Neonatal Abstinence Syndrome (NAS) Project
It is estimated that one infant is born exposed to maternal in-utero narcotic abuse every hour in the United States. The NAS epidemic is steadily increasing, overwhelming social service systems and public payers. In Ohio in 2011, treating infants born with NAS cost more than $70 million and nearly 19,000 inpatient days. Preliminary data from pilot work funded by the Ohio Children’s Hospital Association (OCHA) estimates that up to 50% of neonates with NAS in Ohio were not receiving optimal care, despite evidence-informed data and national guidelines that exist to indicate best practices for identification and treatment of these infants. Thus, there is substantial opportunity for improvement, and reducing variation in identification and treatment will correct deficiencies in both under-identification, and under- and overtreatment.
The aim of the OPQC NAS Project is to increase identification of and compassionate withdrawal treatment for full-term infants born with Neonatal Abstinence Syndrome (NAS), and reduce length of stay by 1 day across participating sites by June 30, 2016. With funding from the Ohio Department of Medicaid, OPQC tests strategies for implementing evidenced-informed treatment protocols to all 54 Level 2 and Level 3 NICUs across Ohio, and will then disseminate identification protocols to all Level 1 hospitals.
OPQC Neonatal Abstinence Syndrome – Phase-2, Orchestrated Testing
In the first phase of the NAS Project (from Jan 2014-June 2015), OPQC site teams participated in improving the care for babies born with NAS while reducing the length of stay by standardizing their approach to both pharmacologic and non-pharmacologic care. Although hospitals standardized care, some variation in accepted practices remains across the collaborative.
In the upcoming phase of the project (2015-2016), participating sites will use the Orchestrated Testing/Quality Improvement method designed to learn from the accepted variation in practices across centers in order to determine the specific combination of factors (or practices) that will yield the greatest improvements in outcome.
Specifically, the teams will participate in one of four self-selected formula groupings. Some of the sites already have these formula practices in place, whereas other centers may be changing one or more practices to accommodate the grouping.
OPQC will continue to collect data and provide feedback to teams on the implementation and use of the formula bundles.
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