CADENCE - Continuous And Data-drivEN CarE - ABSTRACT Maternal opioid use disorder (OUD) is the leading cause of maternal mortality in the first year after delivery nationwide. OUD also contributes substantially to out-of-home placements in the child welfare system. Medication for OUD (MOUD) is the primary standard of treatment, however, access to MOUD and prenatal care is limited, siloed, and fragmented in Florida. Gaps in access to and continuity of healthcare (prenatal, postpartum, pediatric, pharmacological and behavioral health) and other services for mothers in OUD recovery lead to poor outcomes for parent, child and family. There is also insufficient data integration, due to inconsistent data collection methods or use of diagnostic codes, to identify mother-infant dyads affected by OUD that could inform optimal care at the local level. Single-site studies that integrate substance use disorder programs in pregnancy have been shown to improve neonatal and maternal outcomes. With that in mind, the long-term goal of this study is to leverage high-quality local and timely data to improve OUD outcomes before, during, and after pregnancy with an integrated care approach that can be replicated throughout the state. The objective of the proposed project is to consolidate multiple streams of public health and clinical healthcare data to analyze equitable access and outcomes for families affected by maternal OUD for use in quality improvement cycles to rapidly refine our integrated CADENCE (Continuous and Data-Driven Care) Program. Our central hypothesis is that integrated, continuous, data-driven care will improve CADENCE patient outcomes. We will test this hypothesis through the following aims: 1) create an interactive data dashboard for maternal, neonatal, and infant outcomes for pregnancies affected by OUD; 2) pilot the CADENCE program and rapidly refine using a data-driven approach; 3) determine the improvement in clinical outcomes at the program level using the data from the dashboard and assess the implementation of the CADENCE program; 3) analyze the cost of the CADENCE program and long-term costs of maintenance of the program. Upon completion of our aims, the expected outcomes include improve maternal, neonatal, and infant outcomes using an integrated care model and data-driven approach to tailor services to community and patient needs. Primary outcomes increase in maternal engagement in recovery or MOUD treatment at delivery, neonates with NOWS (neonatal withdrawal syndrome) requiring pharmacologic treatment at delivery, and infant’s age at referral to the Early Steps early intervention program. Our proposed plan is innovative as it is grounded in systems thinking, uses population-level and integrated clinical data to develop a dashboard methodology, and addresses an area of medicine with few previously published efficacy studies. This project meets the goals of the NIH as it aims to decrease racial inequities in prenatal care and increase access to prenatal care to decrease maternal and child mortality and morbidity.
