Opioid Use Disorder

Opioid Use Disorder / en Fri, 25 Apr 2025 22:51:34 -0500 Fri, 04 Apr 25 16:04:14 -0500 Study finds AI screening for OUD led to fewer hospital readmissions /news/headline/2025-04-04-study-finds-ai-screening-oud-led-fewer-hospital-readmissions The National Institutes of Health April 3 released a <a href="https://www.nih.gov/news-events/news-releases/ai-screening-opioid-use-disorder-associated-fewer-hospital-readmissions">study</a> that found an artificial intelligence screening tool was as effective as health care providers in identifying hospitalized adults at risk for opioid use disorder and referring them to inpatient addiction specialists. When compared with patients who received consultations with providers, patients screened by AI had 47% lower odds of hospital readmission within 30 days after their initial discharge, saving nearly $109,000 in care costs.&nbsp; &nbsp; Fri, 04 Apr 2025 16:04:14 -0500 Opioid Use Disorder HHS extends public health emergency for opioid crisis /news/headline/2025-03-19-hhs-extends-public-health-emergency-opioid-crisis The Department of Health and Human Services March 18 <a href="https://www.samhsa.gov/newsroom/press-announcements/20250318/secretary-kennedy-renews-public-health-emergency-declaration-address-national-opioid-crisis" target="_blank">announced</a> that it renewed the public health emergency for the nation’s opioid crisis an additional 90 days. The PHE, first declared in 2017, was set to expire March 21. The declaration allows federal agencies to use every appropriate emergency authority to address the opioid crisis. Wed, 19 Mar 2025 15:10:04 -0500 Opioid Use Disorder OIG report finds just 40% of Medicare enrollees who started treatment for opioid use disorder continued /news/headline/2025-02-20-oig-report-finds-just-40-medicare-enrollees-who-started-treatment-opioid-use-disorder-continued The Department of Health and Human Services Office of Inspector General Feb. 18 released a <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Foig.hhs.gov%2Freports%2Fall%2F2025%2Fnot-all-medicare-enrollees-are-continuing-treatment-for-opioid-use-disorder%2F&amp;data=05%7C02%7Cngill%40aha.org%7C46fbc5bf44d14c0fa9ed08dd51f0e114%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638756817190971857%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=YwRl2rcwO6R%2BOi3XfTWjdrJ09c2gR1ou%2BFvUj46VAeA%3D&amp;reserved=0" target="_blank">report</a> that found about 40% of Medicare enrollees who began opioid use disorder treatment with buprenorphine continued with it for at least six months in office-based settings. Those who did not continue treatment were more likely to have died for any cause during the study period than those who did. One-third of enrollees who began treatment with buprenorphine received at least one behavioral therapy service; those who did not receive these services were less likely to continue treatment. Few enrollees received services paid for by Medicare aimed at sustaining access to treatment, such as counseling and care coordination in an office-based setting or initiation of treatment in the emergency department. Thu, 20 Feb 2025 15:09:33 -0600 Opioid Use Disorder DEA and HHS delay implementation of buprenorphine final rule /news/headline/2025-02-14-dea-and-hhs-delay-implementation-buprenorphine-final-rule Today the Drug Enforcement Administration and Department of Health and Human Services <a href="https://www.federalregister.gov/public-inspection/2025-02793/expansion-of-buprenorphine-treatment-via-telemedicine-encounter-and-continuity-of-care-via">announced</a> that the effective date for the <a href="https://www.federalregister.gov/documents/2025/01/17/2025-01049/expansion-of-buprenorphine-treatment-via-telemedicine-encounter">final rule</a> regarding telemedicine prescribing of buprenorphine will be delayed from Feb. 18 to March 21. &nbsp;As outlined in the <a href="https://www.whitehouse.gov/presidential-actions/2025/01/regulatory-freeze-pending-review/">Jan. 20 White House memorandum</a> announcing the regulatory freeze, the agencies decided to delay the implementation of rules to review any questions of fact, law and policy.&nbsp;The DEA and HHS clarified that the waiver provisions outlined in the <a href="https://www.federalregister.gov/documents/2024/11/19/2024-27018/third-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled">third extension</a> of telemedicine flexibilities for prescribing controlled substances will remain in effect to waive in-person visit requirements through Dec. 31, 2025. The agencies are soliciting comments on whether the effective date of the buprenorphine final rule should be extended beyond March 21. Comments are due Feb. 28.Once implemented, the DEA’s final rule for the telemedicine prescribing of buprenorphine will enable practitioners to prescribe a six-month initial supply of Schedule III-V medications to treat opioid use disorder via audio-only telemedicine interaction without a prior in-person evaluation. Additional information on the buprenorphine final rule can be found in the <a href="/advisory/2025-01-22-telemedicine-prescribing-controlled-substances">AHA Member Advisory</a>. Fri, 14 Feb 2025 16:03:43 -0600 Opioid Use Disorder Englewood Health's Strategies to Combat Rising Opioid Use in Post-Pandemic America /advancing-health-podcast/2025-01-22-englewood-healths-strategies-combat-rising-opioid-use-post-pandemic-america Opioid use has been on the rise in post-pandemic America, and its effects on communities have&nbsp;been devastating. Decreasing opioid use is a major priority for health systems across the nation. In this conversation, Vinnidhy Dave, D.O., hospice specialist and director of palliative medicine at Englewood Health Physician Network, and Lauren Savage, director of population health at Englewood Hospital, discuss what Englewood Health is doing to&nbsp;prevent&nbsp;opioid use in its communities, and how an opioid risk tool provides guidance and protocols to protect higher-risk patients.<hr><div></div><div class="raw-html-embed"><details class="transcript"><summary> <h2 title="Click here to open/close the transcript.">View Transcript &nbsp;</h2> </summary> 00:00:00:01 - 00:00:20:00 Tom Haederle Welcome to Advancing Health. Coming up in today's episode, a conversation with Englewood Health about the rise in the use of opioids since the pandemic. We'll talk about what providers can do to decrease their use and what Englewood Health is doing right now by way of prevention. Your host is Rebecca Chickey, senior director of behavioral health services with the AHA. 00:00:20:03 - 00:00:30:27 Tom Haederle She's speaking with Lauren Savage, director of Population Health, Englewood Hospital, and Dr. Vinnidhy Dave, director of palliative medicine, Englewood Health Physician Network. 00:00:30:29 - 00:00:57:04 Rebecca Chickey Dr. Dave and Lauren, thank you so much for being here with us today to talk about this incredible topic. The opioid crisis during Covid did nothing but escalate, unfortunately. And the more creative the suppliers of opiates and synthetics become, I think the more challenging your job, our role in helping individuals with opioid use disorder, the more challenging it becomes. 00:00:57:04 - 00:01:24:27 Rebecca Chickey So I'm delighted to, first of all let the audience know Englewood was a Foster McGaw Prize finalist. They were acknowledged and presented with this award at AHA's Leadership Summit in 2024. The prize was for a much broader perspective. They have really done a lot of work around all of behavioral health and improving access. But today we want to focus in on opioid stewardship. 00:01:25:04 - 00:01:48:05 Rebecca Chickey And I'm going to break this down in a number of ways. My first question to you is that I'd like you to provide some statistics. What are the driving factors that really allowed you to say this is a problem? This is a challenge, and we have to focus on it. So can you start there? Everyone knows what's going on in their community, but they don't know what's going on in yours. 00:01:48:08 - 00:02:06:16 Lauren Savage Yeah. I mean, I can start and Dr. Dave, feel free to add to the conversation. I think you said it best, Rebecca. This is a problem in everyone's community, and nobody is surprised by the concerns that we're seeing. We do use our community health needs assessment to better understand our community and their needs. 