An Intervention Mapping Approach to Closing the Gap in Maternal OUD and Infant NAS care

项目摘要/摘要 在美国医院分娩的女性中，阿片类药物使用障碍(OUD)的患病率增加了131% 从2010年到2017年。这与新生儿阿片类药物戒断综合征(NOWS)82%的增长直接相关 在同一时期，确诊病例高达千分之七。1、2尽管需要孕产妇治疗， 从产后病房和新生儿重症监护病房(NICU)转诊到OUD治疗的比例很低 在那些接受产前治疗的人中，产后治疗的辍学率很高。 OUD通常在出生后被送到NICU管理阿片类药物的戒断，期间他们的母亲在床边 他们的住处。因此，婴儿在NICU的停留代表着一个关键时期，在这个时期里，诊断母亲的声音，开始 治疗，并指在优先考虑和保留母婴二元纽带的环境中进行的持续护理。 尽管建议将产妇心理健康筛查和转诊整合到儿科环境中 以及在成人医疗保健环境中实现心理健康和药物滥用综合治疗的全球举措， 关于如何缩小#年产妇心理健康和药物滥用治疗方面的差距，信息有限。 儿科环境。我们致力于解决的主要挑战是成人治疗的需要发生在儿科 在尚不存在结构的情况下进行治疗，以使其可行。这项研究的目标是1)到 系统地确定在NICU实施床边治疗的主要促进者和障碍 通过对母亲、NICU提供者和其他利益相关者的深入访谈；2)使用以下步骤 实施图，以制定一套实施战略，以配置丁丙诺啡诱导 产后妇女根据目标1的反馈在NICU中进行OUD；以及3)改进、测试和检查 在两个NICU地点将调整后的模型应用于试点病例系列的可接受性和可行性 更大规模的试验。这一过程将使我们能够提供一套治疗模式和一套实施战略 为NICU中的产后母亲提供循证的OUD治疗，将提高其可及性和 可持续发展。未来的目标包括在随后的混合测试中测试干预和实施策略 有效性--执行研究，以评估它们在多大程度上改善了执行情况， 持续的治疗，以及患有胎儿窘迫的新母亲的结局。

PROJECT SUMMARY/ABSTRACT The prevalence of opioid use disorder (OUD) among women giving birth in US hospitals increased by 131% from 2010-2017. This corresponds directly to the 82% increase in neonatal opioid withdrawal syndrome (NOWS) diagnoses in the same period, up to 7/1000 hospital births.1,2 Despite the need for maternal OUD treatment, referrals from postpartum units and neonatal intensive care units (NICU) to OUD treatment are low and postpartum treatment dropout is high among those who were treated prenatally.3 Infants born to women with OUD are often sent to NICUs after birth to manage opioid withdrawal, with their mothers at their bedside during their stay. An infant's NICU stay therefore represents a critical period in which to diagnose maternal OUD, initiate treatment, and refer for ongoing care in a setting that prioritizes and preserves maternal-infant dyadic bonding. Despite recommendations to integrate maternal mental health screenings and referrals in pediatric settings and a global move towards integrated mental health and substance abuse treatment in adult healthcare settings, limited information exists on how to close the gap in maternal mental health and substance abuse treatment in pediatric settings. The major challenge we aim to address is the need for adult treatment to occur in a pediatric treatment setting where structures do not yet exist to make this feasible. The goals of this study are 1) to systematically identify the primary facilitators and barriers to implementing bedside OUD treatment in the NICU through in-depth interviews with mothers, NICU providers, and other stakeholders; 2) to use steps from implementation mapping to develop a suite of implementation strategies to collocate buprenorphine induction for postpartum women with OUD in the NICU based on feedback from Aim 1; and 3) to refine, test, and examine the acceptability and feasibility of applying the adapted model in a pilot case series in two NICU sites for use in larger trials. This process will allow us to deliver a treatment model and set of implementation strategies for providing evidence-based OUD treatment to postpartum mothers in NICUs that will enhance its accessibility and sustainability. Future goals include testing the intervention and implementation strategies in a subsequent hybrid effectiveness- implementation study to estimate the extent to which they lead to improved implementation, sustained treatment, and outcomes for new mothers with OUD.