TexasAIM Obstetric Care for Women with Opioid Use Disorder Bundle

From 2017-2020, Texas DSHS worked with the Alliance for Innovation on Maternal Health (AIM) multi-state collaboration to contribute to developing and pilot-testing the Obstetric Care for Women with Opioid Use Disorder (OUD) Patient Safety Bundle, which was released by the American College of Obstetricians and Gynecologists (ACOG) and AIM in 2018. Subsequently, DSHS recruited 10 “early adopter” hospitals with experience or strong interest in providing care to women with opioid use disorder to pilot test implementation of this bundle.

Based on learnings from states that piloted the Obstetric Care for Women with the OUD Patient Safety Bundle, AIM developed and replaced the bundle in October 2021 with the new Substance Use Disorders Bundle (SUD). Due to the complex health and social needs that accompany opioid and other substance use disorders, this bundle differs significantly from the other AIM bundles. The practice concepts in this bundle are rooted in both established and emerging evidence. Therefore, much is still being learned and implementation of these practices during Wave 1 of the initiative requires innovation as well as quality improvement.

Incorporating AIM’s SUD Patient Safety Bundle elements and lessons learned by Texas hospitals during the OUD pilot, DSHS launched the Obstetric Care for Women with Opioid and other Substance Use Disorder Innovation and Improvement Learning Collaborative (OSUD IILC) in August 2023 with eight wave 1 hospitals, including hospitals from the original OUD pilot. Patient and community partners were involved along the way, since this bundle impacts clinical practices as well as care coordination along the continuum of care throughout pregnancy and one year post-partum.

The Wave 1 OSUD Learning Collaborative concluded in November 2024 with a Harvest meeting that facilitated discussion among 8 Wave 1 teams to share breakthroughs, challenges, learnings from teams along the journey, and what changes resulted from implementation of the OSUD bundle. TexasAIM will use information gathered from the Harvest to inform future work.

Mental health and substance use disorders are often co-occurring. The Texas Mortality and Morbidity Review Committee reviewed cases of maternal deaths and determined that 100 percent of the 20 pregnancy-related deaths due to mental health conditions in 2019 and 2020 were preventable. Mental health conditions were one of six leading causes of all 2019-2020 pregnancy-related deaths.

85 percent of pregnancy-related deaths due to mental health conditions in 2019-2020 occurred 43 days to one year after the end of pregnancy, highlighting the opportunity for intervention and prevention during pregnancy and the early postpartum period.

The 2024 Texas Mortality and Morbidity Review Committee report stated a recommendation for TexasAIM to continue providing support to health systems with implementing evidence-based standards, guidelines, and best practices; integrating behavioral health care access for women with mental health and substance use disorders; conducting multidisciplinary team simulations; increasing patient and family engagement; and promoting health care quality improvement to reduce maternal mortality and morbidity. The committee also recommended implementing and amplifying provider awareness and participation in maternal safety initiatives to reduce maternal mortality, morbidity and health disparities and improving postpartum care management, including education and health care coordination for those with mental health and/or high-risk medical conditions.

In response to these recommendations, DSHS will launch an initiative to address substance use disorders and mental health conditions in pregnancy in Spring 2025. DSHS will identify partners to collaborate with outpatient clinics to adopt the AIM Perinatal Mental Health Conditions Patient Safety Bundle and use the Perinatal Psychiatry Access Network (PeriPAN). DSHS will implement a statewide Mental health/Inpatient Substance Use Disorder Learning Collaborative beginning in December 2026.

Partnership

TexasAIM team is grateful for its partnership with the TexasAIM Obstetric Care for Women with Opioid and Other Substance Use Disorder Innovation and Improvement Learning Collaborative Faculty.

Provider Resources

• Care for Pregnant and Postpartum People with Substance Use Disorder Patient Safety Bundle
• Resources and quick links related to the Care for Pregnant and Postpartum People with Substance Use Disorder Bundle
• TexasAIM Opioid and other Substance Use Disorder Key Driver Diagram (PDF)
• TexasAIM Opioid and other Substance Use Disorder Family of Measures (PDF)
• Perinatal Mental Health Conditions Patient Safety Bundle
• Perinatal Psychiatry Access Network (PeriPAN)

Questions?

Didn’t find what you were looking for? Find more information on the Alliance for Innovation on Maternal Health webpage or by contacting the TexasAIM Team at TexasAIM@dshs.texas.gov.