Ky. initiative looks to curb rise of babies in opioid withdrawal

Kentucky hospitals have started developing a new statewide data-sharing initiative among emergency departments to better address the growing number of babies experiencing opioid withdrawal.

The Kentucky Hospital Association last week collaborated with hospitals across the state to start sharing real-time information that will help them coordinate care for patients with substance use disorder.

Nancy Galvagni, senior vice president for KHA, said the program is based on a model started in Washington in 2012. ED providers in that state formed a partnership to improve care quality and reduce unnecessary visits. They eventually turned their attention toward the rising number of patients coming into the ED due to opioid abuse.

In the first year of the Washington program, opioid prescriptions coming out of the state's emergency departments decreased by 24%, according to the Washington State Hospital Association.

Approximately 12 other states have adopted similar programs. Galvagni said Kentucky's initiative will target opioid use among pregnant women, which has resulted in a stark increase of babies with neonatal abstinence syndrome, or NAS. That syndrome encompasses several medical conditions caused when a baby withdraws from drug exposure while in the womb.

Babies with NAS have a higher risk of being born premature and of having seizures and birth defects. Kentucky has had one of the country's highest rates of women diagnosed with opioid use disorder when giving birth. In 2014 such cases accounted for 19.3 out of every 1,000 delivery hospitalizations, well above the national average 6.5 per 1,000 for that year, according to the Centers for Disease Control and Prevention.

From 2010 to 2016, the number of cases of NAS recorded among the state's hospitals has increased by nearly 200%, according to the Kentucky Department of Public Health.

KHA said there were approximately 1,500 births of children affected by NAS in 2016, costing an average of $60,000 per delivery, including time spent in the neonatal intensive-care unit. All in all, that's a bill of about $90 million. More than 80% of such cases involve patients covered by Medicaid, according to KHA. Some hospitals see as many as 50% of children born in their facilities affected by NAS.

Dr. Peter Giannone, chief of neonatology at University of Kentucky HealthCare, said his system has seen a stark increase in NAS in the neonatal ICU unit over the past five years across the eastern and central part of the state that it serves.

The growth has come so fast that it began putting a real strain on his system's NICU resources. The hospital had to add a separate eight-bed NICU to focus on NAS cases and meet the demand a couple years ago.

"It's absolutely an epidemic here," Giannone said.

Galvagni said the data-sharing initiative will allow ED physicians to identify and treat NAS cases more quickly. The system will send alerts to providers throughout the state if a baby who has been treated for NAS at one facility shows up at another ED.

So far just one facility—the University of Louisville Hospital—has committed to the partnership, but Galvagni said others are finalizing their contracts, and she expected up to 50 of the state's 100 acute-care facilities will join by year-end.

Giannone said he felt the program would help providers identify withdrawal symptoms in babies early, but it will also support clinicians in their monitoring and follow-up. They will be able to share the most up-to-date best practices with their peers.

But the clinical effort on its own won't be enough to ensure better long-term outcomes for children with NAS, he said. That will take parents receiving treatment for their substance use disorder so that they can better care for their children's needs.

"Anything that we do medically here has to go hand-in-hand with getting help into the communities that are hit hardest by this epidemic," Giannone said. "We must make sure the parents and the families continually have support and don't relapse in order to give these babies the best possible outcome that they can have."