CADENCE - Continuous And Data-drivEN CarE

CADENCE - 持续且数据驱动的 CarE

• 批准号: 10590267
• 负责人: Jennifer Marshall
• 金额: $ 67.85万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10590267
• 关键词: Address; Affect; Age; Agreement; Appointment; Area; Buprenorphine; Caring; Cause of Death; Child; Child Mortality; Child Welfare; Childhood; Clinic; Clinical; Clinical Data; Code; Communication; Communities; Consolidated Framework for Implementation Research; Cost Analysis; County; Data; Data Aggregation; Data Collection; Databases; Development; Diagnostic; Discipline of obstetrics; Early Intervention; Ethnic Origin; Evaluation; Family; Florida; Frequencies; Funding; General Hospitals; Geography; Goals; Gold; Grant; Harm Reduction; Health; Health Services Accessibility; Health system; Healthcare; Home; Hospitals; Individual; Infant; Infant Care; Infrastructure; Institutes; Internal Medicine; Intervention; Lead; Live Birth; Location; Maintenance; Maternal Mortality; Measures; Medicine; Methadone; Methodology; Methods; Mind; Modeling; Morbidity - disease rate; Mothers; National Institute of Drug Abuse; Neonatal; Neonatal Abstinence Syndrome; Opioid; Outcome; Outcome Measure; Parents; Patient Care; Patient-Focused Outcomes; Patients; Pediatrics; Pharmaceutical Preparations; Pharmacological Treatment; Population; Postpartum Period; Pregnancy; Pregnancy Outcome; Prenatal care; Prevention strategy; Process; Provider; Public Health; Publishing; Quality of Care; Race; Recovery; Recovery Support; Registries; Research; Resources; Services; Site; Standardization; Stream; Substance Use Disorder; System; Telephone; Testing; Thinking; Time; Transportation; United States National Institutes of Health; University Hospitals; Woman; base; behavioral health; care coordination; case finding; clinically relevant; cost; dashboard; data integration; efficacy study; gaps in access; health data; health inequalities; high risk; implementation cost; implementation evaluation; improved; infant outcome; innovation; intervention program; maternal opioid use; maternal outcome; neonatal outcome; neonate; opioid exposure; opioid use; opioid use disorder; overdose prevention; pediatric pharmacology; peer support; personalized approach; post intervention; prenatal; primary outcome; program costs; programs; racial disparity; social health determinants; societal costs; standard care

ABSTRACT Maternal opioid use disorder (OUD) is the leading cause of maternal mortality in the first year after delivery nationwide. OUD also contributes substantially to out-of-home placements in the child welfare system. Medication for OUD (MOUD) is the primary standard of treatment, however, access to MOUD and prenatal care is limited, siloed, and fragmented in Florida. Gaps in access to and continuity of healthcare (prenatal, postpartum, pediatric, pharmacological and behavioral health) and other services for mothers in OUD recovery lead to poor outcomes for parent, child and family. There is also insufficient data integration, due to inconsistent data collection methods or use of diagnostic codes, to identify mother-infant dyads affected by OUD that could inform optimal care at the local level. Single-site studies that integrate substance use disorder programs in pregnancy have been shown to improve neonatal and maternal outcomes. With that in mind, the long-term goal of this study is to leverage high-quality local and timely data to improve OUD outcomes before, during, and after pregnancy with an integrated care approach that can be replicated throughout the state. The objective of the proposed project is to consolidate multiple streams of public health and clinical healthcare data to analyze equitable access and outcomes for families affected by maternal OUD for use in quality improvement cycles to rapidly refine our integrated CADENCE (Continuous and Data-Driven Care) Program. Our central hypothesis is that integrated, continuous, data-driven care will improve CADENCE patient outcomes. We will test this hypothesis through the following aims: 1) create an interactive data dashboard for maternal, neonatal, and infant outcomes for pregnancies affected by OUD; 2) pilot the CADENCE program and rapidly refine using a data-driven approach; 3) determine the improvement in clinical outcomes at the program level using the data from the dashboard and assess the implementation of the CADENCE program; 3) analyze the cost of the CADENCE program and long-term costs of maintenance of the program. Upon completion of our aims, the expected outcomes include improve maternal, neonatal, and infant outcomes using an integrated care model and data-driven approach to tailor services to community and patient needs. Primary outcomes increase in maternal engagement in recovery or MOUD treatment at delivery, neonates with NOWS (neonatal withdrawal syndrome) requiring pharmacologic treatment at delivery, and infant’s age at referral to the Early Steps early intervention program. Our proposed plan is innovative as it is grounded in systems thinking, uses population-level and integrated clinical data to develop a dashboard methodology, and addresses an area of medicine with few previously published efficacy studies. This project meets the goals of the NIH as it aims to decrease racial inequities in prenatal care and increase access to prenatal care to decrease maternal and child mortality and morbidity.

摘要 母体阿片类药物使用障碍（OUD）是导致分娩后第一年内孕产妇死亡的主要原因 全国范围开放大学还为儿童福利系统中的家庭外安置做出了巨大贡献。 OUD药物治疗（MOUD）是治疗的主要标准，然而，获得MOUD和产前检查是非常困难的。 在佛罗里达，医疗服务是有限的、孤立的和分散的。在获得保健和保健连续性方面存在的差距（产前， 产后、儿科、药理学和行为健康）和其他服务 导致对父母、子女和家庭不利结果。数据整合也不够，因为 不一致的数据收集方法或使用诊断代码，以确定受 OUD可以在当地一级提供最佳护理。整合物质使用障碍的单中心研究 怀孕期间的方案已被证明可以改善新生儿和产妇的结果。考虑到这一点， 这项研究的长期目标是利用高质量的本地和及时的数据来改善OUD的结果， 在怀孕期间和怀孕后，采用可在全州推广的综合护理方法。的 拟议项目的目标是整合多个公共卫生和临床医疗数据流 分析受孕产妇OUD影响的家庭的公平获得和结果， 改进周期，以快速完善我们的综合CADENCE（持续和数据驱动的护理）计划。 我们的中心假设是，综合的、持续的、数据驱动的护理将改善CADENCE患者 结果。我们将通过以下目标来测试这一假设：1）创建一个交互式数据仪表板， 受OUD影响的妊娠的孕产妇、新生儿和婴儿结局; 2）试点CADENCE计划， 使用数据驱动的方法快速完善; 3）确定该计划的临床结局改善 使用仪表板中的数据进行水平评估，并评估CADENCE计划的实施情况; 3）分析 CADENCE计划的成本和该计划的长期维护成本。完成后 我们的目标，预期成果包括改善孕产妇，新生儿和婴儿的结果，使用综合 护理模式和数据驱动的方法，以定制服务，以满足社区和病人的需求。主要结局 增加产妇在分娩时参与恢复或MOUD治疗，新生儿NOWS（新生儿 戒断综合征），分娩时需要药物治疗，以及婴儿转诊到早期 早期干预计划。我们提出的计划是创新的，因为它是基于系统思维， 人口水平和综合临床数据，以开发仪表板方法，并解决了以下领域 以前发表的疗效研究很少的药物。该项目符合NIH的目标，因为它旨在 减少产前护理方面的种族不平等现象，增加产前护理的机会， 死亡率和发病率。