Standardized policies reduce health care utilization for neonatal abstinence syndrome


The standardization of hospital patient care policies was effective in decreasing health care utilization, such as length of pharmacotherapy and length of hospital stay, for infants with neonatal abstinence syndrome (NAS) according to a report published online April 15 in Pediatrics.

Assessment of the effects of a multicenter, multistate quality improvement collaborative focused on infants requiring pharmacologic treatment for NAS on patient outcomes, including length of pharmacotherapy (LOT), length of hospital stay (LOS), discharge on human milk, discharge with a parent, and discharge on a medication, was undertaken by Dr. Stephen W. Patrick of the departments of pediatrics, health policy, and the Mildred Stahlman Division of Neonatology and the Vanderbilt Center for Health Services Research, both in Nashville, and his colleagues.

In a prospective cohort study, four preplanned serial, cross-sectional quality audits of centers enrolled in the Vermont Oxford Network (VON) NAS Internet-Based Quality Improvement Collaborative were conducted in February 2013, August 2013, February 2014, and August 2014 (Pediatrics. 2016 Apr 15. doi: 10.1542/peds.2015-3835).

The study produced several findings indicative of improved hospital performance and patient outcomes based on the serial audit data from the 199 participating centers. Collectively, the centers examined the medical records of 3,458 infants with NAS, most of whom were born at term (78%) and treated with morphine (83%). Study data suggested that the participating centers effectively standardized their care, as evidenced by a significant increase in their mean number of policies from 3.7 to 5.1 of the 6 measured. Additionally, centers showed significant improvements in all measured policies, which included those focused on the following:

• Maternal substance screening.

• Evaluation and treatment of substance-exposed infants.

• Standardized NAS scoring.

• Inclusion of nonpharmacologic treatment strategies for NAS.

• Standardizing the pharmacologic treatment of NAS.

• The provision of human milk for substance-exposed infants.

As for patient outcomes, the median LOT and LOS decreased by 1 and 2 days, respectively (from 16 to 15 days for LOT [P = .02] and from 21 to 19 days for LOS [P = .002]). In an exploratory analysis, only policies to standardize NAS scoring were found to be significantly associated with improved patient outcomes: changes in LOT of –2.1 days and LOS of –3.1 days. Also, the proportion of infants discharged on a medication taper decreased from 39.7% to 26.5%, the investigators reported.

Dr. Patrick and his associates said that their findings support the American Academy of Pediatrics’ 2012 policy statement calling for standardization of NAS care by showing that such measures result in improved patient outcomes. Additionally, their model showed the ability to achieve rapid-cycle adoption of practice guidelines and that state governments and health agencies can collaborate to improve neonatal care and reduce costs through partnerships with structured systematic quality improvement collaboratives like VON.

This study was supported by the National Center for Advancing Translational Sciences and the National Institute on Drug Abuse, both part of the National Institutes of Health. Dr. Patrick and Dr. Schumacher are consultants to the VON and five other investigators are employees of VON; the other authors indicated no relevant financial relationships.