Understanding Quality Hospital Care for Families with Prenatal Opioid Exposure

Abstract

Background: The Perinatal Quality Improvement Network of Massachusetts (PNQIN) sought to develop novel family-driven quality measures of hospital care for families who experienced prenatal opioid exposure. PNQIN engaged the Institute for Community Health (ICH) to conduct a literature review and facilitate qualitative interviews with mothers.

Methods: ICH used results of a literature review of patient- and family-centered care to develop an interview guide to identify elements of the hospital experience most important to families. ICH interviewed 10 women who had recently given birth and were engaged in recovery services.

Results: Mothers prioritized clear communication, transparent knowledge transfer, and trust-based relationships with providers—elements of care that are important to most hospital patients. Mothers who experienced opioid use before or during pregnancy had low expectations for their treatment in the hospital, which influenced their satisfaction with care. Judgment and stigma carried particular risk for mothers, whose parenting skills and choices were scrutinized by providers and the Department for Children and Families. Relationships with providers were fragile: one negative incident could derail a mother’s entire hospital experience, increasing stress and disrupting relationship building. Negative experiences were mitigated by a hospital-based advocate who helped families navigate hospital stays and provided support after negative interactions.

Conclusion: Prenatal hospital preparation; comprehensive, trauma-informed training for staff; consistent staffing throughout care transitions; and clear, consistent communication can improve the hospital experience for mothers with prenatal opioid use. Finally, a trusted advocate can help mitigate the impact of negative interactions. Findings will help define family-driven measures of quality.