Decreased % of full-term infants
with Neonatal Abstinence
Syndrome (NAS) requiring
pharmacological treatment
• Increased % of babies who go
home with mother
Project Leader: Carole Lannon (PI)
Optimize the health and well-being
of pregnant women with opioid use
disorder and their infants
Global Aim
Pregnant women with
opioid use disorder
Population
Revision Date: 5/21/2018
MOMS+ Project
Key Driver Diagram (KDD)
Timely identification
and tracking of
pregnant women with
opioid use disorders
Compassionate and
coordinated care
Empowerment of
women through
community based
services
Supported
mother/infant dyad
post delivery
• Complete a standardized screening tool on each patient to accurately identify and
diagnose pregnant women with OUD (e.g. 5 P’s, NIDA Quick Screen).
• Establish a coordinated referral system with BH providers, MAT providers, drug courts,
prisons, homeless shelters, and ERs.
• Utilize a tracking system (e.g.. Database, spreadsheet) to follow pregnant women with OUD
history/diagnosis and all babies with prenatal opiate exposure.
• Check OARRS per prescribing protocols.
• Connect women to vocational training opportunities as applicable
• Involve community partners including referrals to faith-based organizations to support
pregnant women with OUD (e.g. support groups, shelters, food pantries, etc.)
• Complete training in trauma informed care and addiction as a chronic illness to provide non-
judgmental support for pregnant women with OUD
• Designate a care coordinator to arrange referrals and ongoing communication between the
trans-disciplinary care team.
• Provide immediate support/counseling at time of identification by OB/FP by using
standardized interviewing techniques.
• Implement a process to prevent acute opiate withdrawal by initiating MAT• Implement a standardized process for referral to appropriate/necessary resources for women
with a positive screen for OUD.
• Coordinate care between OB, BH, MAT, NICU/Pediatrics by regularly reviewing shared
patients (e.g. multi-disciplinary care conference, huddle).
• Tailor counseling and support for healthy behaviors based on patient-specific situation/need
during pregnancy (sobriety, smoking cessation, stable housing and birth spacing (LARC)),
with referral to community resources as needed to augment medical resources.
• Consider implementing or referral to OUD specific Centering Pregnancy© program
• Coordinate Prenatal consultation for pregnant women with OUD with
Neonatology/Pediatrics to discuss Neonatal Abstinence Syndrome (NAS)
• Ensure mom and baby have a Patient Centered Medical Home (post-delivery)
• Provide a warm handoff to pediatric care provider for infant post discharge (e.g.
call/consultation and newborn/maternal summary)
• Provide lactation consultation (if applicable), post partum depression screening and
contraceptive counseling
• Prenatal referral for pregnant women with OUD to Community Health Workers and/or home
visitation programs (dependent on region)
• Postnatal referral or consideration to Help Me Grow and/or parenting classes
• Facilitate continuation and retention of OUD treatment and services during pregnancy and
post-delivery occur (e.g. support of ongoing MAT maintenance services, training care
providers to recognize signs of relapse and that mom is continuing in her treatment
program)
• Coordinate with Department of Job & Family Services/Child Protective Services regarding
reporting requirements and infant plan of safe care
SMART Aim
Key Drivers Interventions
By XX date, 2020 we will:
Optimize maternity medical home to
improve outcomes for pregnant
women with opioid use disorder
(OUD) as measured by:
• Increased identification of
pregnant women with OUD
• Increased % of women with OUD
during pregnancy who receive
prenatal care (PNC), Medication
Assisted Treatment (MAT) and
Behavioral Health (BH)
counseling each month
• Decreased % of full-term infants
with Neonatal Abstinence
Syndrome (NAS) requiring
pharmacological treatment
• Increased % of babies who go
home with mother
Project Leader: Carole Lannon (PI)
Optimize the health and well-being
of pregnant women with opioid use
disorder and their infants
Global Aim
Pregnant women with
opioid use disorder
Population
Revision Date: 8/30/2019
MOMS+ Project
Key Driver Diagram (KDD)
Compassionate care/
culture change
Identification of
pregnant women with
OUD
Supportive care
and monitoring
during pregnancy
Connection to
postpartum support
• Provide training in trauma informed care and addiction as chronic disease
for clinical practitioners
• Ongoing support for practice culture change
• Identify a care coordinator to provide ongoing support and assist with referrals and
ongoing communication among the multi-disciplinary care team.
