MOMS Project Panel Overview

Transcription

1 MOMS Project Panel Overview Rick Massatti, PhD, Ohio Department of Mental Health and Addiction Services Jennifer Bailit, MD, MetroHealth Medical Center Mike Marcotte, MD, Tri-Health Mona Prasad, DO,MPH, -OSU-MCH Through collaborative use of improvement science methods, reduce preterm births & improve perinatal and preterm newborn outcomes in Ohio as quickly as possible.

2 MOMS Project

3 Maternal Opiate Medical Supports In August 2013, the Kasich Administration announced plans to address the epidemic of NAS Maternal Opiate Medical Supports (MOMS) project is a two-year quality improvement initiative that seeks to: Improve maternal and fetal outcome Improve family stability Reduce costs of Neonatal Abstinence Syndrome (NAS)

4 Project Partners State Sponsors Office of Health Transformation Department of Mental Health and Addiction Services Department of Medicaid Pilot Sites CompDrug First Step Home Health Recovery Services MetroHealth Medical Center Clinical Advisory Panel Project Management and Data Infrastructure Ohio Colleges of Medicine Government Resource Center Quality Improvement Vendor Health Services Advisory Group

5 Project Details $4.2 million program over two years Goal was to support interventions and prenatal treatments that improve outcomes for 300 women and babies Funded clinical (e.g., MAT) and non-clinical services (e.g., housing vouchers, transportation, brief babysitting)

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7 Neonatal Abstinence Syndrome in Ohio Rick Massatti, PhD

8 Methods Ohio Hospital Association Statewide clinical and financial database Data submitted by 219 hospitals and 13 health systems. Approximately 99 percent of healthcare systems submit data A few caveats... Aggregate data used Analyses limited to resident Ohioans

9 Neonatal Abstinence Syndrome (NAS) Hospitalizations for NAS Cases were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code (drug withdrawal syndrome in a newborn). Records for infants (age < 1) were pulled if they had applicable ICD-9 CM codes anywhere in discharge fields related to the primary diagnosis or any of the 18 secondary diagnosis fields. The ICD-9 CM code does not distinguish between NAS caused by drugs ingested by the mother versus NAS caused by drugs legitimately given by delivering physicians. The diagnosis of NAS does not include a diagnosis of Fetal Alcohol Spectrum Disorder (ICD-9 CM ).

10 Mother s Drug Abuse at Child s Birth Over 28,800 women were diagnosed with a variety of drug abuse and dependence conditions at their time of delivery between 2004 and The number of delivering women with an abuse or dependence diagnosis increased from 1,554 in 2004 to 4,349 in 2014 (179.9%). Annual diagnosis rates for delivering mothers tripled from 103 per 10,000 live births in 2004 to 310 per 10,000 live births in 2014.

11 Drug Diagnoses at Child s Birth 3,000 2,500 Number of Diagnoses 2,000 1,500 1,000 Marijuana Opiate Cocaine Other* Year A woman could have multiple diagnoses * Other may refer to drugs like hallucinogens and amphetamines Source: Ohio Hospital Association

12 NAS in Ohio Increased opiate use led to the increased prevalence of NAS In 2014, there were 1,875 NAS inpatient admissions according to the Ohio Hospital Association.

13 NAS Statewide Rate per 10k Rate per 10, Year Source: Ohio Hospital Association

14 Rate Comparison per 10k NAS Rate MOMS Rate Source: Ohio Hospital Association

15 NAS Cost As NAS cases became more prevalent, inflationadjusted total inpatient costs associated with NAS increased. From $6.5 million in 2004 to $105.2 million in 2014

16 NAS Length of Stay (LOS) Average LOS (days) Year Source: Ohio Hospital Association NAS Infants All Infants

17 Health Outcomes NAS Infants Year Feeding difficulties Low birth weight Respiratory symptoms Seizure & Convulsion All Ohio Infants Year Feeding difficulties Low birth weight Respiratory symptoms Seizure & Convulsion An infant could have multiple diagnoses Source: Ohio Hospital Association

18 Health Outcomes NAS Infants Year Feeding difficulties 20.80% 20.60% 23.00% 20.70% 22.00% 20.71% 18.51% 16.55% 15.29% 16.73% Low birth weight 32.00% 28.80% 32.30% 25.60% 29.10% 32.04% 26.85% 26.19% 25.48% 25.31% Respiratory symptoms 36.80% 37.70% 40.30% 35.50% 36.20% 30.31% 29.80% 23.25% 24.76% 22.79% Seizure & Convulsion 3.00% 3.10% 2.70% 2.30% 2.60% 1.83% 1.13% 1.40% 0.90% 1.39% All Ohio Infants Year Feeding difficulties 3.10% 3.30% 3.40% 3.60% 3.70% 4.10% 4.31% 4.44% 4.85% 4.79% Low birth weight 11.10% 11.30% 11.70% 11.50% 11.60% 12.10% 11.90% 12.30% 12.39% 12.74% Respiratory symptoms 10.00% 10.00% 9.90% 9.80% 9.80% 10.10% 9.85% 9.88% 9.81% 10.02% Seizure & Convulsion 0.30% 0.30% 0.30% 0.20% 0.20% 0.20% 0.22% 0.22% 0.22% 0.19% An infant could have multiple diagnoses Source: Ohio Hospital Association

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26 NAS Rate by OPQC Region Based on Patient Residence Akron/Canton/Youngstown (Northeastern) Toledo (Northwestern) Cincinnati (Western) Dayton (Southwestern) Cleveland (North Central) Appalachia (Southeastern) Columbus (Central) Source: Ohio Hospital Association

27 Raw Numbers by OPQC Region Akron/Canton/ Youngstown (Northeastern) Cleveland (North Central) Toledo (Northwestern) Appalachia (Southeastern) Cincinnati (Western) Columbus (Central) Dayton (Southwestern) Source: Ohio Hospital Association

28 Contact Information Rick Massatti, PhD, MSW, MPH, LSW Ohio Dept. of Mental Health & Addiction Services 30 East Broad Street, 36 th Floor Columbus, Ohio Phone (614)

29 Mother and Child Dependency Program MetroHealth Medical System Hospital based program Care coordination and social work Pediatrics (neonatal and community based) MAT provided by community, not at MetroHealth ~180 women in a year o 56% have Hepatitis C o 41.4% had previous children in DCFS custody o 33.8% were victims of assault o 12% admitted to prostitution o 90% have used heroin o 61% starting with Rx opioids o 27% are positive for opiates at delivery

30 Cincinnati MOMS Project Maternal Addiction Program Behavioral Health Therapy Inpatient/ Residential Care Intensive Outpatient Therapy Wrap Around Services HOPE Prenatal Care/ Case Management Inpatient MAT induction Referral to community MAT and addiction treatment Enhanced Prenatal Care Delivery Enhanced Postpartum Care Medication Assisted Treatment Medication Assisted Treatment Outpatient Buprenorphine Therapy Addiction Medicine

31 MOMS Franklin County Partners MRC Clinic

32 Questions for the Panelists