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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

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Managing the Mother-Baby Dyad Affected by Substance Disorder: A Statewide Quality Collaborative Initiative.

Kimberly Spence¹, Alison Williams²

¹Associate Professor of Pediatrics, Division of Neonatal-perinatal Medicine, Saint Louis University School of Medicine and Chair of SSM Cardinal Glennon Ethics Team, SLUcare-SSM Health, St. Louis.

Missouri Medicine

|June 10, 2024

Summary

A quality improvement project standardized care for mothers and infants affected by substance abuse disorder (SUD). This initiative improved screening, reduced infant transfers, and enhanced discharge plans for the mother-baby dyad.

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Area of Science:

Perinatal Health
Substance Abuse Disorders
Quality Improvement in Healthcare

Background:

Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS) and Substance Abuse Disorder (SUD) significantly impact maternal and infant outcomes.
Effective care requires a dyadic approach, treating mothers and infants together.
Standardized care protocols are crucial for improving outcomes in this population.

Purpose of the Study:

To implement and evaluate a statewide quality improvement (QI) project aimed at standardizing care for the mother-baby dyad affected by SUD.
To assess the impact of a telehealth-supported collaborative on care delivery for substance-exposed newborns and their mothers.
To promote cross-sector collaboration for improved perinatal SUD care.

Main Methods:

A statewide QI project was initiated by the Missouri Hospital Association (MHA) in partnership with Show-Me ECHO, a telehealth project.
Fourteen hospitals participated from January 2021 to December 2022, utilizing the ECHO model and technical support.
Key performance indicators included non-pharmacologic policy implementation, maternal SUD screening rates, infant transfer rates, and safe care discharge plans.

Main Results:

100% of participating birth centers implemented a non-pharmacologic policy for substance-exposed newborns.
Maternal SUD screening increased significantly by 67.3% (from 57.5% to 96.2%).
Infant transfer rates decreased by 24%, while safe care discharge plans increased by 37% for infants and 144% for mothers.

Conclusions:

The collaborative demonstrated the feasibility and effectiveness of a statewide, cross-sector QI initiative for mother-infant dyads affected by SUD.
Standardized, dyadic care, supported by telehealth, significantly improved key quality metrics.
This model offers a scalable approach to enhance perinatal SUD care and improve maternal and infant outcomes.