Over the past 10-15 years, Tennessee has struggled with the health and societal effects of opioids overprescribing and Opioid Use Disorder. A variety of cultural, socioeconomic, demographic, and medical/pharmaceutical factors have been implicated as causative factors. Tennessee Initiative for Perinatal Quality Care (TIPQC), as its name implies, is focusing on the perinatal aspects of opioid use, and effects on the mother, the infant, and the “dyad” or family unit in the perinatal period. In partnership with UnitedHealthcare Community Plan of Tennessee, OptumLabs, the TN Department of Health (TDH), and the Alliance for Innovation in Maternal Health (AIM), TIPQC has the opportunity to make significant improvements to the perinatal care of these mothers and infants and make a lasting impact on their lives.

Past efforts by TIPQC have shown improvement in the outcomes of Neonatal Abstinence Syndrome (NAS) infants through the consistent use of an evidence-based toolkit. This was accomplished by a statewide collaborative effort with health care agencies and several NICU and newborn nurseries. Building on the earlier successes, TIPQC is taking additional steps to further improve the perinatal care of pregnant women using opioids, and to identify at-risk infants for earlier intervention.

In 2018, the TDH reported 881 cases of NAS in the state, and an unknown number of opioid-exposed newborns (OEN) who were at risk for NAS. TIPQC membership identified this as a crucial project for perinatal health improvement. The proposed study is addressing the issue at 3 levels: 

Maternal: Improve the management of women using opioids during pregnancy by advancing provider and patient education, increasing OUD screening, mapping community resources, and implementing evidence-based practices for addiction treatment, the spectrum of pregnancy care, and pain management protocols.
Infant:  Improve the diagnosis of infants at risk, educate providers and parents, control environmental stimuli for OEN in additional to infants with NAS, and provide other non-pharmacologic treatment.
Dyad: Promote postpartum rooming-in, identify barriers to rooming-in, promote breastfeeding, enhance discharge with parents and plans of safe care, improve the interaction with social services and outside agencies.

This is a unique project that combines the efforts of a variety of obstetric and newborn care providers to develop effective evidence-based protocols or bundles. These protocols can be applied to a variety of clinical settings within the state of Tennessee and through existing collaborative efforts with other health systems across the United States. Every participating unit will make significant contributions and will have the ability to network with other centers on a regular basis. We hope for broad participation across the state to optimize collaboration and knowledge sharing. By working together on opioid use disorder in pregnancy, we have the ability to improve outcomes for women, infants, and their families.

OEN Application - Infant