Improving Care for Opioid-Exposed Newborns Adrienne Woike, MS, RN, WHNP Project Director, VCHIP

Vermont Child Health Improvement Program (VCHIP) Population-based maternal and child health services research and quality improvement program of the University of Vermont Mission is to optimize the health of Vermont's children and families by initiating and supporting measurement-based efforts to enhance private and public child health practice and inform policy. VCHIP started in 1999. Housed in the Pediatrics department at the UVM College of Medicine - it’s a private/public partnership with VDH, DVHA, AAP, insurers and others

VCHIP con’t Our Goals are to: Promote change with quality improvement tools, evidence-based guidelines, and expert coaching to aid practitioners in their efforts to achieve optimal health care for children, youth, and families. Support collaboration among public and private health organizations to facilitate meaningful and sustainable improvements in health delivery systems. Share results of successful measurement-based initiatives through trainings and publications that disseminate best practices, highlight effective models of care, and inform policy. Translate new research and methods into practice by combining our expertise in the fields of improvement science, public health, academic and clinical medicine, and health policy. Develop and lead QI projects in Vermont VCHIP also provides technical assistance and expertise to help inform state and national policy to organizations outside Vermont that share our mission.

VCHIP Projects Perinatal Early Childhood ICON (Improving Care for Opioid-Exposed Newborns)* VRPHP (Vermont Regional Perinatal Health Project)* Early Childhood Universal Developmental Screening Improving Care for Children with Chronic Illness State-wide Quality Improvement Child Health Advances Measured in Practice (CHAMP) Care Coordination This is a list of some of the projects currently ongoing at VCHIP, it is not comprehensive CHAMP - network of practices that engage in collaborative improvement activities to meet the evolving needs of health care professionals, children, and families. - Covers different topics every year. Recently have done immunization rates, adolescent depression screening, promoting healthy weight in pediatrics, asthma care, currently doing Mastering the Metrics of Health Care Reform – developmental screening and adolescent well-care visits

ICON Project goal To improve health outcomes for Medicaid-eligible, opioid-exposed infants by improving availability, access, efficiency and coordination of care and services for opioid-dependent pregnant and parenting women and their infants. Through collaboration, data collection and review, and quality improvement activities, ICON: provides support to health care professionals who care for this population improves systems for implementation of current guidelines and best practice recommendations for care. ICON provides training sessions for professionals; convenes collaborative conference calls; and provides tools and resources relating to substance abuse screening, treatment and service provision to partners across Vermont including but not limited to community hospital teams, primary care practitioners, non-profit organizations and MCH community workers

ICON Database ICON maintains a database with information from UVMMC on their population of opioid-dependent pregnant women and their opioid-exposed infants. These and other data provide the framework used to assess the impact of ICON’s work, identify gaps in care and continuously improve our efforts. Database includes data from moms who delivered at UVMMC and their babies, as well as on opioid exposed infants who were born at community hospitals and transported to UVMMC for observation and/or treatment

VRPHP The mission of VRPHP is to be a high-quality academic health care resource for education, skills competencies and quality improvement in perinatal health care. We partner with the VDH, community hospitals and multi-disciplinary teams of health care professionals to facilitate timely, effective and patient-centered perinatal health care in a rural setting.

VRPHP data Collects and analyzes perinatal data from the 11 VT community birthing hospitals to: support knowledge- and skills-based education and quality improvement activities, directed at both preventative and acute perinatal health care services at Vermont community hospitals assess changes in the delivery of perinatal health care services and health outcomes among community hospitals that serve VT Medicaid-eligible women and newborns. Collect data on numerous measures including opioid-exposed pregnant women and their infants Use this data to look at hospital outcomes over time as well as to compare between community hospitals. Each hospital gets a report at the end of the year with their data identified, and compared to the other hospitals which are de-identified

Data ICON data gives us information on mothers and babies from UVMMC More in-depth data and longer-term follow-up VRPHP data gives us information on mothers and babies from VT community hospitals Data is only directly around pregnancy and immediate post-partum time frame

Opioid-exposed newborns at UVMMC Includes newborns born at UVMMC and transported to UVMMC

Maternal MAT Use MOTHER – Maternal Opioid Treatment: Human Experimental Research Looked at buprenorphine vs methadone 2015 – possibly 21 born without treatment – unsure exact number due to transports

Infants receiving Pharmacologic Therapy Currently around 20% of infants born to mothers on MAT are receiving pharmacologic therapy. At UVMMC they generally treat babies with Morphine – most other hospitals (in VT and out) use morphine.

Length of Stay for opioid-exposed newborns LOS almost twice as long if infant is treated in patient for NAS symptoms. However LOS with methadone is generally shorter than with morphine.

Length of Outpatient Treatment Generally about 80% of infants treated with pharmacologic therapy in patient are discharged home on methadone. They are slowly wean over a few weeks to months. Average length of treatment is around 2-2.5 months outpt

Opioid-exposed infants discharged home with parents Infants discharged home with parents dropped significantly in 2015. Cannot say why for sure, possibly due to passage of Act 60. Will see if this trend continues in 2016.

Developmental Screening Perform the Bayleys developmental screening 8-14 months of age

Trends in Number of Live Born Opioid Exposed Infants This is showing the 11 community hospitals over time – each point is a year. 1 2 3 4 5 6 7 8 9 10 11

Opioid Exposed Born at VT Community Hospitals - 2015 Total infants % of infants Mothers receiving prescribed treatment Maternal Tobacco Use Infants receiving treatment Median LOS (days) Transported 1 17 7.9% 10 5 2 2.3% 4 3 10.2% 12 6 2.7% 7 8 3.8% 32 7.6% 28 25 35 7.3% 29 9 8.0% 22 21 11 54 14.0% 53 50 13 3.6% Total 218   37 Not all transport to UVMMC, some to DHMC or Albany – in 2015 possibly 13 transported to UVMMC? Only 5 hospitals treat babies with morphine for NAS symptoms. Rest transport to higher level of care. RRMC, CVMC, SVMC, BMH, Gifford

Neonatal Transports of Opioid Exposed Infants

Median Length of Stay for Non-Transported Opioid Exposed Infants

Questions? Contact Adrienne.woike@med.uvm.edu 802-656-9191