PERINATAL OPIOID USE AND NEONATAL ABSTINENCE SYNDROME IN MASSACHUSETTS
Perinatal opioid use and neonatal abstinence syndrome (NAS) continues to be a major public health concern in Massachusetts. The incidence of mothers, infants, and families impacted by opioid use during pregnancy continues to rise. The percentage of Massachusetts pregnancy-associated deaths noted to be related to substance use increased from 14% in 2011 to 41% in 2014, with opioids the most common substance indicated. The incidence of NAS in Massachusetts continues to rise, increasing from 13.2 per 1000 live births in 2011 to 17.2 per 1000 live births in 2015 (see figure). By comparison, the national rate was 6.0 per 1000 live births in 2013. Numerous state and community organizations have worked over the years to improve the care and outcomes for opioid exposed newborns and their families in Massachusetts. These efforts have included efforts to increase treatment availability through the Bureau of Substance Abuse Services, to improve protocols for screening and monitoring of high-risk families by the Department of Children and Families, to increase partnerships with community-based agencies and peer support programs, and to increase enrollments of infants with NAS in Early Intervention.
CURRENT NEOQIC AND MPQC IMPROVEMENT EFFORTS
Since 2012, NeoQIC has coordinated an initiative targeted towards improving the care of infants with NAS that has included nearly 40 Massachusetts hospitals. Through webinars, statewide summits, data audits, and performance reports, hospital-based multidisciplinary teams systematically identified opportunities to standardize and improve practices. Substantial improvements have been seen in numerous clinical outcomes, including decreased length of stay, decreased length of pharmacologic treatment, and increased use of human milk. In 2015, the MPQC launched a task force focused on the care of mothers with opioid use, and brought together a diverse array of stakeholders and clinical providers to coordinate efforts to improve the care of these women, with a particular focus on increasing provider trainings on medication-assisted treatment for opioid addiction. In addition, the task force developed a comprehensive toolkit of best practices and resources for the care of mothers with opioid use that has been made widely available to providers throughout the state.
2017 PNQIN INITIATIVE ON PERINATAL OPIOD USE AND OPIOID-EXPOSED NEWBORNS
NeoQIC and MPQC are joining efforts through PNQIN to launch a broad statewide initiative to improve the outcomes of infants, mothers, and families impacted by perinatal opioid use. The first joint PNQIN summit on perinatal opioid use was held in November 2016, and the project was launched in early 2017. Numerous state agencies continue to be vital partners, and the project is receiving support from the Department of Public Health and the Health Policy Commission. The initiative seeks to achieve population-level improvements in outcomes for families impacted by perinatal opioid use across the continuum of care (see figure).
· Increase the percent of mothers with opioid use disorder who are in medication-assisted treatment (MAT) during pregnancy;
· Increase family engagement in the care of newborns at risk of NAS, measured by the percent of opioid-exposed newborns receiving their mother’s milk at time of hospital discharge; and
· Increase Early Intervention enrollment among infants with NAS.
· Multi-disciplinary hospital-based improvement teams
· Structured quality improvement education and methods
· Shared database with hospital and statewide progress reports
· Toolkits of best practices
· Webinars and statewide summits