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OB Prenatal Education Project Table of Contents:

New York State (NYS) Opioid Use Disorder (OUD) in Pregnancy & Neonatal Abstinence Syndrome (NAS) Project

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Background
According to New York State Department of Health (NYSDOH) administrative data, the rate of opioid overdose deaths for females of reproductive age, 18 to 44 years old, has tripled, from 4.2 per 100,000 in 2010, to 12.7 per 100,000 in 2016.  Further, between 2010 and 2014, the incidence of Neonatal Abstinence Syndrome (NAS) in New York State (NYS) has increased 79%, from a rate of 2.9 cases per 1,000 live births in 2010, to 5.2 cases per 1,000 live births in 2014.

Leadership
In response to this growing issue, the NYSDOH’s New York State Perinatal Quality Collaborative (NYSPQC) has joined together with the American College of Obstetricians and Gynecologists (ACOG) District II, Healthcare Association of New York State (HANYS), Greater New York Hospital Association (GNYHA) and National Institute for Children’s Health Quality (NICHQ) to work with NYS birthing hospitals through a quality improvement learning collaborative, the NYS OUD in Pregnancy & NAS Project. 

These lead organizations have convened a clinical advisory work group to guide the work of the project.  The work group, which meets monthly, includes: specialists in maternal-fetal medicine, obstetrics, pediatrics/neonatology, anesthesiology and chemical dependence; and staff from the NYS Office of Alcoholism and Substance Abuse Services (OASAS).  The NYS OASAS is specifically assisting with identifying and communicating linkages to services and education.
New York is participating in the national Alliance for Innovation on Maternal Health (AIM) Program, led by the national ACOG. The AIM project is focused on reducing severe maternal morbidity and mortality. The NYS OUD in Pregnancy & NAS Project aligns with the national AIM project focused on maternal OUD.

Goals
The NYS OUD in Pregnancy & NAS Project, which began in November 2018, seeks to identify and manage women with OUD during pregnancy, and improve the identification, standardization of therapy and coordination of aftercare of infants with NAS.
The project’s goal of improving the identification and treatment of pregnant women with OUD is being achieved by:

  • Delivering provider and patient education;
  • Implementing universal screening (verbal);
  • Improving the management of patients during labor, delivery and immediately postpartum;
  • Coordinating discharge care; and
  • Collaborating across hospital teams to share and learn.

The project’s goal of improving the care of infants with NAS is being achieved by:

  • Delivering provider and patient education;
  • Improving early identification of infants at risk;
  • Improving the management of patients using standardized NAS treatment protocols, including pharmacological and non-pharmacological management;
  • Coordinating discharge care; and
  • Collaborating across hospital teams to share and learn.

Participating Pilot Hospitals
Seventeen NYS birthing hospitals from diverse geographic areas, and representing all levels of NYSDOH perinatal designations, are engaged in the pilot phase of the project.  Teams from these hospitals are learning and applying key principles to improve care and implement the core interventions, and associated measures, as the primary focus of their work.  These core interventions are based on currently available scientific evidence. As part of the improvement process, teams are also learning quality improvement strategies, and collecting data that is sensitive to the changes they are testing and implementing, to track performance and results. 

Measurement
Measures for the NYS OUD in Pregnancy & NAS Project focus on:

  • Opioid Use Disorder in Pregnancy
    • Percent of women with OUD during pregnancy who receive medication assisted treatment (MAT) or behavioral health treatment;
    • Universal screening at prenatal care sites;
    • Universal screening on labor and delivery;
    • General pain management practices;
    • OUD pain management guidelines;
    • Percent of women who were verbally screened for substance use with a screening tool on admission to labor and delivery;
    • Percent of women with OUD at time of delivery; and
    • Percent of women with a referral to MAT or other treatment for opioid use.
  • Neonatal Abstinence Syndrome
    • Average length of stay for newborns with NAS; 
    • Percent of Opioid Exposed Newborns (OEN) receiving mother’s milk at newborn discharge;
    • Percent of OEN who go home to biological mother;
    • Percent of newborns diagnosed as affected by maternal use of opiates; and
    • Percent of newborns diagnosed with NAS.

Project data is collected monthly through the secure, web-based NYSDOH Health Commerce System.  Data is then analyzed and provided back to individual teams, and to the group in aggregate.

Contact
For more information, visit www.nyspqc.org, e-mail NYSPQC@health.ny.gov, or call 518/473-9883.