00:02:06:18 - 00:02:34:16 Lauren Savage In the 2016 and 2019 Community Health Needs Assessment, the need for behavioral health increased tremendously. And at that point, we knew we needed to do more. We also were seeing it in within our own patient population, within our community. And there was also a very generous family that donated to the hospital. And so in 2018, we were also able to open the Gregory P. Shattuck Behavioral Care Center. 00:02:34:18 - 00:03:12:07 Lauren Savage And this center is dedicated to behavioral health and to substance use. The Shattuck family lost a family member to substance use. And they were clear that part of this center should be focused on our treating our patients and our community on substance use, as well. And it was through the Shattuck Center that we were also able to form an opioid stewardship committee, so that we were really able to get a group of dedicated providers, mostly disciplinary team at our hospital, to come together to talk about the epidemic, to learn, you know, what's happening in our community amongst our patients, and to begin to address it. 00:03:12:09 - 00:03:32:08 Vinnidhy Dave, D.O. I would say from the physician side of things, you know, my background is internal medicine. And then I trained in palliative care. For years we always, you know, thought about surgeons as the ones that were giving opioids first to patients. But there's been data over the last few years showing that hospitalists and internist were actually the ones that were exposing patients to opioids 00:03:32:08 - 00:03:54:12 Vinnidhy Dave, D.O. first from the hospital side. So, I think that's where my interest came in, was really how do we work on decreasing the use of opioids in the hospital? How do we decrease the amount of patients we're sending home with opioids? After I read this article in the New England Journal medicine, where it was showing that internists were probably the ones that were exposing patients to opioids first, before surgeons and surgeons have done better job with the last few years. 00:03:54:15 - 00:04:13:12 Rebecca Chickey So a couple of things. One, I heard in terms of key success factors, Lauren, that you said is when you identified the need, you had the data, you replicated it, you shared it, you then found a generous philanthropist to be able to provide you with the funding and the backing that you needed, but then you also created a committee. 00:04:13:13 - 00:04:36:09 Rebecca Chickey So this was not being done in isolation. And that really leads me to my next question. One key part if I understand your program correctly, one key component is around prevention. And it is in terms of what are some alternatives to opiates as well as what are best practices around prescribing privileges? 00:04:36:11 - 00:04:58:15 Vinnidhy Dave, D.O. This is where my kind of work has been with the team and the task force, is really creating what a lot of hospitals are now calling out alternatives to opioids, in the emergency room when we started it and then we started in on the floors in the hospital as well to provide it to our internists hospital as surgeons for normal pain, things that we commonly see. 00:04:58:15 - 00:05:19:17 Vinnidhy Dave, D.O. So in the emergency room we've created a protocol for back pain, kidney stone pain, headaches, intractable abdominal pain that's not surgical. And there's an order set in our Epic system where we put in non opioids that can be given for those types of pains. So you would just type in alto and in that let's say back pain comes up. 00:05:19:17 - 00:05:45:17 Vinnidhy Dave, D.O. And then under back pain there's options of steroids, muscle relaxants, anti-inflammatories, reminding providers that have been trained for years just to go to opioids automatically when someone's in severe pain that these are all the other options we have. And sometimes, you know, as physicians, sometimes when you're in the E.R. you're seeing 40 patients it's hard to remember. But now when you type in pain and your alto pops up and now you see back pain, you can check off these things. 00:05:45:19 - 00:06:23:20 Vinnidhy Dave, D.O. It makes it easier for the providers. And then, of course, we've done a lot of education with the providers. We've done education with the doctors on the floors in the E.R. Most recently now we're working on pain protocol or pain order set, where basically what a lot of hospitals have done for insulin, where there's long acting insulin, short acting insulin, how to check sugars more frequently so that you run into less problems with hypo and hypoglycemia is now we have a whole pain order set that is smart and it uses like if someone has kidney function issues, a liver function issues, certain medications will automatically not pop up so that patients won't accidentally get 00:06:23:20 - 00:06:41:26 Vinnidhy Dave, D.O. like an ibuprofen if they have kidney issues. This will be the only way to order opioids. They can't just give someone oxycodone. They want to give them oxycodone, they have to go to the order set and the order that has your non-opioids there, your opioids there. So you're always actively thinking about other options to give than just automatically going to opioids. 00:06:41:29 - 00:06:50:00 Rebecca Chickey Absolutely. Thank you for that. I may come back to you here with a question, but I want to give Lauren the opportunity to jump in a little bit as well. 00:06:50:03 - 00:07:10:28 Lauren Savage I think we always say this in our department, but we will never have enough providers to provide the treatment needed for the need of our community. So we really have focused a lot on prevention. So a lot of what Dr. Dave is saying in terms of limiting opioid initiations and leveraging our electronic medical record to provide better care. 00:07:11:01 - 00:07:34:24 Lauren Savage He's gone out and done lots of trainings. We've done some targeted trainings to certain providers who need that further education, but we've also done training for our patients when they are prescribed opioids. So, any time a patient is prescribed opioids at discharge that are provided, automatically provided educational materials to better understand what they're being prescribed and how to not, you know, misuse that prescription. 00:07:34:26 - 00:08:00:07 Rebecca Chickey I should share with you. We worked with the CDC, AHA worked with the CDC probably about five years ago now, but I think it is still very on point and helpful. We have a two-pager that we can provide to families and patients. So not just the patients, but letting the family know what are some of the signs and symptoms if they start to see you know, perhaps abuse of the opioids if they do go home with them. 00:08:00:09 - 00:08:22:18 Rebecca Chickey So my next question is, I think you've also developed a screening tool for OUD, probably, much broader, but for all substance use disorders, particularly given the statistics that you just said, Dr. Dave, regarding, you know, what happens upon admission and discharge. So can you tell me a little bit about the screening tool and how you baked it into your EHR? 00:08:22:21 - 00:08:50:12 Vinnidhy Dave, D.O. So we've implemented the opioid risk tool, which is probably the most studied one out of what we have right now. And it's implemented into our EHR, where anybody can put the phrase in: dot.org.key or dot.risk. And it pops up and it's also part of our preoperative screening as well. So in the preoperative area, if someone is tagged to be high risk, then they're referred to a pain management provider so that we can follow them 00:08:50:12 - 00:09:08:09 Vinnidhy Dave, D.O. postoperatively if there's any concerns. We've done education with the residents and the hospitals about using this tool. So if they do start someone on opioids in the hospital, they're able to understand what risk factors the patients have. And then we've shared this with our outpatient providers as well, because we have hundreds of primary care doctors that are part of our network. 00:09:08:09 - 00:09:13:07 Vinnidhy Dave, D.O. So they can use that as well when they're prescribing opiates to their patients. 