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

Through collaborative use of improvement science methods, reduce preterm births & improve perinatal and preterm

newborn outcomes in Ohio as quickly as possible.

MOMS Plu lus Project

November Action Period Call

Ohio Perinatal Quality Collaborative

November 15, 2019

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Welcome

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Housekeeping: Participant Code

➢ PLEASE BE CERTAIN TO USE YOUR PARTICIPANT CODE!! ➢#participant code#

This call will now be recorded

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Housekeeping: Chat box

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

Today’s Presenters

Today’s Facilitators Project Management Team

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Mike Marcotte, MD TriHealth/ OPQC Faculty Mentor Andrea Hoberman, MPH OPQC QIC Jalea Stowers-Grimes, BBA OPQC Project Specialist Cole Jackson, MS OPQC Project Specialist

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

• OB-GYN Tri-Health
• Family Practice Summa Health
• Pediatrics MetroHealth

Mike Marcotte, MD Lynn Hamrich, MD Anne Valeri-White, DO Philip Fragassi, MD All Teach ~ All Learn Team sharing regarding the case scenario All participants 12:50 pm Next steps/Wrap up Andrea Hoberman

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SMART Aim Key Drivers Interventions

By January 31, 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

• pioid 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 tracking 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

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Mike Marcotte, MD

Postpartum transitions to care

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• “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.

Case Scenario:

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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)

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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

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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

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Transitions to care - initial visit components

• Family Practice
• Pediatrics

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Summa Health Nursery Transitions

Anne Valeri, DO, FAAFP Lynn Hamrich, MD, FAAFP

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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

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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

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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

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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

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Metro Health

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Philip A. Fragassi, MD Department of Pediatrics

MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.

Primary Care Provider Role

As in other health conditions, self- management, with mutual support, is very important in recovery from addiction.

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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.

Mother and Child Dependency Program

Multidisciplinary Clinic at MetroHealth

• MFM
• Addiction psychiatry
• Social work coordinators
• Neonatology
• Pediatrics
• Developmental pediatrics
• Liver/ID

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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.

Important Components of Care for Prenatally Exposed Children

• Medical issues
• Assessment of Maternal Recovery and

Mental Health

• Documentation
• Follow Up
• Community Resources

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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.

Medical Issues

• Hep C status and Follow-up (one negative Antibody test

after age 18 months)

• Developmental testing and referral (healthy start, pre-

school special education)

• Mental Health issues in child to include grief and PTSD

(psychology or pediatric behavioralist)

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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.

Documenting on the Patient (MOM1)

• Person being interviewed ***.
• What drugs did you use during your pregnancy? ***
• Have you ever used IV drugs (injected with a needle in your vein?) ***
• Do you know your Hepatitis C status? ***
• Are you currently on methadone or suboxone? ***
• What is your current dose? ***
• Who has custody of the baby/child? ***
• Is the father of your baby involved? *** Is he using any drugs presently? *** Do

you feel safe in your home? ***

• Are you signed up for WIC for your baby? ***
• Do you have any transportation needs? ***

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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.

MOM2

• Person being interviewed ***.
• Are you currently on methadone or suboxone? ***
• What is your current dose? ***
• Have you relapsed within the last year? ***
• Who has custody of the baby/child? ***
• Is the father of your baby involved? *** Is he using any

drugs presently? *** Do you feel safe in your home? ***

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What does this look like in your region or site?

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All Teach ~ All Learn

What are essential elements of care you have been providing to mom that you include when handing off the dyad care to the pediatrician or Family Practice team?

For audio/telephone: *6 : Mute or Unmute To chat; type in question/comment and hit submit

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Suggested PDSA…

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Upcoming webinar…

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Hosted by: U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health – Region 5 For more information: Michelle.Hoersch@hhs.gov Direct link to webinar: https://www.mymeetings.com/nc/join.php?i=PWXW963349 7&p=4674812&t=c

Upcoming webinar…

Next steps

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Teams:

• The next MOMS+ Action Period Call will be Friday, December 20th

from 12N – 1pm Suggested PDSA: select ONE element of the handoff to peds/FP discussed on today’s call to test in your practice setting Key Contacts: Review/submit Monthly Progress Report; the November MPR will be sent out Monday, December 2nd and DUE on December 11th

It takes a village…

The MOMS Plus 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.