Ad­dress­ing neona­tal ab­sti­nence syn­drome be­fore birth

Modern Healthcare - - BEST PRACTICES - By El­iz­a­beth Whit­man

In 2012, doc­tors and nurses at an OB-GYN clinic in ru­ral Athens County, Ohio, started ob­serv­ing an uptick in preg­nant pa­tients ad­dicted to opi­oids. The clinic’s prac­tice man­ager, Pam Born, who had lived in the county since 1985, had wit­nessed plenty of med­i­cal prob­lems in her 32 years as a reg­is­tered nurse, but this was dif­fer­ent.

The pro­por­tion of ba­bies across ru­ral Amer­ica born de­pen­dent on opi­oids has soared in the past decade or so. This con­di­tion, neona­tal ab­sti­nence syn­drome, causes tremors, vom­it­ing and other with­drawal symp­toms, and height­ens the risk of health com­pli­ca­tions. It is also ex­pen­sive: hos­pi­tal costs for a baby born with the con­di­tion aver­age $66,700, com­pared with $3,500 for ba­bies with­out it.

Many providers were try­ing to treat neona­tal ab­sti­nence syn­drome in ba­bies, Born no­ticed, but fewer sought to pre­vent it by man­ag­ing ad­dic­tion dur­ing preg­nancy. So, en­list­ing help from sev­eral oth­ers at the clinic, she set out to do just that.

They started small. Born found a lo­cal provider that could of­fer med­i­ca­tion-as­sisted treat­ment for opi­oid ad­dic­tion, and she reached out to a team of nurse nav­i­ga­tors at Ohio Univer­sity.

At first, these nurse nav­i­ga­tors worked to sim­ply connect pa­tients with ad­dic­tion ser­vices be­cause the pri­or­i­ties were to pro­vide pre­na­tal care and med­i­ca­tion-as­sisted treat­ment to wean pa­tients off opi­oids.

The pro­gram soon ex­panded, how­ever, as providers re­al­ized that other forms of help—coun­sel­ing, trans­porta­tion hous­ing, food, job train­ing—would im­prove their pa­tients’ chances of over­com­ing ad­dic­tion. Of­ten those ser­vices were al­ready of­fered by state agen­cies; pa­tients just needed to know how to ac­cess them.

Nurse nav­i­ga­tors played a key role in this process. They sched­uled ap­point­ments for pa­tients, co­or­di­nated trans­porta­tion ser­vices, and fol­lowed up to en­sure pa­tients at­tended ap­point­ments.

Also vi­tal was a shared elec­tronic health record sys­tem so that every­one in­volved in a pa­tient’s care was on the same page. Once pa­tients sign a re­lease, nurse nav­i­ga­tors, ad­dic­tion spe­cial­ists and providers at the OB-GYN clinic have ac­cess to a pa­tient’s record and could re­in­force each other’s care plans.

The clinic did that by giv­ing nav­i­ga­tors and be­hav­ioral health providers ac­cess to its cloud-based EHR sys­tem, which was de­vel­oped by Bos­ton-based Athenahealth. “They ba­si­cally just gave them lo­gins and pass­words and they were good to go,” said Dr. Todd Rothen­haus, chief med­i­cal of­fi­cer at Athenahealth.

As for the cost of the ap­proach, it wasn’t much. Many of the pa­tients are en­rolled in Med­i­caid or have in­sur­ance that cov­ers the ser­vices. Trans­porta­tion and new­born sup­plies like di­a­pers con­sti­tuted the big­gest costs.

In 2013, Ohio launched the Ma­ter­nal Opi­ate Med­i­cal Sup­port Pro­ject, a three-year, $4.2 mil­lion grant to four com­mu­ni­ties across Ohio aimed at re­duc­ing the in­ci­dence of neona­tal ab­sti­nence syn­drome. The state pro­gram builds on the ap­proaches pi­o­neered by Born’s team, though she hes­i­tated to take credit for its gen­e­sis. The Athens clinic is par­tic­i­pat­ing in the MOMS pi­lot as part of a pro­ject based at a Health Re­cov­ery Ser­vices fa­cil­ity that’s ex­pected to reach be­tween 90 and 150 preg­nant women.

Early data from the Athens ex­per­i­ment of­fer promis­ing re­sults. From 2014 to 2016 in the state of Ohio, 85.5% of ba­bies born to Med­i­caidel­i­gi­ble women with ad­dic­tion were full-term. In Athens, 93.8% were.

If ru­ral providers else­where want to do the same, they should “look at (their) pa­tients, de­cide the needs, and look at the or­ga­ni­za­tions that are in place al­ready,” Born said. To bring them all to­gether, she said, “there just needs to be a cat­a­lyst.”

Iden­tify pa­tients’ spe­cific needs, such as hous­ing or trans­porta­tion

or­ga­ni­za­tions Look for ex­ist­ing that of­fer these ser­vices

to pa­tient Al­low shared ac­cess records to fa­cil­i­tate co­or­di­na­tion of ser­vices and care Cre­ate a non­judg­men­tal en­vi­ron­ment so that pa­tients de­pen­dent on opi­oids feel safe com­ing for­ward

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