00:09:13:09 - 00:09:15:29 Rebecca Chickey Lauren, what would you like to add? 00:09:16:01 - 00:09:36:03 Lauren Savage Yeah. So in addition to the opioid risk tool, we've also implemented a screening tool in our emergency room. So I'm going to go back to my point of prevention. And if we can screening individuals and earlier determine whether or not they have a substance use concern, we can provide them the correct resources and connect them to the appropriate level of care. 00:09:36:06 - 00:09:59:14 Lauren Savage So all individuals who come to our emergency room, I believe it's 18 and up. We are screening for all substances, opioids included. And any patient who screens positive will receive counseling by one of our emergency room doctors, by our social workers. And if needed, a social worker will make a referral for that patient for additional services. 00:09:59:16 - 00:10:22:07 Rebecca Chickey I have to admit, one of my biases is that that's the wave of the future, to screen for psychiatric and substance use disorders for every admission, it's somewhere between 1 in 4 or 1 in 5 admissions to the hospital has &nbsp;- and is probably much higher than that in the emergency room - has a comorbid psychiatric or substance use disorder. 00:10:22:15 - 00:10:44:05 Rebecca Chickey That is not, as you said, they're presenting diagnosis or the presenting reason for their admission, but it's there nonetheless. And we should always take the opportunity to identify and treat, if needed. And also, you know, that happens sometimes to improve outcomes and shorten length of stay. And anyway, I could speak on that for hours. I won't here. 00:10:44:12 - 00:10:51:17 Lauren Savage You are correct though. It's about 20% of the individuals we are screening have a positive screen for substance use. 00:10:51:19 - 00:11:14:05 Rebecca Chickey As we begin to bring this to a close, let me ask you this key important fact. What's the impact then, for all this work, for creating the center, for implementing the screening programs, for doing the training, for changing the culture, quite honestly? For using technology to help in decision-making process. What's the impact you've seen? 00:11:14:07 - 00:11:39:23 Lauren Savage One impact I can share. I think you touched it when you just said changing the culture. Englewood Health has really recognized that 20% of the patients that we've screen in the emergency room are in need of additional counseling and support. So, just two months ago we have now opened an outpatient addiction medicine office so that we are more easily able to treat the patients that we identify within our own system. 00:11:39:26 - 00:12:01:14 Vinnidhy Dave, D.O. And I can follow what Lauren said. I think, you know, we've seen a huge difference just from the hospital side, from our providers, from our residents when you know, they're ordering, I'm seeing less opioids being ordered if we're ordering opioids. Even the nurses are sometimes questioning it or they'll ask me on the side like, is this appropriate? So there's this huge culture shift that we've seen with education. 00:12:01:16 - 00:12:23:21 Vinnidhy Dave, D.O. And I think making the providers feel comfortable using other medications and not feeling like they have to go to an opioid first, that it's kind of a domino effect throughout the program. And, you know, we're seeing outpatient providers, inpatient providers really trying to make sure that they're only using the opioid when they feel it's really appropriate. And it's not the first thing that they're going to do in terms of treatment. 00:12:23:23 - 00:12:55:18 Rebecca Chickey That's phenomenal. What would you say are two key success factors that allowed you to do this? Was it a champion like Dr. Dave stepping up and saying, we've got to do this, and I'm here to be a team player to make it happen. Obviously, I think earlier you mentioned, a wonderful philanthropist that allowed you to have the funds to do that. But what are a couple of key success factors that the listeners would need to know about to implement something similar in their own organization? 00:12:55:21 - 00:13:17:15 Lauren Savage I think for our stewardship, it really was a collaboration of different disciplines coming together and recognizing the role that each of us plays in this process. Because it was all of us working together that we were able to implement all of these workflow changes and utilizing our electronic medical record and the education of our providers and the education of our community. 00:13:17:18 - 00:13:21:07 Lauren Savage It required all of us to work together to achieve the goals we set forth. 00:13:21:09 - 00:13:44:05 Vinnidhy Dave, D.O. I was thinking the same thing that Lauren said. I think it's really getting the providers in different areas to really bring this together and make it move forward quickly, whether it's, you know, someone from IT, whether it's you know, someone from social work, whether it's ER doctor, the chief of anesthesia, you know, chief of medicine, chief of psychiatry, and then, you know, Lauren making sure these meetings happen on top of it. 00:13:44:05 - 00:14:05:16 Vinnidhy Dave, D.O. and we're making sure we're planning for it beforehand. And then making sure we have a plan for the next one, and really, I think, a point person and then being able to get the right people together to implement it, and then everyone being passionate about it. Everyone on the team was excited about, we want to try to do this, and we want to try to reduce opioids and we want to try to, you know, get better care for our patients. 00:14:05:19 - 00:14:40:09 Rebecca Chickey Awesome. Well, thank you so very much for your willingness to share your time and your expertise. I'm hoping that this podcast, along with other work that AHA has done and that you have done, will inspire others to go on this journey for this very, very important clinical disease and disorder. And I again say congratulations on being one of AHA's Foster McGaw Prize finalists, and I will point the listeners to AHA's resources on opioids at AHA.org/opioids. 00:14:40:11 - 00:14:48:22 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details></div> Tue, 21 Jan 2025 23:36:36 -0600 Opioid Use Disorder AHA podcast: Thinking Outside the Box to Reduce Behavioral Health Stigma and Disparities /news/headline/2024-11-06-aha-podcast-thinking-outside-box-reduce-behavioral-health-stigma-and-disparities In this conversation, Matthew Hoag, director of integrated behavioral health at Denver Health, shares how the organization is innovating through integration to meet the behavioral health needs of its communities. One example is its state-of-the-art mobile opioid treatment unit. <a href="/advancing-health-podcast/2024-11-06-thinking-outside-box-reduce-behavioral-health-stigma-and-disparities">LISTEN NOW</a>&nbsp;<div></div> Wed, 06 Nov 2024 15:26:06 -0600 Opioid Use Disorder Thinking Outside the Box to Reduce Behavioral Health Stigma and Disparities /advancing-health-podcast/2024-11-06-thinking-outside-box-reduce-behavioral-health-stigma-and-disparities For historically underserved populations, stigma and lack of access to behavioral health services can present huge barriers to treatment. In this conversation, Matthew Hoag, director of integrated behavioral health at Denver Health, shares how the organization is innovating through integration to meet the behavioral health needs of its communities, including with its state-of-the-art mobile opioid treatment unit.<hr><div></div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript &nbsp; </h2> </summary> 00:00:00:11 - 00:00:26:11 Tom Haederle Often, people with severe mental illness lead shorter lives, sometimes up to 25 years less. For historically underserved populations and minorities, this can be compounded. A recent Kaiser Family Foundation report found that rates of death by suicide are rising faster among black, Hispanic, and other people of color than whites. There are many reasons for this, including access to care, stigma, and even implicit bias in the health care system itself. 