Goodman D, Zagaria AB, Flanagan V, et al. Feasibility and acceptability of a checklist and learning collaborative to promote quality and safety in the perinatal care of women with opioid use disorders. Journal of Midwifery and Women’s Health. 2019;64:104-111. doi: 10.1111/jmwh.12943
Researchers developed a package of interventions for perinatal care settings providing care to pregnant women with opioid use disorder (OUD) with guidance from an interprofessional advisory group. The intervention package included a 26-item checklist of essential elements in the evidence-based care of women with OUD, a year-long learning collaborative with representatives from participating practices, and a toolkit with related resources to facilitate best practice. Eight diverse, maternity care providing practices piloted the intervention package. Researchers extracted medical record data from participating practices capturing patients treated before (n=55) and after (n=168) implementation. Measures included the proportion of eligible records that incorporated the checklist, the proportion of records including a substance use disorder diagnosis in the problem list, and rates of recommended practices (hepatitis C screening, pharmacotherapy for mental health disorders, treatment of tobacco use disorder, access to naloxone, patient education about breastfeeding and risks of substance use), and clinical outcomes (birthweight, gestational age at birth, urine toxicology, tobacco use at birth). All sites implemented the checklist, and learning collaborative participants from all sites found the checklist helpful. The checklist was included in 78% of records post-implementation. There was a statistically significant improvement occurred in documentation of a substance use disorder diagnosis in the medical record, access to the lifesaving drug naloxone (Narcan), provision of nicotine replacement therapy, education about breastfeeding, and follow-up testing for Hepatitis C after implementation of the intervention package.