Project STEPuP: A prenatal provider education and training program to improve medication-assisted treatment use during pregnancy and maternal and child health outcomes

主题DAT 18 -06：妊娠期间阿片类药物使用障碍（OUD）的患病率比2008年增加了四倍。 在过去十年中，与药物使用有关的孕产妇和新生儿发病率和死亡率也有所增加。药物治疗- 妊娠期间使用辅助治疗（MAT）可减少不良结局， 循证医学实践（EBP）用于妊娠期间OUD治疗。尽管如此，40%的孕妇 不接受MAT。目前，没有有效的战略来扩大获得MAT的机会， 孕妇的可获得性，特别是在孕产妇使用阿片类药物的农村、低资源环境中， 不成比例的高。作为解决这一差距的第一步，我们在一个大的 宾夕法尼亚州的卫生系统，以确定障碍和促进扩大治疗服务的高 需要，低资源产科环境。我们的利益相关者确定了一个以妇女为中心的、低成本的 资源，可持续的，提供者一级的干预，以促进在产科环境中采用MAT。 因此，我们在本申请中的目的是测试产前提供者教育的有效性， 培训计划，旨在促进采用EBP为OUD在怀孕期间称为项目STEPuP （怀孕和产后期间的药物滥用治疗和教育）。项目STEPUP，接地 我们的研究团队进行的初步和试点工作，有4个组成部分，旨在解决障碍， MAT和EBP的采用：1）“中心辐射”，远程支持的提供者教育和培训计划，2） 成瘾远程咨询支持，3）病例管理和远程精神病学支持，以及4）与 卫生系统管理人员和付款人，以解决行政和报销相关的需求。到 为了实现这一目标，我们将在12个产科地点进行一项分组随机临床试验， 宾夕法尼亚和纽约。将在妊娠期间、分娩时评估870例患者的结局 产后1年。我们的中心假设是，项目STEPuP将促进EBP的采用， 增加MAT的使用，改善OUD孕妇和产后妇女的健康结果， 子女具体而言，我们的目标是：1）建立组织准备，以促进项目STEPuP 实施; 2）评估项目STEPuP对供应商采用EBP进行OUD的影响， 评估提供者采用EBP对孕产妇和儿童健康结果的影响。我们 通过解决如何在怀孕期间增加MAT使用的重大知识缺口， 通过审查产前服务提供者在扩大治疗机会方面可以发挥的作用，

Topic DAT18-06: The prevalence of opioid use disorder (OUD) during pregnancy has quadrupled over the past decade, as have maternal and neonatal morbidity and mortality related to substance use. Medication- assisted treatment (MAT) use during pregnancy reduces adverse outcomes and is the recommended, evidence-based practice (EBP) for OUD treatment during pregnancy. Despite this, 40% of pregnant women with OUD do not receive MAT. Currently, there are no effective strategies to expand MAT access and availability for pregnant women, especially in rural, low-resource settings where maternal opioid use is disproportionately high. As an initial step to address this gap, we engaged key stakeholders across a large health system in Pennsylvania to determine barriers and facilitators to expanding treatment services in high need, low-resource obstetric settings. Our stakeholders identified a critical need for a women-centered, low- resource, sustainable, provider-level intervention to facilitate the adoption of MAT in obstetric settings. Therefore, our objective in this application is to test the effectiveness of a prenatal provider education and training program designed to facilitate the adoption of EBP for OUD during pregnancy called Project STEPuP (Substance abuse Treatment and Education during Pregnancy and Postpartum). Project STEPuP, grounded in preliminary and pilot work conducted by our research team, has 4 components designed to address barriers to MAT and EBP adoption: 1) a “hub and spoke,” remotely-supported provider education and training program, 2) addiction teleconsultation support, 3) case management and telepsychiatry support, and 4) a partnership with health system administrators and payers to address administrative and reimbursement related needs. To achieve this objective, we will conduct a cluster-randomized clinical trial across 12 obstetric sites in Pennsylvania and New York. Outcomes among 870 patients will be assessed during pregnancy, at delivery and through 1 year postpartum. Our central hypothesis is that Project STEPuP will facilitate EBP adoption, increase MAT utilization and improve health outcomes among pregnant and postpartum women with OUD and their children. Specifically, we aim to: 1) create organizational readiness to facilitate Project STEPuP implementation; 2) assess the effect of Project STEPuP on provider adoption of EBP for OUD during pregnancy; and 3) evaluate the effect of provider adoption of EBP on maternal and child health outcomes. Our research is significant by addressing the substantial knowledge gap of how to increase MAT use in pregnancy and innovative by examining the role that prenatal providers can play in expanding treatment access.