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Transitions of Care From Birth to Outpatient Care for Infants Who Have Been Prenatally Substance-Exposed
Kathleen E Hannan1, Venice Ng Williams2, Sunah S Hwang1
1Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado.
Insights
Improving care transitions for infants prenatally substance-exposed (IPSEs) requires addressing system-level barriers and enhancing communication. Integrating nonmedical personnel and de-siloing clinical care groups are key to optimizing outcomes for IPSEs and their families.
Area of Science:
- Neonatal care
- Public health
- Health services research
Background:
- Infants prenatally substance-exposed (IPSEs) require coordinated care transitions from birth hospitalization to home.
- Effective care transitions are crucial for optimizing health outcomes and family support for IPSEs.
- Identifying multilevel factors influencing these transitions is essential for improving care quality.
Purpose of the Study:
- To identify multilevel factors impacting care transitions for infants prenatally substance-exposed (IPSEs) and their families.
- To explore clinician and staff perspectives on facilitators and barriers to successful care transitions.
- To inform strategies for optimizing the transition of care from inpatient to outpatient settings for IPSEs.
Main Methods:
- Qualitative study utilizing semistructured interviews with 17 inpatient and outpatient clinicians and clinical staff.
- Participants were recruited from hospitals involved in the Colorado Hospital Substance Exposed Newborn Quality Improvement Collaborative (CHoSEN QIC).
- Inductive thematic analysis was conducted using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
Main Results:
- Outer-context facilitators/barriers included the need for standardized patient identification, integrated care systems, and addressing sociopolitical challenges like policy lag.
- Inner-context facilitators/barriers involved building family rapport, optimizing medical team communication, leveraging nonmedical staff for coordination, and early discharge disposition planning.
- Themes spanned across multiple levels, highlighting interconnectedness of factors influencing care transitions.
Conclusions:
- De-siloing clinical care groups and enhancing communication among providers are critical for families affected by substance use.
- Incorporating key nonmedical personnel into care coordination is essential.
- Integrating care and communication across systems represents a crucial next step for optimizing care for IPSEs.
Objective:
The birth hospitalization for infants prenatally substance-exposed (IPSEs) is a critical opportunity to connect with families and optimize the transition of care from inpatient to outpatient settings. Through qualitative interviews with clinicians and clinical staff, we sought to identify multilevel factors that impact care transitions from birth hospital to home for IPSEs and their families.
Methods:
We recruited inpatient and outpatient clinicians and clinical staff (N = 17) from hospitals participating in the Colorado Hospital Substance Exposed Newborn Quality Improvement Collaborative (CHoSEN QIC), a state-based perinatal quality initiative focused on standardizing the care of IPSEs, for semistructured interviews. Multiple coders engaged in inductive thematic analysis, using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to generate thematic memos across participants.
Results:
We identified facilitators and barriers within and across levels of the outer and inner context. Outer-context themes included the need for standardized patient identification, integrated care systems for effective transitions, and sociopolitical context, including challenges with changing laws and lagging policies. Inner-context themes included the value of rapport building with families, optimization of medical team communication, critical role of nonmedical team members for care coordination, and the importance of early identification of discharge disposition.
Conclusions:
Participants across inner and outer contexts highlighted the importance of de-siloing clinical care groups serving families affected by substance use, including the need for enhanced communication among groups and the importance of incorporating key nonmedical personnel. Integrating care and communication across systems will be crucial next steps for optimization of care of this population.
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