A statewide quality improvement (QI) initiative for better health outcomes and family stability among pregnant women with opioid use disorder (OUD) and their infants.

A collaborative led by state health and human service agencies, academic leaders, and stakeholders tested interventions to expand use of medication assisted treatment (MAT) through a maternal medical home (MMH) model that coordinated behavioral health and prenatal care with social supports for pregnant women with opioid use disorder (OUD) enrolled in Medicaid. The program was anchored in four clinical organizations with distinct models of care: community behavioral health, residential behavioral health, hospital-based obstetrical practice, and co-located obstetrical and behavioral health. A modified version of the Institute for Healthcare Improvement Breakthrough Series Model for Improvement was implemented using monthly performance data feedback to conduct small tests of change and improve care. Administrative data from the state's Medicaid, vital statistics, and child welfare systems were linked to evaluate the impact of MOMS on 252 mother-infant dyads compared to a sample of 846 Medicaid beneficiaries with OUD in the third trimester of pregnancy. MOMS participation was associated with increased likelihood of MAT in trimesters one, two and three (AOR = 2.30, 4.40, 2.75, respectively), behavioral health counseling during trimesters two and three (AOR = 3.75 and 2.07, respectively), retention in MAT during postpartum months one through three and four through six (AOR = 2.86, 2.40, respectively), and marginally lower out-of-home placement of infants born to mothers with OUD (AOR = 0.66). Within the MOMS program, greater participation in behavioral health treatment and MAT (χ2(3) ≥ 12.09) was observed in the co-located behavioral health/obstetrical care practice site compared to behavioral health-led and obstetrical provider-led sites.

Predictors of Labor Force Status in a Random Sample of Consumers with Serious Mental Illness.

Employment among persons with severe mental illness has been challenging. Supported employment programs have had some success; however, much remains to be understood about client motivations for employment. A labor force participation study was mailed to persons receiving services in a Midwestern state's publicly funded behavioral health system, and a random sample of participants resulted in 964 valid surveys. Analysis showed significant differences between Medicaid coverage program and labor force status, with some programs likely to have higher percentages of employed persons. A multinomial logistic regression model explored the odds of employment and unemployment to not being in the labor force. Perception of incentives to employment greatly increased the odds, while age and perception of barriers to employment decreased the odds for both groups when compared to those not in the labor force. Findings have implications for the design of employment programs and coverage benefits.

The assimilation of evidence-based healthcare innovations: a management-based perspective.

In order to reap the benefits of the nation's vast investments in healthcare discoveries, evidence-based healthcare innovations (EBHI) must be assimilated by the organizations that adopt them. Data from a naturalistic field study are used to test a management-based model of implementation success which hypothesizes strategic fit, climate for EBHI implementation, and fidelity will explain variability in the assimilation of EBHIs by organizations that adopted them under ordinary circumstances approximately 6 years earlier. Data gathered from top managers and external consultants directly involved with these long-term EBHI implementation efforts provide preliminary support for predicted positive linkages between strategic fit and climate; climate and fidelity; and fidelity and assimilation. Mediated regression analyses also suggest that climate and fidelity may be important mediators. Findings raise important questions about the meaning of assimilation, top managers' roles as agents of assimilation, and the extent to which results represent real-world versus implicit models of assimilation.