Mom is medicine: Implementing maternal-delivered nonpharmacologic care for neonatal opioid withdrawal

妈妈就是药：对新生儿阿片类药物戒断实施产妇非药物护理

• 批准号: 10448783
• 负责人: Clayton John Shuman
• 金额: $ 16.45万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448783
• 关键词: Address; Adoption; Affect; Agreement; Award; Breast Feeding; COVID-19 pandemic; Caring; Characteristics; Clinical Treatment; Clinical Trials; Collection; Complement; Complex; Conduct Clinical Trials; Data; Data Collection; Data Set; Diagnosis; Eating; Effectiveness; Evidence based intervention; Expenditure; Exposure to; Future; Goals; Health; Health Services Research; Helping to End Addiction Long-term; Hospital Costs; Hospital Units; Hospitalization; Hospitals; Infant; Intervention; Interview; Investments; Knowledge; Leadership; Length; Length of Stay; Link; Maternal Exposure; Medical Records; Medicine; Mentors; Mentorship; Methodology; Methods; Mothers; National Institute of Child Health and Human Development; Neonatal; Neonatal Abstinence Syndrome; Neonatal Intensive Care Units; Newborn Infant; Nurse' s Role; Outcome; Perinatal; Pharmaceutical Preparations; Pharmacological Treatment; Pilot Projects; Policies; Postpartum Period; Public Health; Randomized Controlled Trials; Recovery; Reporting; Research; Research Personnel; Research Proposals; Role; Scientist; Severities; Skin; Skin Care; Sleep; Structure; Surveys; Techniques; Testing; Training; United States National Institutes of Health; Weaning; Withdrawal Symptom; Woman; analytical method; care delivery; care outcomes; career development; cost; cost estimate; dalton; demographics; design; drug withdrawal; evidence base; experience; high risk infant; implementation determinants; implementation efforts; implementation evaluation; implementation facilitators; implementation framework; implementation outcomes; implementation science; implementation strategy; improved; improved outcome; innovation; long-term sequelae; neonatal care; neonatal outcome; novel; opioid epidemic; opioid exposure; opioid overdose; opioid use; opioid withdrawal; perinatal health; programs; recruit; research and development; routine care; skills; substance use; success; theories

PROJECT SUMMARY/ABSTRACT The long-term goal of this K08 career development proposal is to advance my training in perinatal health services research with the goal of improving the health of substance-exposed, maternal-infant dyads. My new skills and experiences will be in 1) management of complex datasets; 2) multilevel and triangulation analytics; 3) implementation strategy design and testing; and 4) leadership for policy engagement and impact. The aims of the research proposal seek to improve outcomes of opioid- exposed infants by improving breastfeeding and skin-to-skin care practices. Nonpharmacologic approaches are considered primary treatment for opioid-exposed infants. However, many opioid-using women eligible to breastfeed do not and less than 50% of those who start, stop within six days postpartum. Opioid- exposed infants are vulnerable to withdrawal symptoms, resulting in longer lengths of hospitalization, exposure to pharmacologic treatment, and increased hospital costs. It is well-recognized that breastfeeding and skin-to- skin care can reduce severity and number of neonatal withdrawal symptoms, improve maternal-infant bonding as well as decrease lengths of stay and reduce costs. Despite these benefits, breastfeeding and skin-to-skin rates remain remarkably low and it is unclear why they have not been broadly implemented. It may be because most implementation efforts have focused on clinician activities (e.g., assessment, diagnosis, pharmacologic treatment) and not on mothers and their care for their newborns. Toward the goal of better understanding the structural and personal barriers to breastfeeding and skin-to-skin as treatment for opioid-exposed infants, the proposed 5-year study will examine factors affecting breastfeeding and skin-to-skin practices using a mixed methods design. Four hospitals have been recruited for collection of medical record data from linked maternal- infant dyads (N=360), survey data from clinicians (N=513 anticipated) to describe and explore relevant implementation factors, and longitudinal semi-structured interview data from opioid-exposed mothers (N=30). Aim 1 scrutinizes the effects of maternal, neonatal, and unit context factors on breastfeeding and skin-to-skin care to treat opioid-exposed infants using method triangulation and multilevel analytics. Aim 2 detects and interrogates the implementation facilitators, barriers, and strategies relevant to implementation of maternal- delivered care using semi-structured interviews with mothers, data triangulation and theory-informed implementation mapping. Aim 3 conducts a pilot implementation strategy and evaluates implementation and care delivery outcomes. Completion of these aims provides the requisite training and data for an R01 proposal. This proposal is synergistic and uniquely complimentary with NICHD’s current investment in addressing neonatal opioid withdrawal. Formal training is planned under the mentorship of Dr. Vanessa Dalton and co-mentors with relevant methodologic and content expertise. Training will complement my expertise in implementation science, address training gaps, and contribute to the success and public health impact of the proposed research.

项目概要/摘要 这个K08职业发展建议的长期目标是推进我在围产期健康方面的培训 服务研究，旨在改善接触物质的母婴二人的健康。 我的新技能和经验将体现在 1）复杂数据集的管理； 2）多层次和 三角测量分析； 3）实施策略设计与测试； 4）政策领导 参与度和影响力。该研究提案的目的旨在改善阿片类药物的结果 通过改善母乳喂养和皮肤接触护理实践来预防暴露的婴儿。非药物性 这些方法被认为是阿片类药物暴露婴儿的主要治疗方法。然而，许多使用阿片类药物的女性 符合母乳喂养资格的人不进行母乳喂养，并且只有不到 50% 的母乳喂养者在产后六天内停止母乳喂养。阿片类药物- 接触过的婴儿容易出现戒断症状，​​导致住院时间延长、接触 药物治疗，增加住院费用。众所周知，母乳喂养和肌肤接触 皮肤护理可以减轻新生儿戒断症状的严重程度和数量，改善母婴关系 以及减少停留时间并降低成本。尽管有这些好处，母乳喂养和肌肤接触 利率仍然非常低，尚不清楚为什么它们没有得到广泛实施。可能是因为 大多数实施工作都集中在临床医生的活动（例如评估、诊断、药理学 治疗）而不是母亲及其对新生儿的护理。为了更好地理解 母乳喂养和皮肤接触作为阿片类药物暴露婴儿治疗的结构性和个人障碍， 拟议的为期 5 年的研究将使用混合方法来研究影响母乳喂养和肌肤接触实践的因素 方法设计。已招募四家医院收集关联产妇的病历数据 婴儿二人组 (N=360)，来自临床医生的调查数据 (N=513 预计) 来描述和探索相关 实施因素以及来自阿片类药物暴露母亲的纵向半结构化访谈数据（N = 30）。 目标 1 审查孕产妇、新生儿和单位环境因素对母乳喂养和肌肤接触的影响 使用三角测量和多级分析方法护理治疗阿片类药物暴露婴儿。目标 2 检测并 询问与实施孕产妇相关的实施促进因素、障碍和战略 通过对母亲进行半结构化访谈、数据三角测量和理论指导来提供护理 实施映射。目标 3 进行试点实施策略并评估实施和关怀 交付成果。完成这些目标可为 R01 提案提供必要的培训和数据。这 该提案与 NICHD 目前在解决新生儿问题上的投资具有协同作用和独特的互补性 阿片类药物戒断。正式培训计划在 Vanessa Dalton 博士及其共同导师的指导下进行 相关的方法和内容专业知识。培训将补充我在实施科学方面的专业知识， 解决培训差距，并为拟议研究的成功和公共卫生影响做出贡献。