00:00:26:13 - 00:00:48:12 Tom Haederle There isn't one magic solution to all of these problems, but as Denver Health has found out, the integrated care system goes a long way towards reducing health disparities and providing the care that patients need and deserve. 00:00:48:15 - 00:01:11:13 Tom Haederle Welcome to Advancing Health, a podcast from the �� Association. I'm Tom Haederle with AHA communications. In this podcast, hosted by Rebecca Chickey, senior director of Behavioral Health Services with AHA, we learn how Denver Health's commitment to integration as a tool for increasing access to behavioral health has benefited the communities it serves by reducing stigma and health disparities. 00:01:11:15 - 00:01:23:25 Tom Haederle As Matthew Hoag, director of Integrated Behavioral Health for Denver Health, says, a patient can now discretely get all of their health conditions addressed in one place. And that's incredible. Here's Rebecca. 00:01:23:28 - 00:02:07:12 Rebecca Chickey It is my honor indeed to be here with Matthew Hoag from Denver Health. He has so much experience in the value of integrating physical and behavioral health. And it's an honor for myself and our listeners today to be able to listen and learn from him. Today, we're really going to focus on the value of integrating physical and behavioral health in terms of how it can help reduce health disparities for historically underserved communities, individuals, and communities of color, as well as those individuals who suffer from severe and persistent mental illness, such as schizophrenia and bipolar disorder. 00:02:07:15 - 00:02:50:06 Rebecca Chickey The reason that these things are so important is what Matthew's going to share with us. But I want to put in just a couple of thoughts. One, when you hear what he says about the importance of integration and the value that that delivers for individuals with severe and persistent mental illness, one of the really important things is that is what people often refer to as bi-directional integration, meaning individuals with severe mental illness often die 17 to 25 years earlier than those individuals without. And that's not due to suicide. That is due to their inability because of poor management in many cases of their mental illness. 00:02:50:09 - 00:03:23:20 Rebecca Chickey And then health disparities exist across the board for communities of color. And when you begin to look at it through the lens of behavioral health care, unfortunately, the magnitude of those disparities often goes up. So with that as general background, Matthew, can you tell me just a little bit about the realities - as I started talking about - and the vulnerabilities around mental health disparities, and what are those challenges that those individuals face? 00:03:23:22 - 00:03:48:18 Matthew Hoag Thank you. Rebecca. Before we start, too, I just want to acknowledge my privilege as a as a white male. And just hammer home that I choose to work in a community health center here at our Denver health hospital because I believe in our organization's mission to provide all in our community access to the highest quality and equitable health care, regardless of the patient's background or ability to pay 00:03:48:18 - 00:04:18:15 Matthew Hoag so really appreciate the opportunity to talk on these topics. You know, what we know is that an estimated 43% of people with mental health concerns are connected to care, and that's a pretty alarming statistic. Some of the realities and challenges for individuals of color, include implicit bias, which comes up quite a bit in how patients might be identified or selected for referrals to behavioral health or identified or even properly diagnosed. 00:04:18:15 - 00:04:39:19 Matthew Hoag And so this this plays a huge impact for individuals of color. The other thing that's kind of difficult within behavioral health is it can be very difficult to navigate our complex health system, but even more specifically, our sometimes complex behavioral health system, because it can be difficult to know what somebody feels like they need to be connected to. 00:04:39:19 - 00:05:01:26 Matthew Hoag And so if there isn't really good screening, really good assessments, sometimes individuals and families are at a loss of where to go or where to start, or who even to ask to begin that journey. I think another area that we see, and that we're trying really hard as an organization to impact, is a lack of diversity among our care teams. 00:05:01:28 - 00:05:26:02 Matthew Hoag We, at Denver Health have community health centers. And what I love about Denver Health is these community health centers are situated in very historic neighborhoods within Denver County, we're I think the fifth largest federally qualified health system in the country. We strive to have those clinics be a reflection of those communities they serve. Really requires us to have staff as a reflection of those patients. 00:05:26:04 - 00:05:50:24 Matthew Hoag Why that's important is because trust. Trust is incredibly important with the care team to be able to break down some of these racial disparities. Now, where does integrated behavioral health come in with this? I could talk about integrated behavioral health all day. We have really good research that shows that improves patient outcomes, reduce total cost of care, increase access above all to behavioral health. 00:05:50:24 - 00:06:14:17 Matthew Hoag And we also see that patients like what is incredibly valuable to me is that when I have a medical provider pull me in to consult with a patient for a behavioral health concern, sometimes that patient has been coming to that clinic for ten, 15 years. Their parents had gone there. Their parents still go there for care. Their kids get their vaccinations, get wellness exams there. 00:06:14:21 - 00:06:35:22 Matthew Hoag And so when I come into the room, I have this unparalleled level of support and trust already because that medical provider who has that trust with that patient says, this is Matt. He's an expert in X, Y, and Z depression, whatever substance treatment. And he wants to come talk with you to see how we can support that goal or support. 00:06:35:22 - 00:06:41:19 Matthew Hoag You know, let's talk a little bit more about, you know, what's going on over here. And that's the value of integrated care. 00:06:41:21 - 00:07:15:15 Rebecca Chickey You have talked about the importance of trust. The fact that it's real time, meaning you can call in a medical provider or you can be called in as the expert to help that patient real time. Is that something that you see has also been beneficial in terms of reducing the stigma, because you've used the term trust a couple of times, but often we hear the horrible word, the big thing in the room, the stigma of even seeking or talking about mental health treatment or my anxiety or panic attack. 00:07:15:18 - 00:07:17:13 Rebecca Chickey Is that another aspect of this? 00:07:17:15 - 00:07:51:23 Matthew Hoag Absolutely. Stigma, I'm glad you brought that up. Stigma is all about what we're trying to reduce and what our integrated behavioral health can be really substantial. Early on in my career with integrated behavioral health, I specialized within substance treatment and co-occurring as well with other behavioral conditions. But one thing I always when I walked into the room, as I always try to keep in the focus, that it is very likely that the individual that I'm about to meet has had a negative interaction or has been judged for a behavioral health or substance treatment condition at some point prior to meeting me. 00:07:51:26 - 00:08:09:09 Matthew Hoag And so I try to think about how I approach that from a culturally sensitive way, but also identify and create some safety where I can. I'm very fortunate to have that collaborative medical team to help with that trust, but it's something that we have to be very, very cognizant about because it is a reality that's in the room. 00:08:09:11 - 00:08:32:09 Rebecca Chickey It's so very important because stigma exists for all of us, regardless of your ethnicity, the location or culture that you've been brought up in, your skin color. But unfortunately for many, many different cultures and even genders, we still see the statistics show that women are more likely to ask for help than men, regardless of everything else. 00:08:32:12 - 00:08:45:24 Rebecca Chickey And then within certain cultures that stigma is at a much higher bar. So it's just uplifting and hopeful that, integration can address those in a way that is seamless in many ways. 00:08:46:01 - 00:09:27:27 Matthew Hoag Absolutely. And I think what folds into the trust piece is the cultural competency of our staff. And so, you know, our organization and our integrated behavioral team places part of our values as a team is around diversity, equity and inclusiveness and belonging and how that shows up in our clinical practice, being able to identify microaggressions within teams and being able to have open discussions about how that influences us as providers, but also impacts our ability to deliver effective clinical care. Something that is also really important with this - in order to have and to recruit for diverse care teams, is we often put a lot of emphasis on recruitment, but retention is also really 00:09:27:27 - 00:09:32:00 Matthew Hoag important for keeping that healthy for our teams. 