• Use tracking system to monitor care of pregnant women with OUD diagnosis (e.g..
Database, spreadsheet)
• Use standardized checklist for maternity care of the pregnant patient with
OUD
• Coordinate care among OB, BH, MAT, care navigator by regularly reviewing
shared patients (e.g. multi-disciplinary care conference, huddle).
• Tailor counseling and support for healthy behaviors based on patient-specific
situation/need during pregnancy (sobriety, smoking cessation, stable housing and
future contraception plan) with referral to community resources as needed to
augment medical resources.
• 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).
• At time of identification, assess need to prevent acute opiate withdrawal by
initiating or referring to MAT
• Establish connections for coordinated referral to maternity care from BH and MAT
providers, drug courts, prisons, homeless shelters, and ERs.
• Ensure mom and baby have a Patient Centered Medical Home (post-delivery)
• Provide a warm handoff to pediatric care provider for infant post discharge
• Provide lactation consultation (if applicable), post partum depression screening
and contraceptive counseling; and ”normalization” of postpartum transition
(overwhelmed)
• Facilitate continuation of OUD treatment and services post-delivery occur
• Coordinate with Department of Job & Family Services/Child Protective Services
regarding reporting requirements and infant plan of safe care
Key Drivers Interventions
Project Leader: Carole Lannon (PI) Revision Date: 8/30/2019
MOMS+ Project
Key Driver Diagram (KDD)
Compassionate care/
culture change
Identification of
pregnant women with
OUD
Supportive care
and monitoring
during pregnancy
Connection to
postpartum support
• Provide training in trauma informed care and addiction as chronic disease for clinical
practitioners
• Ongoing support for practice culture change
• Identify a care coordinator to provide ongoing support and assist with referrals and ongoing
communication among the multi-disciplinary care team.
• Use tracking system to monitor care of pregnant women with OUD diagnosis (e.g..
Database, spreadsheet)
• Use standardized checklist for maternity care of the pregnant patient with OUD
• Coordinate care among OB, BH, MAT, care navigator by regularly reviewing shared
patients (e.g. multi-disciplinary care conference, huddle).
• Tailor counseling and support for healthy behaviors based on patient-specific situation/need
during pregnancy (sobriety, smoking cessation, stable housing and future contraception
plan) with referral to community resources as needed to augment medical resources.
• 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).
• At time of identification, assess need to prevent acute opiate withdrawal by initiating or
referring to MAT
• Establish connections for coordinated referral to maternity care from BH and MAT providers,
drug courts, prisons, homeless shelters, and ERs.
• Ensure mom and baby have a Patient Centered Medical Home (post-delivery)
• Provide a warm handoff to pediatric care provider for infant post discharge
• Provide lactation consultation (if applicable), post partum depression screening and
contraceptive counseling; and ”normalization” of postpartum transition (overwhelmed)
• Facilitate continuation of OUD treatment and services post-delivery occur
• Coordinate with Department of Job & Family Services/Child Protective Services
regarding reporting requirements and infant plan of safe care
Tools
• Trauma Informed care
training programs?
• Screening tool (5Ps, NIDA,
etc)
• SBIRT pocket guide
• Suggested script for
patient consent into
registry
• MOMS+ Data Registry
• OPQC OUD Checklist
• “Stoplight” template for
inter- disciplinary care
conference (Good
Samaritan Tri-Health)
• Working on Plan of Safe
Care prenatally with mom
(ODJFS CARA Brochure
MOMS form)
Poll Question:
• Do you use the OPQC MOMS+ SharePoint
site to access any of these tools?
□ Yes, I use the SharePoint site to access these
tools
□ No, I don’t use the SharePoint site to access
these tools
Access SharePoint
• Live demo
All Teach ~ All LearnWhat tools are utilized by your team?
16
To submit a question to the presenters, type your question or
comments into the CHAT box and hit send
Type your
questions and
comments here
Key Driver
Interventions
MOMS+ Project
Key Driver Diagram (KDD)
Compassionate
care/ culture
change
• Provide training
in trauma
informed care
and addiction as
chronic disease
for clinical
practitioners
• Ongoing support
for practice culture
change
Tools
• What are some trauma
Informed care training
programs teams might
have used?
