Prenatal identification of opioid use disorder is associated with optimal OUD care in pregnancy

The Illinois Perinatal Quality Collaborative (ILPQC) launched a Mothers and Newborns affected by Opioids quality improvement (QI) initiative in May 2018 to increase opioid use disorder (OUD) screening with a universal validated self-report tool and optimize care for pregnant patients with OUD in participating hospitals. The objective of this analysis is to assess whether earlier identification of OUD is associated with delivery of optimal OUD care in pregnancy. Hospitals reported a random sample of 10 deliveries/month to evaluate screening prenatally and during delivery admission and monthly measures for patients with OUD at delivery. ILPQC facilitated collaborative learning opportunities, rapid-response data, and QI support. Generalized linear mixed effects models looking at 6-month increments from Jul 2018 to Dec 2020 were used to determine whether the odds of OUD identified prenatally improved and if prenatal identification of OUD was associated with an increase in optimal OUD care (medication assisted treatment (MAT), recovery treatment services (RTS), and Narcan counseling) adjusted for patient and hospital characteristics. 92 hospitals reported screening data on over 25000 deliveries and 2095 patients with OUD at delivery. The percent of pregnant patients screened with a validated tool increased prenatally (3% to 47%) and during delivery admission (2% to 88%) (Figure 1). Among pregnant patients with OUD, identification prenatally increased from 82% to 88%, though the proportion identified prenatally vs during delivery admission did not change (β: 0.97, 95% CI (0.86, 1.09), p =0.57). Identification of OUD prior to or during pregnancy was associated with increased odds of receipt of optimal OUD care after adjusting for patient and hospital characteristics (Table 1). A statewide QI initiative was associated with increased screening for OUD prenatally and during delivery admission. Pregnant patients with OUD are more likely to get optimal care with prenatal identification of OUD. Statewide QI efforts should continue efforts to increase prenatal screening for OUD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)