00:09:32:03 - 00:09:38:27 Rebecca Chickey As we begin to wrap up, are there a couple of things that you think have made Denver Health's program successful? 00:09:39:00 - 00:10:06:18 Matthew Hoag I think the thing I most appreciate about where I work is the individuals I work with as well. We're a large organization, and we have done some pretty cool things that are a little out there, but we're not afraid to try that. One particular project I want to highlight is we just last year launched a mobile opioid treatment unit, and this was a collaboration between our brick and mortar opioid treatment program and our community health services. 00:10:06:18 - 00:10:27:15 Matthew Hoag And so this mobile unit actually goes out to two of our qualified health centers, our eastside and westside clinic. And we do walk-ins for opioid treatment, particularly for methadone. And what's amazing about that is if, you know, you know how sometimes there's some realities and difficulties with accessing Opidone and it's, you know, very regulated, very structured. 00:10:27:18 - 00:10:46:12 Matthew Hoag You usually have to go really early in the morning to receive that. We did something where we enhanced a lot of current patients care, because we have patients who go to the Eastside Health Center, then go across town to you know, their opioid treatment program. It's not quite integrated, but what I would call is it's very co-located and very collaborative. 00:10:46:15 - 00:11:07:05 Matthew Hoag But a patient can discreetly now get all of their health conditions addressed in one place. And that's incredible. Especially with fentanyl opioid epidemic being able to enhance care in a way that is trauma informed as well as, kind of helping break down some of those barriers to access. I like that we get to do that. 00:11:07:10 - 00:11:15:12 Matthew Hoag I'm incredibly grateful, and it feels incredibly special to be able to try to do things like that, to really enhance care for all of our patients. 00:11:15:15 - 00:11:37:06 Rebecca Chickey So the key point, I think, for the listeners is to not be afraid to try. That was unusual. That's out of the box. I think sometimes when we're young, we try everything, right? Sometimes to the demise of our parents or whoever is bringing us up. But we're not afraid to try. And sometimes I think the world changes that perspective. 00:11:37:07 - 00:11:56:04 Rebecca Chickey So, we need to remember. Don't be afraid to try, because you're all you're trying to do is to improve outcomes and reduce the cost of care and improve somebody's life. Thank you so much for sharing your time and your expertise with us today. Thank you for the work that you're doing across the fine mountain city of Denver. 00:11:56:06 - 00:11:59:01 Rebecca Chickey And thank you for your passion for your work. 00:11:59:03 - 00:12:00:12 Matthew Hoag Thanks for having me. 00:12:00:14 - 00:12:08:25 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details> </div> Wed, 06 Nov 2024 07:19:28 -0600 Opioid Use Disorder AHA receives CDC grant to address opioid, stimulant use disorder and expand infection prevention resources /news/headline/2024-10-24-aha-receives-cdc-grant-address-opioid-stimulant-use-disorder-and-expand-infection-prevention-resources The AHA Oct. 24 &nbsp;<a href="/press-releases/2024-10-24-aha-receives-cdc-grants-strengthen-opioid-use-disorder-care-and-expand-infection-prevention-resources">announced</a> it has been awarded a nearly $1.5 million grant from the Centers for Disease Control and Prevention as part of its National Partners Cooperative Agreement. The funding will support hospitals and health systems in their efforts to address opioid and stimulant use disorder along with infection prevention and control. It also allows the Health Research &amp; Educational Trust, an affiliate of the AHA, to lead opioid use disorder initiatives in primary care clinics, hospitals during discharge and transitions, and pharmacies. The project aims to enhance patient access to care and support long-term recovery efforts.&nbsp; &nbsp; “The opioid crisis remains a significant public health challenge,” said Chris DeRienzo, M.D., chief physician executive of the AHA and president of HRET. “This funding strengthens the vital link between patients and lifesaving treatments and provides critical support to hospitals and health systems in building the infrastructure necessary for a healthier future.”&nbsp; In addition, the grant will extend the Living Learning Network, a virtual community of over 1,200 members focused on peer learning in areas such as patient safety, sepsis and health equity. A portion of funds will also build on previous CDC work at rural hospitals and establish a Rural IPC Community of Practice to foster collaboration and develop tailored IPC metrics for rural settings. Thu, 24 Oct 2024 15:24:55 -0500 Opioid Use Disorder AHA Receives CDC Grants to Strengthen Opioid Use Disorder Care and Expand Infection Prevention Resources /press-releases/2024-10-24-aha-receives-cdc-grants-strengthen-opioid-use-disorder-care-and-expand-infection-prevention-resources CHICAGO (October 24, 2024) – The �� Association (AHA) today announced it has been awarded nearly $1.5 million in funding from the Centers for Disease Control and Prevention (CDC) as part of its National Partners Cooperative Agreement. This funding will support hospitals and health systems in their efforts to address opioid use disorder (OUD) and stimulant use disorder (StUD) and infection prevention and control.The CDC funding will allow the Health Research &amp; Educational Trust (HRET), an affiliate of the AHA, to lead opioid use disorder initiatives in three key clinical settings: primary care clinics, hospitals during discharge and transitions, and pharmacies. The project aims to enhance patient access to care and support long-term recovery efforts.“The opioid crisis remains a significant public health challenge,” said Chris DeRienzo, M.D., chief physician executive of the AHA and president of HRET. “This funding strengthens the vital link between patients and lifesaving treatments and provides critical support to hospitals and health systems in building the infrastructure necessary for a healthier future.”The funding also supports work to enhance existing efforts on infection prevention and control (IPC). Specifically, it will extend the Living Learning Network (LLN), a virtual community of over 1,200 members focused on peer learning in areas such as patient safety, sepsis and health equity.Finally, part of this new grant funding will be designated for specific work at rural hospitals. It will build on previous CDC work and establish a Rural IPC Community of Practice to foster collaboration and develop tailored IPC metrics for rural settings.