MOMS+ Systems Inventory –
Aggregate 2018 (baseline) & 2019 (one year)
18
Poll Question:
• Does your hospital use a screening tool for all
pregnant patients system wide?
□ Yes, we use a screening tool system wide
(please type which tool is used in the chat box)
□ No, we do not use a screening tool system wide
□ Uncertain
□ N/A; I don’t work in a clinical setting and/or hospital
system
Key Driver Interventions
MOMS+ Project
Key Driver Diagram (KDD)
Identification of
pregnant women with
OUD
• 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).
• At time of identification, assess need to prevent
acute opiate withdrawal by initiating or referring to
MAT
• Establish connections for coordinated referral to
maternity care from BH and MAT providers, drug
courts, prisons, homeless shelters, and ERs.
Tools
• Screening tool (5Ps,
NIDA, etc)
• SBIRT pocket guide
Poll Question:
• Does your practice use a checklist in the care
of the pregnant patient with OUD?
□ Yes, we use the OPQC checklist
□ Yes, we use our own checklist
□ No, we don’t currently use a checklist
□ N/A; I don’t work directly with the patient
Key Driver Interventions
MOMS+ Project
Key Driver Diagram (KDD)
Supportive
care and
monitoring
during
pregnancy
• Identify a care coordinator to provide ongoing support and assist with referrals and ongoing
communication among the multi-disciplinary care team.
• Use tracking system to monitor care of pregnant women with OUD diagnosis (e.g..
Database, spreadsheet)
• Use standardized checklist for maternity care of the pregnant patient with OUD
• Coordinate care among OB, BH, MAT, care navigator by regularly reviewing shared
patients (e.g. multi-disciplinary care conference, huddle).
• Tailor counseling and support for healthy behaviors based on patient-specific situation/need
during pregnancy (sobriety, smoking cessation, stable housing and future contraception plan)
with referral to community resources as needed to augment medical resources.
Tools
• Suggested script for patient
consent into registry
• MOMS+ Data Registry
• OPQC OUD Checklist
• “Stoplight” template for inter-
disciplinary care conference
(Good Samaritan Tri-Health)22
MOMS+ Project
Key Driver Diagram (KDD)
Tools
• Suggested script for patient consent into registry
• MOMS+ Data Registry
• OPQC OUD Checklist
• “Stoplight” template for inter- disciplinary care
conference (Good Samaritan Tri-Health)
23
Poll Question:
• Does your practice work with the patient to
complete a plan of safe care prior to delivery?
□ Yes, we work with the patient to complete this prior
to delivery
□ No, we do not work with the patient to complete this
prior to delivery
□ N/A; I don’t work directly with the patient
Key Drivers Interventions
MOMS+ Project
Key Driver Diagram (KDD)
Connection
to
postpartum
support
• Ensure mom and baby have a Patient Centered Medical Home
(post-delivery)
• Provide a warm handoff to pediatric care provider for infant post
discharge
• Provide lactation consultation (if applicable), post partum depression
screening and contraceptive counseling; and ”normalization” of
postpartum transition (overwhelmed)
• Facilitate continuation of OUD treatment and services post-delivery
occur
• Coordinate with Department of Job & Family Services/Child
Protective Services regarding reporting requirements and
infant plan of safe care
Tools
• Working on Plan
of Safe Care
prenatally with
mom (ODJFS
CARA Brochure
MOMS form)
Ideal care for the mother-infant dyad
during the first year post-partum
Next Steps
MOMS Plus Project
• Teams:
- The next MOMS+ Action Period Call will be
Friday, October 18th at 12N
– Suggested PDSA: Test one of the
suggested tools aligned with the
updated/renewed KDD
• Key Contacts:
– Review/submit Monthly Progress Report; the
September MPR will be sent out next
Wednesday 9/25/1927
It takes a village…
The MOMS+ Project is funded by the Medicaid Technical Assistance and Policy Program (MEDTAPP) and administered by the Ohio Colleges of Medicine Government
Resource Center. The views expressed in this meeting are solely those of the authors and do not represent the views of state or federal Medicaid programs.
