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Coordinating Outpatient Care for Pregnant and Postpartum Women with Opioid Use Disorder: Implications from the COACHH Program

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Abstract

Purpose With the rise of opioid use disorder (OUD) among women of childbearing age, effective care models must address the complex needs of pregnant and postpartum women with OUD. This paper describes promising practices and implementation challenges from the Collaborative Outreach and Adaptable Care at Hallmark Health (COACHH) program, which utilizes a collaborative care team to coordinate outpatient care for pregnant and postpartum women with OUD. Description Semi-structured interviews were conducted with members of the COACHH team to discuss program logistics and takeaways. Interviews were coded to analyze themes. Assessment The COACHH team identified the need for specialized, time-intensive care coordination to address the unique needs of pregnant and postpartum women with OUD. First, the team prioritizes forming trusting relationships with patients to holistically understand patients’ needs, improve patient engagement, and connect patients with resources. Second, the wide range of patient needs necessitates a team with diverse professional skills, whose members share an understanding of addiction and pregnancy. Third, finding the right quantitative outcome measurements is difficult; instead, success is measured in qualitative terms, stressing relationships and engagement as signals of change. Finally, the team encounters challenges with low referral rates, lack of provider awareness, and fragmented services. Conclusion We identified care delivery and program design considerations that may inform others who wish to coordinate care for pregnant and postpartum women with OUD. The program continues to face challenges enrolling patients and measuring outcomes, reflecting the need for tailored approaches and metrics for this population.

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Notes

  1. The Massachusetts Health Policy Commission is an independent state agency that monitors reform in health care delivery and payment systems, and develops policies to reduce overall cost growth while improving the quality of patient care. CHART is a phased investment program that funds clinical transformation projects in non-profit, non-teaching Massachusetts community hospitals with low relative price. Administered over a two-year performance period, CHART Phase 2 projects have one or more of the following aims: reduce readmissions and improve transfers to post-acute care; reduce unnecessary emergency department utilization; enhance behavioral health care.

  2. Hallmark Health became MelroseWakefield Healthcare in May 2018.

  3. The COACHH program serves three groups of patients: (1) patients with personal history of frequent ED utilization, (2) patients with a history of near-lethal opioid overdose requiring administration of naloxone reversal, and (3) obstetric patients with active opioid use disorder.

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Acknowledgements

The authors wish to gratefully acknowledge the following individuals for their thoughtful review and feedback in preparation of this case report: Carol Plotkin, Hallmark Health System and the offices of the Executive Director and General Counsel, Massachusetts Health Policy Commission. This study was funded by the Massachusetts Health Policy Commission.

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Authors and Affiliations

  1. Massachusetts Health Policy Commission, 50 Milk Street, 8th Floor, Boston, MA, 02109, USA

    Fran E. Hodgins, Jessica M. Lang, Gabriel G. Malseptic, Lauren H. Melby & Kathleen A. Connolly

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  1. Fran E. Hodgins
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  2. Jessica M. Lang
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  3. Gabriel G. Malseptic
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  4. Lauren H. Melby
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  5. Kathleen A. Connolly
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Correspondence to Jessica M. Lang.

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Hodgins, F.E., Lang, J.M., Malseptic, G.G. et al. Coordinating Outpatient Care for Pregnant and Postpartum Women with Opioid Use Disorder: Implications from the COACHH Program. Matern Child Health J 23, 585–591 (2019). https://doi.org/10.1007/s10995-018-2683-y

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