Opqc: addressing gaps and equitably improving maternal-infant outcomes in ohio - measures of population-level perinatal outcomes indicate the state of ohio has significant disparities in…

Opqc: addressing gaps and equitably improving maternal-infant outcomes in ohio - measures of population-level perinatal outcomes indicate the state of ohio has significant disparities in maternal-infant outcomes and substantial gaps between current outcomes and optimal health. To improve perinatal health and address disparities, population-level perinatal QI initiatives, with a focus on ensuring an equitable distribution of benefits, are urgently needed. This is particularly true for ohio's women and infants affected by opioid use disorder (OUD) because throughout each wave of the opioid epidemic, ohio has been considered one of the hardest HIT states. The CDC has highlighted the significant impact of the US opioid crisis on maternal and child health and emphasized the key role of perinatal quality collaboratives in improving care and outcomes for this population. The ohio perinatal quality collaborative (opqc) will work to meaningfully improve health outcomes of pregnant women enrolled in medicaid in the state of ohio. In year 1 of the award, we will work to: (1) improve identification of pregnant medicaid enrollees with OUD, 2) link them to needed services (medical, behavioral, and social), and 3) ensure receipt of narcan during pregnancy and immediately after delivery. These objectives align with the recommendations of the ohio department of health (ODH)'s pregnancy associated mortality review report and the alliance for innovation in maternal health (aim) OUD bundle. There is strong rationale to focus on pregnant medicaid-enrolled women with OUD in ohio due to increased risk of pregnancy-associated deaths and demonstrated disparities in access to treatment, especially among black pregnant women. A key element of opqc's approach includes engagement with all key stakeholders, including patients and families. Opqc will work collaboratively with the empower project, a patient-centered collaborative of women with perinatal lived experience of OUD, to support the proposed improvement efforts. The ohio department of medicaid (ODM)'s nurture ohio online epregnancy risk assessment form (praf) system will serve as the data platform for these initial improvement efforts. The epraf system is ODM's method of pregnancy notification for medicaid enrolled women. The praf includes data on substance use screening, utilization of treatment, social determinants of health, medical risk factors, and demographics including race, ethnicity, age, and place of residence. Of the 27,842 prafs submitted between january 1, 2021 and april 30, 2022, 11,281 (40%) indicated a need for additional services or support, and 1012 (3.6%) indicated a substance use disorder (SUD). Of those identified with OUD, 42% were not in treatment. The demographics by race were 50.9% white, 40.7% black, and 6.9% hispanic, contrasting with ohio 2020 census data of 81.7% white, 13.1% black, and 4.0% hispanic. The project opqc proposes in year 1 addresses the ODH pamr recommendations, aligns with the alliance for innovation in maternal health (aim) OUD bundle, and benefits from collaboration with ODM to use praf data. Using the epraf real-time data platform will allow opqc to use practice-level and aggregate data for QI efforts, initially focusing on identifying women with OUD and increasing connection to treatment. We will use ODH vital statistics and ohio hospital association data to monitor outcomes of reducing the risk of pregnancy-associated death. Collectively, the work proposed will address the disparities in outcomes for those on medicaid and address the disparities in care and referral to treatment for pregnant black individuals. We will collaborate with patient partners, our engaged network of maternity care and infant providers, and state colleagues to implement improvement initiatives that will equitably change the outcome for mothers and babies in ohio.