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.

项目总结/文摘