&nbsp; &nbsp;### About the �� Association (AHA) The �� Association (AHA) is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities. The AHA advocates on behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners – including more than 270,000 affiliated physicians, 2 million nurses and other caregivers – and the 43,000 health care leaders who belong to our professional membership groups. Founded in 1898, the AHA provides insight and education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at&nbsp;<a href="https://nam11.safelinks.protection.outlook.com/?url=http%3A%2F%2Flink.mediaoutreach.meltwater.com%2Fls%2Fclick%3Fupn%3DeDNMJiR1601yOe4MaifqClqdHitT0SBDo6hVejI-2F0uk-3DIBW6_kFmn947cPXeH4Nw5FKo9qWRARJUhwQXnY03SXbOJmd4fh-2FMf2fOpasllheBrYb-2F8tnjtjNDujBrG4uugreK5OWkDI227pG8YPlYGd-2Boz0WRezRdoSQJc-2FP-2FpAltWiLE92K3nooc-2FooQkkdlWTzT4ACRlP9W08ehFw2sv6X87qqF5sGb3sx9-2Fx6xTwk4XAp-2FGGvoCI-2FQl1mnhXdbLIAW-2FHoJZV5J46jZF2Q0hwQW61iKjAIPA4ligeJEG7CjLFTLQD2uNgE3LaomEMOwQCZ60yyEyv-2Bocg3oRDYIfnUCYkn-2FBx6AEywMqTGaQRBxL38CUJdTTGaszhb2vWhV9XQYZyvwNYY3JWq9qfyCpgylq7nHYgHlEEEO-2FvoaiVx090XoO&amp;data=04%7C01%7Ccmilligan%40aha.org%7C3a442c9984df4ea82ab608d913b7d3ee%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637562502528140012%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&amp;sdata=X2DZVso3YeFlCEln%2FGHrL9xUhOXWWPkZ8DXib4xi1Lw%3D&amp;reserved=0">www.aha.org</a>.&nbsp; Thu, 24 Oct 2024 10:59:05 -0500 Opioid Use Disorder It Takes a Village: A New Approach to Opioid Abuse Helps Mothers and Babies /advancing-health-podcast/2024-06-10-it-takes-village-new-approach-opioid-abuse-helps-mothers-and-babies- As opioid abuse has reached epidemic proportions, the number of babies born dependent on these drugs also has increased dramatically. The award-winning&nbsp;WISH (Women and Infant Substance Help) Center at SSM Health St. Mary's Hospital is combating this serious problem with innovative and people-first solutions that help mothers get off and stay off opioids and other substances. In this conversation, Chris DeRienzo, M.D., senior vice president and chief physician executive at the AHA, speaks with three&nbsp;WISH&nbsp;Center&nbsp;experts about how its approach is helping to protect the health of new mothers and their babies.For more information on the SSM WISH Center visit <a href="https://www.youtube.com/watch?v=vzaZZrLRAn0&amp;t=1s">https://www.youtube.com/watch?v=vzaZZrLRAn0&amp;t=1s</a>#CHIWeek #CHI<hr><div></div><div class="raw-html-embed"><div class="raw-html-embed"> <details class="transcript"><summary> <h2 title="Click here to open/close the transcript.">View Transcript &nbsp;</h2> </summary> 00;00;00;17 - 00;00;27;14 Tom Haederle As opioid abuse has reached epidemic proportions, the number of babies born dependent on these drugs also has increased dramatically. The award winning WISH Center that stands for Women and Infants Substance Help, opened in 2016 at SSM Health, the Saint Mary's Hospital in Saint Louis, Missouri, to provide new approaches that help women get off and stay off opioids and other substances that harm their health and that of their child. 00;00;27;17 - 00;00;41;20 Tom Haederle Stay with us to learn more about how the WISH Center is making a difference. 00;00;41;23 - 00;01;07;11 Tom Haederle Welcome to Advancing Health, a podcast from the �� Association. I'm Tom Haederle with AHA communications. For pregnant or postpartum women who are struggling with opioid substance disorder, reaching and maintaining sobriety is a continuous process that may take years. The WISH Center helps make this brave and difficult journey easier by leveraging many community resources that offer support. Truly, it takes a village. 00;01;07;14 - 00;01;29;11 Tom Haederle In this podcast, Dr. Chris DeRienzo, AHA’s chief physician executive, speaks with three WISH Center experts on how its approach is helping to protect the health of new mothers and their babies. Donna Spears is director of the maternal service line for the WISH Center. Dr. Niraj Chavan is medical director and Dr. Karen Fowler directs its women and neonatal clinical program. 00;01;29;14 - 00;01;30;22 Tom Haederle Let's join them. 00;01;30;25 - 00;01;50;28 Chris DeRienzo, M.D. Welcome everyone to this week's podcast. We are so excited to celebrate CHI week and get to highlight the incredible work of the SSM WISH Center and how they engage with their community. We have three outstanding guests joining us today from SSM and I know we have a relatively short period of time that we get to spend with them. 00;01;51;00 - 00;02;15;26 Chris DeRienzo, M.D. So we're going to jump right in. And I'm going to ask the team to begin sharing with us at some of the conditions in their community that led to the creation of the WISH Center. And perhaps, you can start with sharing a little bit about your community in general, because I don't know that every one of our listeners has a good feel for who is SSM and what is the kind of community that you serve? 00;02;15;28 - 00;02;23;25 Chris DeRienzo, M.D. But then really specifically, you know, get into get into the details and share with us more about how this incredible center works. 00;02;23;27 - 00;02;46;18 Donna Spears, RN Well, my name is Donna Spears, and I'm the director for the Saint Louis region for SSM Health, Women's Health Services. And I was the founding director for the WISH Center based out of Saint Louis, Missouri. Several years ago, we noticed an increase in our pregnant population delivering babies that had the effects of what was recognized of opioids. 00;02;46;21 - 00;03;21;12 Donna Spears, RN Opioid use disorder, neonatal abstinence syndrome, and noticed an increase of patients that were using opioids while pregnant when there was no type of services around that could support their needs. And, basically try to give them an opportunity for a prenatal care episode as well as delivery and sobriety. So that was the whole genesis for the why behind it, to create something basically for better outcomes for mom and moms and babies. 00;03;21;15 - 00;03;40;22 Donna Spears, RN But there of course were many other nuances to that. There was a lot of research that had to go into it, a great deal of work, but ultimately it was decided that we should develop the WISH Center to provide that space, normalize the care for women and try again to, you know, move moms and babies to healthy outcomes. 00;03;40;25 - 00;04;01;27 Chris DeRienzo, M.D. Donna, thank you so much for sharing that background. I'm a neonatologist and I remember practicing ten years ago in western North Carolina, and there were days where only 10 or 12% of our NICU census would be babies who were experiencing withdrawal symptoms from opiates. And, you know, our follow up clinics, sometimes it was as high as 25 or 30% of the kiddos who were visiting us that day. 00;04;01;27 - 00;04;21;28 Chris DeRienzo, M.D. And so, it means a lot that the folks like you are trying to engage so far upstream in the process. And I'm wondering, perhaps this question goes to Dr. Chavan and Dr. Fowler, talked about some of the ways that you've had to leverage those community strings in order to be able to bring your center the success that you've seen. 00;04;22;00 - 00;04;55;28 Niraj Chavan, MD Yeah. Thank you. for our listeners, just in terms of, a little bit about, you know, who I am and what I'm doing at WISH. My name is Niraj Chavan, I have the honor and truly the privilege of serving as the medical director for our WISH Center. And really, when you talk about leveraging community partnerships and, where we are at and what our community looks like, I think the number one thing is really getting a good grasp of what is your community. And what our community looks like has actually evolved over the span of the whole of last decade, right from 2014 to when WISH was first started, to 2024 00;04;55;28 - 00;05;34;03 Niraj Chavan, MD where we're in right now and a lot has changed over the period of time. COVID just being one of the big, big, big things that hit all of us, certainly in the most unexpected of ways. But, you know, when we look at leveraging our community, I think one of the most recent additions and most welcome additions that we've been looking forward to over several years is our doula program. And this is really in response to understanding the need from our community for having something like that, specifically in the perinatal, substance use disorder space, which, has been certainly a benchmark for anybody working in this space, but also setting a precedent at a 00;05;34;03 - 00;05;55;03 Niraj Chavan, MD national level. So we have a doula program where our patients are able to connect with their doulas. And these are folks from the community coming from where our patients are coming from. So they're able to literally understand and quite literally meet the patient where they are. And when I say that, quite literally, I actually mean that quite literally, because they don't always meet here physically at WISH. They might meet at a Starbucks, for example. 