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: 10653203
• 负责人: Clayton John Shuman
• 金额: $ 16.39万
• 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/10653203
• 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; Consolidated Framework for Implementation Research; Data; Data Collection; Data Set; Diagnosis; Eating; Effectiveness; Eligibility Determination; 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; Maps; 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; care delivery; care outcomes; career development; complex data; contextual factors; cost; cost estimate; dalton; demographics; design; drug withdrawal; evidence base; experience; high risk infant; implementation determinants; implementation efforts; implementation evaluation; implementation facilitators; 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.

项目摘要/摘要 这项K08职业发展建议的长期目标是提高我在围产健康健康方面的培训 服务研究的目的是改善暴露于物质的孕产妇二元组的健康状况。 我的新技能和经验将在1）复杂数据集的管理中； 2）多级和 三角分析； 3）实施策略设计和测试； 4）政策领导 参与和影响。研究提案的目的旨在改善绿o- 通过改善母乳喂养和皮肤护理习惯来暴露婴儿。非药物 方法被认为是接触阿片类药物的主要治疗方法。但是，许多使用阿片类药物的女性 符合母乳喂养的条件没有，少于50％的人在产后六天内停止。阿片类药物 暴露的婴儿容易出现戒断症状，​​导致住院时间更长，暴露 进行药物治疗，并增加医院费用。公认的是，母乳喂养和皮肤至 皮肤护理可以减少严重性和新生儿戒断症状的数量，改善产妇粘结 以及降低住院时间并降低成本。尽管有这些好处，但母乳喂养和皮肤皮肤 价格再次保持较低，目前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活动上（例如，评估，诊断，药理学 治疗）而不是母亲及其对新生儿的照顾。旨在更好地理解 母乳喂养和皮肤的结构和个人障碍作为接触阿片类药物的婴儿的治疗 拟议的5年研究将检查影响母乳喂养和皮肤练习的因素 方法设计。已招募了四家医院，以收集从链接的母校那里收集病历数据。 婴儿二元组（n = 360），来自临床医生的调查数据（n = 513个预期）来描述和探索相关 实施因素和来自阿片类药物的母亲的纵向半结构化访谈数据（n = 30）。 AIM 1刮擦母亲，新生儿和单位上下文因素对母乳喂养和皮肤的影响 注意使用方法三角测量和多级分析来治疗阿片类药物暴露的婴儿。 AIM 2检测和 询问与实施母体有关的实施促进者，障碍和策略 使用与母亲的半结构化访谈，数据三角剖分和理论信息进行护理 实现映射。 AIM 3执行试点实施策略并评估实施和护理 交付成果。这些目标的完成为R01提案提供了必要的培训和数据。这 提案与NICHD目前在新生儿有关的投资中是协同的和独特的。 阿片类药物提取。计划在Vanessa Dalton博士的心态下和联合会所的心态下进行正规培训 相关的方法论和内容专业知识。培训将完成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。