title: Improving Care for Neonatal Abstinence Syndrome.
abstract: Care for neonatal abstinence syndrome (NAS), a postnatal drug withdrawal syndrome, remains variable. We designed and implemented a multicenter quality improvement collaborative for infants with NAS. Our objective was to determine if the collaborative was effective in standardizing hospital policies and improving patient outcomes.
  
  
  
  From 2012 to 2014, data were collected through serial cross-sectional audits of participating centers. Hospitals assessed institutional policies and patient-level data for infants with NAS requiring pharmacotherapy, including length of pharmacologic treatment and length of hospital stay (LOS). Models were fit, clustered according to hospital, to evaluate changes in patient outcomes over time.
  
  
  
  Among 199 participating centers, the mean number of NAS-focused guidelines increased from 3.7 to 5.1 of a possible 6 (P < .001), with improvements noted in all measured domains. Among infants cared for at participating centers, decreases occurred in median (interquartile range) length of pharmacologic treatment, from 16 days (10 to 27 days) to 15 days (10 to 24 days; P = .02), and LOS from 21 days (14 to 33 days) to 19 days (15 to 28 days; P = .002). In addition, there was a statistically significant decrease in the proportion of infants discharged on medication for NAS, from 39.7% to 26.5% (P = .02). After adjusting for potential confounders, standardized NAS scoring process was associated with shorter LOS (-3.3 days,95% confidence interval, -4.9 to -1.4).
  
  
  
  Involvement in a multicenter, multistate quality improvement collaborative focused on infants requiring pharmacologic treatment for NAS was associated with increases in standardizing hospital patient care policies and decreases in health care utilization.
authors.affiliation: Departments of Pediatrics, Health Policy, and Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee; stephen.patrick@vanderbilt.edu.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Patrick
authors.affiliation: Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan;
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schumacher
authors.affiliation: Vermont Oxford Network, Burlington, Vermont; Departments of Pediatrics, and.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Horbar
authors.affiliation: Vermont Oxford Network, Burlington, Vermont; Departments of Pediatrics, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire;
authors.forename: Madge E
authors.initials: ME
authors.lastname: Buus-Frank
authors.affiliation: Vermont Oxford Network, Burlington, Vermont; Mathematics and Statistics, University of Vermont, Burlington, Vermont;
authors.forename: Erika M
authors.initials: EM
authors.lastname: Edwards
authors.affiliation: Vermont Oxford Network, Burlington, Vermont;
authors.forename: Kate A
authors.initials: KA
authors.lastname: Morrow
authors.affiliation: Vermont Oxford Network, Burlington, Vermont;
authors.forename: Karla R
authors.initials: KR
authors.lastname: Ferrelli
authors.affiliation: Division of Neonatology, University of Massachusetts Medical School, Worcester, Massachusetts; Neonatal Quality Improvement Collaborative of Massachusetts, Boston, Massachusetts;
authors.forename: Alan P
authors.initials: AP
authors.lastname: Picarillo
authors.affiliation: Neonatal Quality Improvement Collaborative of Massachusetts, Boston, Massachusetts; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Vermont Oxford Network, Burlington, Vermont; Departments of Pediatrics, and.
authors.forename: Roger F
authors.initials: RF
authors.lastname: Soll
mesh_terms: D002170:Canada; D002985:Clinical Protocols / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008485:Medical Audit; D009357:Neonatal Abstinence Syndrome / Q000188:drug therapy*; D058850:Opiate Substitution Treatment; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D058996:Quality Improvement; D006113:United Kingdom; D014481:United States