1119 Initiative to improve care for pregnant patients with opioid use disorder can reduce disparities

Abstract

The Illinois Perinatal Quality Collaborative (ILPQC) Mothers and Newborns affected by Opioids quality improvement (QI) initiative aims to increase the percent of pregnant patients with Opioid Use Disorder (OUD) receiving optimal OUD care. The objective of this analysis is to assess if the receipt of optimal care improved over time regardless of patient demographics and examine reduction in disparities in care across the initiative. Participating hospitals reported monthly key measures for all patients delivering with OUD between baseline 2017 to June 2020. ILPQC facilitated collaborative learning opportunities, rapid-response data, and QI support. Generalized linear mixed effects regression were used to determine whether optimal OUD care changed over time by quarter, and patient characteristics-by quarter interactions were explored. Patients were 20% Black, median age 30, 16% no prenatal care, with delivery 85% urban location and 55% Level III hospitals. Data suggest the receipt of OUD care for 2,171 pregnant patients from 84 participating hospitals improved over time including connecting patients to Medication Assisted Treatment (MAT) (OR 1.09 (1.04, 1.15)), Recovery Treatment Services (OR 1.10 (1.03, 1.16)), and Narcan counseling (OR 1.55 (1.46, 1.67)), with improvement shown regardless of patient characteristics (Tab 1). For the first quarter of the initiative (Q3 2018), White patients had 2 times greater odds of receiving MAT compared to Black patients (OR 2.05 (1.68, 2.51)). However, the odds of receiving MAT increased 17% (OR 1.17 (1.09, 1.27)) each quarter for Black patients where for White patients the odds of MAT increased 7% each quarter (OR 1.07, (1.03, 1.11)) (Fig 1). Optimal OUD care improved significantly across the MNO initiative, regardless of patient characteristics. At baseline, Black patients with OUD were less likely to be on MAT, however across the initiative improvements in MAT rates were seen for all patients with the greatest improvement for Black patients. Ongoing work should continue to address disparities in optimal obstetric OUD care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)