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

缩小孕产妇 OUD 和婴儿 NAS 护理差距的干预映射方法

• 批准号: 10726985
• 负责人: Sara L. Kornfield
• 金额: $ 24.38万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10726985
• 关键词: Address; Adult; Affect; Birth; Buprenorphine; Caring; Case Series; Childhood; Clinical; Collaborations; Communities; Consolidated Framework for Implementation Research; Data; Diagnosis; Discipline of obstetrics; Dropout; Environment; Feedback; Future; Goals; Health Services Accessibility; Healthcare; Hospitals; Infant; Intensive Care Units; Intervention; Interview; Manuals; Maps; Mental Health; Modeling; Mothers; Neonatal Abstinence Syndrome; Neonatal Intensive Care Units; Outcome; Parents; Patients; Postpartum Period; Postpartum Women; Practice Guidelines; Pregnant Women; Preparation; Prevalence; Process; Protocols documentation; Provider; Psychological Factors; Recommendation; Research; Resources; Role; Site; Structure; Suggestion; Testing; Time; Woman; acceptability and feasibility; behavior change; behavioral health; critical period; design; effectiveness/implementation hybrid; effectiveness/implementation study; evidence base; follow-up; health assessment; health care settings; implementation barriers; implementation design; implementation strategy; improved; intervention mapping; maternal opioid use; maternal outcome; medication for opioid use disorder; mental set; opioid use disorder; opioid withdrawal; pilot test; postpartum health; prenatal; preservation; prevent; provider behavior; screening; substance abuse treatment; willingness

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.

项目概要/摘要 美国医院分娩妇女阿片类药物使用障碍 (OUD) 患病率增加 131% 2010年至2017年。这直接对应于新生儿阿片戒断综合征 (NOWS) 增加 82% 同一时期的诊断，高达 7/1000 的医院分娩。1,2 尽管需要产妇 OUD 治疗， 从产后病房和新生儿重症监护病房 (NICU) 转诊至 OUD 治疗的人数很少，而且 在产前接受过治疗的患者中，产后治疗的退出率很高。3 患有以下疾病的妇女所生的婴儿 OUD 通常在出生后被送往新生儿重症监护室 (NICU)，以控制阿片类药物戒断，其母亲在其床边陪伴。 他们的住宿。因此，婴儿入住 NICU 是诊断母亲 OUD、启动 NICU 的关键时期。 治疗，并转介在优先考虑和维护母婴二元关系的环境中进行持续护理。 尽管建议将孕产妇心理健康筛查和转诊纳入儿科环境 以及全球在成人医疗保健环境中综合心理健康和药物滥用治疗的举措， 关于如何缩小孕产妇心理健康和药物滥用治疗方面的差距的信息有限。 儿科环境。我们要解决的主要挑战是儿童需要进行成人治疗 尚不存在使之可行的结构的治疗环境。本研究的目标是 1) 系统地确定在 NICU 实施床边 OUD 治疗的主要促进因素和障碍 通过对母亲、新生儿重症监护病房 (NICU) 提供者和其他利益相关者的深入访谈； 2）使用步骤 实施映射以制定一套实施策略，以搭配丁丙诺啡诱导 根据目标 1 的反馈，新生儿重症监护病房 (NICU) 中患有 OUD 的产后妇女； 3) 完善、测试和检查 在两个 NICU 站点的试点案例系列中应用改编模型的可接受性和可行性 更大的试验。这个过程将使我们能够提供治疗模型和一套实施策略 为 NICU 中的产后母亲提供循证 OUD 治疗，这将提高其可及性和 可持续性。未来的目标包括在随后的混合项目中测试干预和实施策略 有效性-实施研究，以估计它们在多大程度上改善了实施， OUD 新妈妈的持续治疗和结果。