An Intervention Mapping Approach to Closing the Gap in Maternal OUD and Infant NAS care

缩小孕产妇 OUD 和婴儿 NAS 护理差距的干预映射方法

• 批准号: 10726985
• 负责人: Sara L. Kornfield
• 金额: $ 24.38万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10726985
• 关键词: Address; Adult; Affect; Birth; Buprenorphine; Caring; Case Series; Childhood; Clinical; Collaborations; Communities; Consolidated Framework for Implementation Research; Data; Diagnosis; Discipline of obstetrics; Dropout; Environment; Feedback; Future; Goals; Health Services Accessibility; Healthcare; Hospitals; Infant; Intensive Care Units; Intervention; Interview; Manuals; Maps; Mental Health; Modeling; Mothers; Neonatal Abstinence Syndrome; Neonatal Intensive Care Units; Outcome; Parents; Patients; Postpartum Period; Postpartum Women; Practice Guidelines; Pregnant Women; Preparation; Prevalence; Process; Protocols documentation; Provider; Psychological Factors; Recommendation; Research; Resources; Role; Site; Structure; Suggestion; Testing; Time; Woman; acceptability and feasibility; behavior change; behavioral health; critical period; design; effectiveness/implementation hybrid; effectiveness/implementation study; evidence base; follow-up; health assessment; health care settings; implementation barriers; implementation design; implementation strategy; improved; intervention mapping; maternal opioid use; maternal outcome; medication for opioid use disorder; mental set; opioid use disorder; opioid withdrawal; pilot test; postpartum health; prenatal; preservation; prevent; provider behavior; screening; substance abuse treatment; willingness

PROJECT SUMMARY/ABSTRACT The prevalence of opioid use disorder (OUD) among women giving birth in US hospitals increased by 131% from 2010-2017. This corresponds directly to the 82% increase in neonatal opioid withdrawal syndrome (NOWS) diagnoses in the same period, up to 7/1000 hospital births.1,2 Despite the need for maternal OUD treatment, referrals from postpartum units and neonatal intensive care units (NICU) to OUD treatment are low and postpartum treatment dropout is high among those who were treated prenatally.3 Infants born to women with OUD are often sent to NICUs after birth to manage opioid withdrawal, with their mothers at their bedside during their stay. An infant's NICU stay therefore represents a critical period in which to diagnose maternal OUD, initiate treatment, and refer for ongoing care in a setting that prioritizes and preserves maternal-infant dyadic bonding. Despite recommendations to integrate maternal mental health screenings and referrals in pediatric settings and a global move towards integrated mental health and substance abuse treatment in adult healthcare settings, limited information exists on how to close the gap in maternal mental health and substance abuse treatment in pediatric settings. The major challenge we aim to address is the need for adult treatment to occur in a pediatric treatment setting where structures do not yet exist to make this feasible. The goals of this study are 1) to systematically identify the primary facilitators and barriers to implementing bedside OUD treatment in the NICU through in-depth interviews with mothers, NICU providers, and other stakeholders; 2) to use steps from implementation mapping to develop a suite of implementation strategies to collocate buprenorphine induction for postpartum women with OUD in the NICU based on feedback from Aim 1; and 3) to refine, test, and examine the acceptability and feasibility of applying the adapted model in a pilot case series in two NICU sites for use in larger trials. This process will allow us to deliver a treatment model and set of implementation strategies for providing evidence-based OUD treatment to postpartum mothers in NICUs that will enhance its accessibility and sustainability. Future goals include testing the intervention and implementation strategies in a subsequent hybrid effectiveness- implementation study to estimate the extent to which they lead to improved implementation, sustained treatment, and outcomes for new mothers with OUD.

项目摘要/摘要 在美国医院分娩的妇女中阿片类药物使用障碍（OUD）的患病率增加了131% 从2010年到2017年这直接对应于新生儿阿片类戒断综合征（NOWS）增加82% 在同一时期的诊断，高达7/1000医院出生。1，2尽管需要产妇OUD治疗， 从产后病房和新生儿重症监护病房（NICU）转诊到OUD治疗的比例很低， 在产前接受治疗的妇女中，产后治疗退出率很高。 OUD通常在出生后被送到NICU以管理阿片类药物戒断，在分娩期间，母亲在床边 和保持身材因此，婴儿的NICU停留代表了诊断母亲OUD、启动OUD治疗的关键时期。 治疗，并在优先考虑和维护母婴二元关系的环境中进行持续护理。 尽管建议在儿科环境中整合孕产妇心理健康筛查和转诊 以及在成人医疗机构中进行综合精神健康和药物滥用治疗的全球行动， 关于如何缩小孕产妇心理健康和药物滥用治疗方面的差距， 儿科环境。我们要解决的主要挑战是需要成人治疗发生在儿科 治疗设置，其中结构尚不存在，使这一点可行。本研究的目的是：（1） 系统地确定在NICU实施床边OUD治疗的主要促进因素和障碍 通过与母亲，NICU提供者和其他利益相关者的深入访谈; 2）使用从 执行情况摸底调查，以制定一套执行战略， 根据目标1的反馈，在NICU中患有OUD的产后妇女;以及3）改进、测试和检查 在两个NICU中心的试点病例系列中应用适应模型的可接受性和可行性， 更大的审判这一过程将使我们能够提供一个治疗模型和一套实施战略， 为新生儿重症监护病房的产后母亲提供循证OUD治疗，以提高其可及性， 持续发展未来的目标包括在随后的混合动力汽车中测试干预和实施战略 有效性-执行情况研究，以估计这些措施在多大程度上改善了执行情况， 持续的治疗，以及OUD新妈妈的结果。