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.

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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

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

Mother and Child Dependency Program Multidisciplinary Clinic at MetroHealth • MFM • Addiction psychiatry • Social work coordinators • Neonatology • Pediatrics • Developmental pediatrics • Liver/ID MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching. 32

Important Components of Care for Prenatally Exposed Children • Medical issues • Assessment of Maternal Recovery and Mental Health • Documentation • Follow Up • Community Resources MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching. 33