Ohio’s Multi-Pronged Approach to Addressing the Opioid Crisis
Since 2007, the Ohio Perinatal Quality Collaborative (OPQC)—a statewide consortium of perinatal clinicians, hospitals, policy makers and governmental entities—has leveraged quality improvement (QI) science to significantly improve birth outcomes for moms and babies across Ohio. Their achievements include reducing early elective deliveries by 75 percent across the state and a statewide progesterone program that reduced preterm birthrates before 32 weeks by 20 percent in at-risk women. The OPQC’s successful projects illustrate the potential of leveraging the QI framework and powerful statewide partnerships to drive population level improvement. In its efforts, the OPQC has partnered with a number of stakeholders, including the Ohio Department of Medicaid, the Ohio Department of Health, the Ohio Department of Mental Health and Addiction Services, and the Ohio Chapter of the March of Dimes.
In recent years, the OPQC has started addressing the thousands of families affected by the opioid crisis and is testing innovative strategies for improvement.
The OPQC is one of 47 state and multi-state PQCs working with the National Network of Perinatal Quality Collaboratives (NNPQC), a Centers for Disease Control and Prevention-funded initiative seeking to improve maternal and infant health outcomes by advancing evidence-informed clinical practices. More than a quarter of NNPQC teams are working on projects that address maternal opioid use disorder and neonatal opiate withdrawal syndrome, reflecting an urgent national need for improvement.
“As one of the first PQCs, Ohio is an invaluable mentor for states who are earlier in development,” says NICHQ NNPQC Executive Project Director Pat Heinrich, RN, MSN, CLE. “Their innovative work around Opioid Use Disorder (OUD) illustrates the effectiveness of their QI approach, and their lessons-learned and strategies can and should be spread to hospitals, communities, and states across the country. We need to do more to help mothers and babies affected by this national public health crisis.”
OUD among pregnant mothers in Ohio has dramatically increased, growing by 491 percent between 2004 and 2011. This escalation corresponds to a spike in babies born with neonatal abstinence syndrome (NAS), which can cause babies to experience painful drug withdrawal symptoms resulting in prolonged hospitalizations and can potentially adversely affect their long-term health outcomes.
Recognizing that the crisis had reached epidemic proportions, the OPQC worked with state partners to develop a multipronged improvement strategy focused on providing comprehensive care for the mother-infant dyad. Below, the OPQC shares four core elements of their approach so that state and hospital improvement teams can learn alongside them.
Standardize identification and treatment for opioid exposed infants in Neonatal Intensive Care Units (NICUs)
Between 2014 and 2018, the OPQC collaborated with more than 50 NICUs across the state (96 percent of all Ohio NICUs). Over the course of the project, participating hospitals cared for 9,600 babies born exposed to opiates.
“When we started this work, there was significant variation in how these infants were treated in the NICU—because there was no standardized protocol for NAS treatment—and there were large differences in length of stay,” explains Carole Lannon, MD, MPH, the Collaborative Science Lead for the OPQC. “We built on work done by the six children’s hospitals of the Ohio Children’s Hospital Association, and supported the hospital NICUs in adopting a set of straightforward evidence-based practices, called bundles; standardizing care; and then helping people understand that it was safe and effective.”
Breastfeeding, which has numerous benefits for mothers and babies, is an important part of the nonpharmacological approach. But not all mothers could immediately breastfeed. Hospitals were uncertain about which formula would work best for babies with NAS who could not get mom’s milk, so they used an innovative quality improvement method to test the different formulas across four different groups of hospitals. The OPQC discovered that a high calorie formula had the best outcomes in terms of reducing NAS symptoms. The non-pharmacologic bundle was updated to recommend high calorie formula when breastmilk is unavailable, and the new bundle was implemented widely across the collaborative.
Racially Motivated Violence is a Children’s Health Issue
In the wake of recent mass shootings in Buffalo, Uvalde, and Highland Park, and too many others, we discuss the mental health implications of racially motivated and gun violence on children and their families with Stacy Scott, PhD, MPA, Executive Project Director and Equity Lead at NICHQ, and Becky Russell, MSPH, Senior Director of Applied Research and Evaluation at NICHQ.
NICHQ Employee Spotlight: Kenn Harris
Here, NICHQ Executive Project Director and Engagement Lead Kenn Harris shares his experience with the Federal Healthy Start Program and encourages organizations to dive deeper when addressing equity.
To Improve Maternal Health, We Must Depoliticize Racial Equity
Earlier this year, data from the Centers for Disease Control and Prevention (CDC) showed that maternal mortality rates increased during the first year of the pandemic, continuing a decades-long trend of increasing pregnancy-related deaths. With our Joint Organizational Commitment, NICHQ acknowledges that racism is a public health crisis and lays out our commitments to critically analyze and change our organizational systems with the goal of advancing racial equity.
Look for NICHQ at Upcoming Spring Maternal Child Health Conferences
Teams at the National Institute for Children’s Health Quality are preparing for an exciting spring 2022 conference season, where staff will provide keynote addresses, give poster presentations, and facilitate workshops at a variety of national maternal and child health conferences.
NICHQ Employee Spotlight: Ashidah Baker, Associate Director of Human Resources
NICHQ Associate Director of Human Resources Ashidah Baker, shares insight about NICHQ’s HR policies and practices and how they're reflective of the organization's equity journey.
New Roadmap Provides Framework for Engaging Patient and Family Partners in Quality Improvement
Patient and family partnerships are an essential element of health equity. By supporting patient and family voices and encouraging space for collaboration, public health professionals can help ensure shared vision and values are at the forefront of determining solutions to improve a community’s health outcomes. The National Institute for Children’s Health Quality (NICHQ) and the Florida Department of Health Office of Children’s Medical and Specialty Services have recently developed a Roadmap to Inviting, Engaging, and Including Patient/Family Partners in Quality Improvement and Other Related Initiatives.