00;05;55;03 - 00;06;22;22 Niraj Chavan, MD They might meet at a grocery store, for example. But being able to understand where our patients are coming from, and meeting them, understanding what their needs are and responding to that sort of in a community-centric approach. I think that's been one key aspect of leveraging those community partnerships. And I think the other solid example, really, I would say, is our postpartum program, where we're able to continue caring for these patients not just through pregnancy, but all the way through two years postpartum. 00;06;22;22 - 00;06;51;04 Niraj Chavan, MD And this is way before anything along the lines of Medicaid expansion and expansion was even on the horizon. And so when we're doing that, we're really doing that in response to what the community has been telling us. Understand what their needs are. And while we're doing that, we're able to partner with so many different agencies, whether it's the diaper bank, for example, whether it's, some of the behavioral health facilities where we work at, to make sure that we're able to understand and respond to those community needs. 00;06;51;06 - 00;07;10;10 Chris DeRienzo, M.D. And, Dr. Fowler, I'm wondering if you might want to jump into the conversation here as well, because, those community needs are absolutely always evolving. And I love the fact that you have that emphasis, not just in the in the pre partum period, but we know that the risks involved in that postpartum period are incredibly high, both for moms and babies alike. 00;07;10;12 - 00;07;35;27 Karen Fowler, MD There's a couple of key points that both Donna and Niraj are making, and one of them is normalizing the experience of these women who are in this clinic. And I think when you normalize it for these women, what they understand is that they can access areas of the community and ways to live a healthy, sober life, long term and help them interact with the community in a way that they haven't before. 00;07;36;00 - 00;08;04;29 Karen Fowler, MD Or maybe they have, but it's been a long time. I also think one of the key thoughts in this whole concept is that sobriety is an ongoing...it doesn't end when she delivers, or that 6 to 12 week postpartum mark. This is something that these families will manage for years. And you know, staying healthy, it requires them to have long term support so that two years is really short, in the long scheme of things. 00;08;04;29 - 00;08;09;02 Karen Fowler, MD But I think it really increases the level of success that these families have. 00;08;09;04 - 00;08;30;15 Chris DeRienzo, M.D. It must. I mean, you're right, it's a short two years, but gosh, the level of impact over those two years. I'm a neonatologist but I'm also a father of three kids, and I remember going through, you know, ages birth to two with all three of them. And, you know, we weren't trying to do that and manage of what we know is a chronic condition in terms of substance use disorder. 00;08;30;15 - 00;08;54;22 Chris DeRienzo, M.D. So, I'm just blown away by the work that you're doing. Talk to us a little bit about tactical lessons that you've learned in building this program. And for anyone who hasn't, would strongly recommend that you go out to YouTube and you watch the video. it's only about seven minutes long that that gives you some visuals on the way this program works and the communities they serve because, gosh, it is incredibly impactful. 00;08;54;22 - 00;09;14;26 Chris DeRienzo, M.D. But, for those who are listening, this could be to any of the three of you, Donna, Niraj or Karen. Share with us a key tactical lesson, that if I'm a team in a hospital, somewhere else in the country and I see this need in my community, &nbsp;that I could benefit from hearing through your experience as I embark on that journey to help build it. 00;09;14;28 - 00;09;37;19 Niraj Chavan, MD You know, I think one of the key tactical lessons I would say, when you are working in this space is to understand that it's not a one man show. It really takes a team. And the big part of that journey is who is in your team. So when you're looking at caring for patients, whether they're pregnant or postpartum with substance use disorder, and the most important thing to understand is that it takes a village. 00;09;37;19 - 00;10;17;00 Niraj Chavan, MD Right. And so when we talk about it takes a village, it really then kind of hinges upon understanding who all is in that village. So for example, when you look at our team, physicians are physician providers, for example, just one piece of that puzzle. The other pieces are, I would actually argue, as important or more important perhaps, than that one physician provider. For example, our social workers - we have a handful of prenatal social workers, and then that dedicated postpartum social workers. Behavioral health counselors, a therapist, our peer support specialists, a psychiatrist who dedicatedly is now focusing on perinatal or reproductive psychiatry, a clinical pharmacist. 00;10;17;00 - 00;10;37;22 Niraj Chavan, MD Our nurse practitioners, our prenatal nurses. And again, our doulas, like I talked about a little while ago. So, you know, understanding who all is in that team. And more importantly, perhaps assembling that team is really a key tactical strategy that I would say all our listeners would benefit from. Because unless you get the right players, you're not going to have a successful team. 00;10;37;22 - 00;10;47;24 Niraj Chavan, MD And when we talk about the team-based approach to care, it's just as important to make sure that they have the right attitude and the right people in the mix as what they're going to be doing actually. 00;10;47;26 - 00;11;15;22 Donna Spears, RN Another key component would be the need for perinatal behavioral health support and ongoing behavioral health support, because that is fundamental to this program. And so we have co-located substance use counselors. We have psychiatry. You know, we have, again, the social workers, we have other resources for patients, within the community that they can access for services for ongoing management as well. 00;11;15;24 - 00;11;34;27 Donna Spears, RN It's very important that that's a component of anyone's care model, because you have to consider the majority of these women are dual diagnosis. There's been some sort of past trauma or some sort of mental health situation that must be addressed to help address the SUD/OUD issues as well. 00;11;35;00 - 00;11;59;21 Karen Fowler, MD It really does take a village, and paying for that village is really tricky. Paying for that village and paying for this model of care, quite honestly, would not happen without operational wizards like Donna. Like people in the health system that understand that when you have these 12 people on the care team, billable services and actually getting paid to do this work is not straightforward. 00;11;59;21 - 00;12;19;27 Karen Fowler, MD These are not procedures. These are not - yes, we're doing MFM ultrasounds, etc. - but one of my ongoing lessons right now is the art of creating these relationships with payers. We're talking about models of care that actually make sense that we can sustain this. I think WISH is very sus - have we talked about what WISH stands for, by the way? Did I miss that? 00;12;20;03 - 00;12;22;03 Chris DeRienzo, M.D. We haven't yet. If you would, please share. 00;12;22;09 - 00;12;25;23 Karen Fowler, MD Donna Niraj, you say it so much more eloquently. 00;12;25;26 - 00;12;47;10 Donna Spears, RN It's an acronym for Women and Infants Substance Help. When we came up the name, we wanted something that gave hope to the patients that joined us without it being something that was scary. So, as we talk about normalizing, I think it's important to put out that we put ours in a medical building on campus at SSM Saint Mary's in St. Louis. 