Improving Outcomes through a Neonatal Abstinence Syndrome Collaborative in Maryland

Abstract

Objectives: A statewide Maryland Perinatal Neonatal Quality Collaborative, facilitated by the Maryland Patient Safety Center (MPSC), identified the three specific, measurable, attainable, relevant, and time-limited (SMART) aims to improve outcomes of NAS care: (1) to reduce hospital length of stay (LOS), (2) to reduce interhospital transfers, and (3) to reduce 30-day readmission rates of infants with neonatal abstinence syndrome (NAS). Study Design: The Maryland collaborative developed a bundle of best practices for care of infants with NAS. MPSC partnered with Vermont Oxford Network (VON) to utilize the VON NAS toolkit and provide its standardized NAS educational curriculum to address the three objectives for participating birthing hospitals. Efforts began in quarter 4 (Q4) 2016 and continued for two years. Thirty-one of Maryland’s 32 delivery hospitals (97%) participated in the two-year collaborative. Additionally, one specialty pediatric hospital with a NAS unit participated in the group learnings. Participating facilities implemented components of the MPSC NAS bundle and provided their staff caring for infants with NAS and their mothers access to the VON standardized educational curriculum. MPSC partnered with VON to conduct two audits of implementation of policies and procedures in Q1 2016 and Q3 2018. The Maryland Department of Health supplied quarterly aggregate hospital information on LOS, interhospital transfers, and 30-day readmissions of infants with a discharge diagnosis of ICD-10 P96.1. Results: Among term infants with NAS with total hospital stay greater than 5 days, we observed a non-significant reduction in both mean and median LOS of 1.5 days. In this same group, the rate of interhospital transfers fell significantly from 20.1% in 2016 to 13.8% in 2017 and to 11.0% in 2018. Conclusion: The best practice bundle created by the Maryland collaborative was associated with a reduction in the percentage of infants with NAS who required interhospital transfer, thereby reducing family disruption.

The Cystic Fibrosis Learning Network: A mixed methods evaluation of program goals, attributes, and impact

“…Although networks vary in form, size, shape and scope, they commonly: foster collaboration between healthcare professionals, patients and families, and researchers; connect people across geographic regions and clinical disciplines to share knowledge, resources, and best practices; drive goal‐directed actions toward a shared vision and mission; and provide systems for data sharing and knowledge dissemination. Participation in a learning health network can improve health outcomes 10‐15 …”

“…Participation in a learning health network can improve health outcomes. [10][11][12][13][14][15] The Cystic Fibrosis (CF) Care Center Network (CCN), accredited by the US CF Foundation (CFF), includes 286 programs that deliver care to nearly 40 000 patients. [16][17][18][19] Patient-level process and outcome measures are captured during all clinical encounters and entered into the CFF Patient Registry (CFFPR).…”