Advancing Treatment Outcomes for Pregnant Women with Opioid Use Disorder

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PROJECT SUMMARY/ABSTRACT Ashley A. Leech, PhD, MS is an Assistant Professor in the Department of Health Policy at the Vanderbilt University School of Medicine. As a health decision scientist and health services researcher, Dr. Leech seeks to identify and improve the delivery of high-value health services to address the specialized needs of reproductive age and pregnant women in the US. This training grant will support her career goal of becoming a leading investigator who specializes in decision science methodology to empirically inform decision making on health services and resource priorities for marginalized women and their children in the US. Specifically, by evaluating real-world tradeoffs associated with treatment strategies and assessing the value of conducting further research to reduce decision uncertainty and optimize treatment benefits, she aims to provide a strong evidence base to improve the care for pregnant women afflicted by addiction. Opioid use disorder in pregnancy has more than quadrupled in the last two decades, resulting in adverse pregnancy and birth outcomes and a subsequent rise in healthcare utilization. Furthermore, access to treatment for pregnant women remains limited and varies geographically and across treatment strategies and care settings. High-value care for opioid use disorder in pregnancy requires methodologically rigorous studies that measure both the value of existing and new interventions and analyze the effects of resource constraints on decision making. To address these gaps, Aim 1 of the proposed research assesses the value of all available treatment options for pregnant women with opioid use disorder and quantifies the value of obtaining more research to guide future treatment and management decisions for these patients. Aim 2 takes this analysis a step further by incorporating resource constraints into the model to optimize care processes and delivery amid an environment with multiple barriers to timely and appropriate access to treatment. Results from these aims will collectively inform clinical practice, resource prioritization, and important policy decisions that can improve the availability of services for this population. During the award period, Dr. Leech will gain additional methodological expertise in advanced calibration, value of information analysis, and optimization methods for decision making, while also becoming well-informed in the clinical and policy space to improve the management and care for pregnant women and children affected by opioid use. Her mentoring and advisory team are nationally recognized clinicians, methodologists, and health policy experts who will provide the critical mentorship necessary to advance her career in the fields of addiction, decision science, and maternal and child health. This award will enable Dr. Leech to become a leading and independently funded research investigator.