Transitions of Care From Birth to Outpatient Care for Infants Who Have Been Prenatally Substance-Exposed

OBJECTIVE The birth hospitalization for infants prenatally substance-exposed (IPSEs) is a critical opportunity to connect with families and optimize the transition of care from inpatient to outpatient settings. Through qualitative interviews with clinicians and clinical staff, we sought to identify multilevel factors that impact care transitions from birth hospital to home for IPSEs and their families. METHODS We recruited inpatient and outpatient clinicians and clinical staff (N = 17) from hospitals participating in the Colorado Hospital Substance Exposed Newborn Quality Improvement Collaborative (CHoSEN QIC), a state-based perinatal quality initiative focused on standardizing the care of IPSEs, for semistructured interviews. Multiple coders engaged in inductive thematic analysis, using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to generate thematic memos across participants. RESULTS We identified facilitators and barriers within and across levels of the outer and inner context. Outer-context themes included the need for standardized patient identification, integrated care systems for effective transitions, and sociopolitical context, including challenges with changing laws and lagging policies. Inner-context themes included the value of rapport building with families, optimization of medical team communication, critical role of nonmedical team members for care coordination, and the importance of early identification of discharge disposition. CONCLUSIONS Participants across inner and outer contexts highlighted the importance of de-siloing clinical care groups serving families affected by substance use, including the need for enhanced communication among groups and the importance of incorporating key nonmedical personnel. Integrating care and communication across systems will be crucial next steps for optimization of care of this population.