00;12;47;12 - 00;13;18;00 Donna Spears, RN And if you walk in it looks like any other physician offices nestled amongst other physician offices. It's important that patients not feel like they're walking into something that has a flashing neon sign that says Substance Use Disorder and Pregnancy Center. So let's give it a positive name. Let's give it something that provides some hope, but also normalizes and put them in a setting with the special nuances built into the center that can provide the support and care that they need to be successful. 00;13;18;02 - 00;13;37;06 Chris DeRienzo, M.D. These are the times where sometimes I wish that instead of recording a podcast, we were recording a podcast of some kind. Because for your listeners, if you could see the heads nodding in agreement with all of the things that are being shared again, we're here today with the outstanding team from SSM and their WISH center. And we've talked about operational sustainability. 00;13;37;06 - 00;13;56;15 Chris DeRienzo, M.D. We've talked about how you build the program. And we only have a few minutes left. And I'm curious, you know, you all have gotten to such an outstanding place, but when you were starting this work, what was the approach that you took to really understand both the needs of the patients and the community that you're serving, but also the assets that you could lead on? 00;13;56;15 - 00;14;16;19 Chris DeRienzo, M.D. I mean, you've spoken to the way that which that we're treating the whole person. It's a multi-year commitment. But if I'm, you know, in western North Carolina and I'm looking at you all as this ideal that I want to emulate, how do I know, you know, where in my community I've got some strengths already and where we might need to be building? 00;14;16;19 - 00;14;18;19 Chris DeRienzo, M.D. How did you start that process? 00;14;18;21 - 00;14;37;11 Donna Spears, RN That's more through, sort of an asset inventory when you do that, as well as gap analysis to see what you have, what you don't have. And then, after you do an assessment of your internal resources, then you look at your external. Who wants to be a partner, who wants to be at the table, who will support the service? 00;14;37;13 - 00;15;03;02 Donna Spears, RN So then you can do that through that type of work as well. We're very lucky that we're a mission-based organization. And so because of that, when we take, you know, business proposals forward for a new center like this that is expensive to run, that needs support from AHA and state legislatures and legislators and others to be able to create sustainable, reimbursement models... 00;15;03;04 - 00;15;31;09 Donna Spears, RN When you think about the work that goes into that, you really need to, you know, also consider what all assets are needed, what resources are needed, and what is the benefit? So when you, as Dr. Fowler mentioned, when you think about the benefit, you know, it benefits society in general to have productive moms, to have people that, you know, live in sobriety that could live, you know, productive lives with jobs and, have healthier moms and babies. 00;15;31;09 - 00;15;54;25 Donna Spears, RN You know, we've reduced NICU days significantly from when we first started. When you think about just the cost, you know, to society, for this type of care for these babies, not just during, you know, post-birth, but also long term, then you have to think about, you know, that's a huge impact. So there's a lot to this, a lot to consider 00;15;54;25 - 00;16;01;27 Donna Spears, RN and what needs to be part of it to make a comprehensive care model and meet all the facets for a very complex service. 00;16;01;29 - 00;16;19;17 Chris DeRienzo, M.D. It is absolutely, as you've pointed out, Donna, the right thing to be doing. You know, when you make that heavy investment early on, you are bending the curve of an entire family's life outcome from that point onward. And so, again, it speaks to my heart, because you're talking about my NICU babies and I just love it. 00;16;19;20 - 00;16;38;25 Chris DeRienzo, M.D. I know we're short on time. And so I would love to invite the group to just share, whatever closing thoughts you'd like and again, specifically focusing in on, wondering what you have found to be the best ways to do that as you serve your community through the WISH Center. And again, thank you all so much for being willing to share your stories today. 00;16;38;28 - 00;16;57;27 Niraj Chavan, MD I think one of the biggest things when it comes to, approaching partners in the community and really finding partners that you want to work with or that you want to sort of partner with is it's all about finding the right fit. So, you know, I think to a little bit about, the mission and, you know, it's the mission. 00;16;57;27 - 00;17;19;17 Niraj Chavan, MD It's the vision and it's kind of what sort of shared goals do you have? And, you know, having that shared mental model in terms of growth, in terms of serving the community that you're looking at in terms of understanding what their needs are and in terms of respecting what each partner is bringing to the table. So, you know, when we look at sort of partnership, it really is a two way stream. 00;17;19;20 - 00;17;36;22 Niraj Chavan, MD And that, symbiosis, if you will, or that mutual sort of benefit will only flourish if we have all of these in alignment. So I think finding that right fit, I would say, would be sort of the one day home thing that I would encourage all our listeners to sort of look out for. 00;17;36;24 - 00;17;41;27 Chris DeRienzo, M.D. Very well said, Niraj. And Donna or Karen, anything else you'd like to share in closing? 00;17;42;00 - 00;18;03;13 Donna Spears, RN I think it's also important to call out that, part of meeting patients where they are is to understand their needs. And Dr. Fowler has led a very extensive project related to social determinants of health screening across our organization, and a pilot program that's now further into embedded in not just, a pilot anymore. 00;18;03;15 - 00;18;29;20 Karen Fowler, MD What we have learned through this SDOH work in doing it in a standardized process, etc. And two piece of advice I would give to anybody starting this work in other areas of the country or other health systems is the sooner you can create data that shows benefit, the more sustainable you are. And I think one of the lessons that we've had in this work is our SDOH data is not good. 00;18;29;20 - 00;18;47;25 Karen Fowler, MD We're not good at coding on Z codes. We in obstetrics and maternal health, we're just not good at that area. And so the better we can be when we start...again, sustainability, the way we pay for this work. You can't look away from data. So the earlier the benefit the better. And that's what I would tell anybody that's starting this work. 00;18;47;25 - 00;19;19;09 Karen Fowler, MD The other piece is the sooner you can create relationships in awareness with payers, with your state Medicaid, with other policymakers, the earlier, you can get traction in really making change that makes sense for this work to sustain. Again, I'm all about sustainability. WISH Center has deep roots. They have figured out that. But I also know that scaling this is hard and we as a health system need to figure that out. 00;19;19;09 - 00;19;22;26 Karen Fowler, MD So those are the two pieces that I think are really important. 00;19;22;28 - 00;19;42;06 Chris DeRienzo, M.D. We are out of time today. It has been a true privilege Donna, Niraj and Karen, to get to visit with you. We heard about how to engage the community, how to figure out where the assets are to build from, to meet your community where they are, and these closing words about making sure that you grow those deep roots from the outset. 00;19;42;07 - 00;20;01;02 Chris DeRienzo, M.D. Oh, gosh. this has been a gem. Again thank you to everyone for listening in during this CHI week special presentation. And if you want to learn more about the WISH Center again, there's a really terrific video. All you got to do is look up SSM Health WISH center. You'll find that on YouTube. And I hope you enjoy. 00;20;01;05 - 00;20;02;18 Chris DeRienzo, M.D. Take care everyone. 00;20;02;20 - 00;20;11;01 Tom Haederle Thanks for listening to Advancing Health. 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