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Comparative Effectiveness of Integrated vs. Referral-Based Care for Pregnant Women with Opioid Use Disorder: Initiating a Large, PCORI-Funded Project

December 21, 2018

Sarah Lord, PhD
Director, Dissemination & Implementation Core
Center for Technology and Behavioral Health
Geisel School of Medicine at Dartmouth College

Daisy Goodman, CNM, DNP, MPH
Director of Women’s Health Services
Dartmouth-Hitchcock Perinatal Addiction Program
Assistant Professor of Obstetrics and Gynecology
Dartmouth Institute for Health Policy and Clinical Practice

About the Presentation: Northern New England (Vermont, New Hampshire, Maine) has among the highest rates of opioid use disorder (OUD) and opioid related deaths in the country, including among pregnant and parenting women. Medication for opioid use disorder (MOUD) is the standard of care for treatment of OUD. Pregnant women with OUD may be particularly motivated to initiate treatment. Regional maternity care practices fall into two broad categories: Integrated models, in which maternity care, MOUD, and psychosocial services are provided together, or Referral-Based models, where maternity care is provided at one location and women are referred to community providers for MOUD and other services.

In this presentation we will describe the rationale and protocol of a four-year observational comparative effectiveness study funded by the Patient-Centered Outcomes Research Institute to explore the impact of different models of MOUD for pregnant women with OUD on maternal and infant outcomes during pregnancy and postpartum. Our research questions are based on an urgent need expressed by patients, providers, and policymakers to identify what models of service delivery are best for women and their infants.

We are partnering with 21 maternity care practices across New Hampshire, Vermont, and Maine. A Study Advisory Committee that includes maternity care and pediatric providers, addiction treatment clinicians, state Medicaid and policy representatives, community advocates, and pregnant and parenting women with lived experience will be integrally involved in all aspects of the study, from planning and recruitment, to data collection, analysis, and presentation of results. This collaborative, participatory research approach is what we believe will make this project a success and help to ensure that we can deliver actionable results that can help improve outcomes for pregnant women and their children.

About the Presenters: Sarah Lord, PhD, is an Assistant Professor of Psychiatry at the Geisel School of Medicine at Dartmouth College, and director of the Dissemination and Implementation Core of the Center for Technology and Behavioral Health (CTBH), a NIDA-supported P30 Center of Excellence at Geisel. Dr. Lord has received funding from the National Institutes of Health, the National Science Foundation, the US Department of Education, and the Patient Centered Outcomes Research Institute. Recent projects include a feasibility pilot of a wearable sensor system to detect stress, assessment of readiness of rural primary care providers and patients to adopt digital therapeutic approaches for patient substance use and mental health needs, and an implementation study of a digital care management platform to facilitate supported employment in four community mental health systems. Current initiatives include a large multisite four-year observational comparative effectiveness study of optimal models of medication-assisted treatment for pregnant women with opioid use disorders in rural northern New England, a three-year study to develop and evaluate efficacy of a yoga- mindfulness intervention for pregnant women with opioid use disorder, and a three-year project to adapt a digital care management platform to facilitate implementation of Assertive Community Treatment to individuals with serious mental illness and co-occurring substance use conditions.

Daisy Goodman, DNP, MPH, APRN, CNM is an Assistant Professor of Obstetrics and Gynecology and Community and Family Medicine at the Geisel School of Medicine at Dartmouth. Her clinical background is in women’s health, midwifery, and addiction nursing. She completed her clinical training as a midwife and women’s health nurse practitioner at the Frontier School of Midwifery and Family Nursing, a Doctorate in Nursing Practice from the Massachusetts General Hospital Institute of Health Professions, a Masters in Public Health from the Dartmouth Institute for Health Policy and Clinical Practice, and completed a post-doctoral fellowship in healthcare quality improvement through the Veteran’s Administration Quality Scholars (VAQS) Program. She currently directs women’s health services at the Dartmouth-Hitchcock Moms in Recovery Program, and teaches healthcare quality improvement at The Dartmouth Institute. Dr. Goodman was one of the first wave of advanced practice nurses in New Hampshire to obtain a waiver to prescribe buprenorphine. Her research focuses on improving access to substance use treatment for women through integrated delivery models, the intersection between women’s health care and treatment for substance use, and the comparative effectiveness of integrated care models for women with substance use disorders.