(33) Perinatal Quality Collaboratives: Supporting People with Substance Use Disorders

Background & Introduction: Between 2010 and 2017 in the United States (US), the number of women with opioid-related diagnoses at delivery increased by 131% (1). Seven percent of women with a recent live birth report prescription opioid use and, among them, one in five report misuse (obtaining prescription opioids from a non-healthcare provider or using them for non-pain relief purposes (1)). Between 2010-2017, Neonatal Abstinence Syndrome increased 82% (1). In 2020, mental health conditions, including overdose related to substance use disorders (SUD), were the leading cause of pregnancy-related death in the US (2).
Although pregnancy may motivate individuals with SUD to seek addiction treatment, pregnant women with SUD may encounter stigma/bias and may experience gaps in receipt of appropriate care for SUD (3). Though recommended, screening for SUD is often not performed; when performed, providers report lacking knowledge to manage and refer (3).
Perinatal Quality Collaboratives (PQCs) are state networks working to equitably improve maternal and infant outcomes by advancing evidence-based clinical practice through data-driven quality improvement (QI) initiatives. This poster will describe how 18 CDC-supported PQCs and the National Network of PQCs (NNPQC) improved the healthcare of pregnant and postpartum people and their newborns impacted by SUD and related mental health conditions.

Methods: From 9/30/2023 to 9/29/2024, CDC supported 18 PQCs and the NNPQC to address three objectives: 1) increase the implementation of QI initiatives focused on SUD and related mental health conditions; 2) support pregnant and postpartum people with SUD and related mental health conditions, their newborns and families by linking them with evidence-based care, harm reduction services and/or recovery support services; and 3) increase linkages between clinical and community partners to provide care and treatment, including mental health care, to pregnant and postpartum people with SUD and related mental health conditions. The 18 PQCs supported hospitals and other healthcare facilities to improve care by providing training, technical assistance, and educational opportunities, including developing learning collaboratives that allowed hospital teams to share knowledge and experiences. NNPQC activities helped support and increase the capacity of PQCs. Information about the 18 PQCs and NNPQC activities was collected via project period midpoint and final reporting documents and technical assistance calls between CDC and the PQCs/NNPQC. We will summarize and describe the compiled information and highlight successes from two PQCs. Presented frequencies and percentages represent the achievement of objectives from QI initiatives from the 18 CDC-supported PQCs.

Results: During the project period, advancements were made to improve the quality of care provided to pregnant and postpartum people with SUD and their newborns. New protocols to improve care were implemented in 160 birthing hospitals and 41 other healthcare settings (outpatient provider practices (n=11), non-birthing acute-care hospitals (n=24), community health centers (n=4), and behavioral health centers (n=2)) to enhance equitable and standardized healthcare practices. PQCs provided over 50 learning sessions for healthcare providers that focused on screening for SUD, perinatal mental health conditions, and related topics to appropriately support and link pregnant and postpartum patients to care.
The PQCs facilitated access to treatment by creating 88 resources to assist providers in referring pregnant and postpartum people and their newborns to treatment. Twelve clinical-community linkages (cross-sector connections that enhance prevention and management of conditions) were made to increase referrals to treatment. These resources and linkages included SUD-related resource repositories, interactive maps of treatment locations, partnerships between hospitals and treatment facilities in rural areas and healthcare deserts, and collaboration between clinical and harm reduction (e.g., naloxone distribution) organizations.
Additional advancements included NNPQC-hosted trainings on appropriate use of toxicology screenings during the perinatal period, mandatory reporting considerations, and improving screening and management of maternal mental health conditions. To aid in information sharing among PQCs and distribution of SUD-related materials, NNPQC created dedicated website space. They also integrated people with lived experience (PWLE) into their Executive Committee to guide program activities.
Example activities from the Colorado and Washington PQCs will be shared. Through a learning collaborative approach, Colorado’s PQC increased the percentage of patients screened for SUD at participating hospitals from 60% to 87%. Referrals to substance use disorder and mental health treatment increased from 53% to 65%. Washington’s PQC evaluated their learning collaborative pre-, mid-, and post-implementation of the QI initiative. They found a 27% increase in hospitals implementing Eat, Sleep, Console (a practice that supports substance exposed newborns by maximizing nonpharmacologic methods and increasing family involvement in their treatment) (4); a 20% increase in hospitals implementing universal verbal substance use screening protocols; and an 18% increase in hospitals implementing rooming in policies, which allow birth parents and newborns to room together during the entire hospital stay.

Conclusion & Discussion: From 9/30/2023-9/29/2024, CDC supported 18 PQCs and the NNPQC in bridging care gaps for pregnant and postpartum people and their infants impacted by SUD and related mental health conditions. Examples of successes during the project period included adoption of new protocols to enhance standardized care, creation of learning collaboratives, facilitation of over 50 learning sessions, and development of 88 resources to improve referral to care. These efforts to improve care processes demonstrate the essential role that PQCs play in shaping a healthcare landscape where every family impacted by SUD and mental health conditions receives comprehensive, compassionate, and evidence-based care.
Project limitations included compiling information about the diverse PQC activities, addressing screening and reporting challenges among PQCs, and navigating disparate views on best practices for this population. This project’s findings, successes, and lessons learned can inform future work of PQCs to improve the lives of pregnant and postpartum people and their newborns impacted by SUD and related mental health conditions.

References: (1) Centers for Disease Control and Prevention. About Opioid Use During Pregnancy. U.S. Department of Health and Human Services, 2024.
(2) Trost SL, Busacker A, Leonard M, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 38 U.S. States, 2020. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2024.
(3) Wright, Tricia E. et al., The role of screening, brief intervention, and referral to treatment in the perinatal period. Amer J of Obs & Gyn. 2016 Nov; 215(5): 539-547. https://dx.doi.org/10.1016/j.ajog.2016.06.038
(4) Grisham LM, Stephen MM, Coykendall MR, Kane MF, Maurer JA, Bader MY. Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome. Adv Neonatal Care. 2019 Apr;19(2):138-144. doi: 10.1097/ANC.0000000000000581. PMID: 30855311.