pqcnc: opqc presentation
TRANSCRIPT
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8/9/2019 PQCNC: OPQC Presentation
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Improving The Grade
Promoting Healthy Birth Outcomes in Ohio
The Ohio Perinatal Quality Collaborative
Dave McKenna
Roni Christopher
Barbara Rose
We have no relevant conflicts of interest to disclose.
..a statewide improvement collaborative
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Through collaborative use of improvementscience methods, reduce preterm births and
improve outcomes of preterm newborns in
Ohio as quickly as possible. (March 2007)
Key features:
Focus on population perinatal health = all pregnancies
Collaboration between obstetrics and pediatrics
Evidence based decision making
Collaboration with state policy makers
www.OPQC.net
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Our Impact on Ohio
47% of all births occurred in OPQC hospitals
64% of preterm births (
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What have we accomplished?
Focus on population health 50% of births; 80% of infants 22-29 weeks
All Level 3
Target improved care and improved access to care
Focus on continuum of care Prenatal (obstetrics) and neonatal care and decisions
Collaborations between health care and public health Vital Statistics and Medicaid
HB 197
National attention MOD, VON State Leaders Group, AAP neonatal quality measures group, CMSHAI research agenda
Improved care ~1000 women per year move from 36-37 weeks to term
better care of infants with catheters
..a statewide improvement collaborative
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OPQC NICU Participants
..a statewide improvement collaborative
Akron Children's Hospital
Akron Children's Hospital at St. Elizabeth Health Center
Aultman Hospital - Canton
Cincinnati Children's Hospital Medical Center
Cleveland Clinic
Dayton Children's Medical Center
Doctor's Hospital Columbus
Fairview Hospital - Cleveland
Good Samaritan Hospital - Cincinnati
Grant Hospital - Columbus
Hillcrest Hospital - Cleveland
MetroHealth Medical Center - Cleveland
Miami Valley Hospital - Dayton
Mount Carmel East Hospital - Columbus
Mount Carmel St. Ann's Hospital - Columbus
Mount Carmel West Hospital - Columbus
Nationwide Children's Hospital (Riverside, Grant, DoctorsCampuses) - Columbus
Riverside Hospital - Columbus
St. Vincent Mercy Children's Hospital - Toledo
Summa Health System - Akron
The Ohio State University Medical Center Columbus
Toledo Children's Hospital
University Hospital - Cincinnati
University Hospital - Cleveland - Rainbow Babies
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OPQC Obstetric Participants
..a statewide improvement collaborative
Akron Children's Hospital - Maternal Fetal Medicine
Akron General
Aultman Hospital - Canton
Fairview Hospital - Cleveland
Good Samaritan Hospital - Cincinnati
Grant Medical Center
Hillcrest Hospital - Cleveland
Mercy Anderson Hospital - Cincinnati
MetroHealth Medical Center - Cleveland
Miami Valley Hospital - Dayton
Mount Carmel East Hospital - Columbus
Mount Carmel St. Ann's Hospital - Columbus
Mount Carmel West Hospital - Columbus
Riverside Methodist Hospital - Columbus -
St. Elizabeth Health Center - Youngstown -
St. Vincent Mercy Medical Center - Toledo
Summa Health System - Akron
The Ohio State University Medical Center - Columbus
The Toledo Hospital
University Hospital Case Medical Center - MacDonald Women's Hospital - Cleveland
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Project Aim: In one
year, reduce by 60%,
the number of
women in Ohio of
36.1 to 38.6 weeks
gestation for whom
initiation of labor or
caesarean section is
done in absence of
appropriate medical
or obstetric indication
(Scheduled
delivery)
Dating criteria:
optimal estimation
of gestational age
Inform consumers of risk/benefits of deliveries < 39 weeks
Communicate to patient/clinic/hospital ultrasound results
Promote need for early dating to practitioners and consumers
Public awareness campaign
Promote need for early dating to practitioners and consumers
Promote sonography < 20 weeks to establish dates
Document criteria used to establish EDC
Appropriate use of fetal maturity testing
Empower nurses /schedulers to require dating criteria
Identify a specific contact for authorization dispute re: dating
Provide patient with hard copy results of ultrasound
Empower nurses /schedulers to require dating criteria
Document rationale and risk/benefit for scheduled deliveriesat 36.1 to 38.6 weeks gestation
Document discussion with patient about the above
Both patient and MD sign consent statement for scheduled
delivery between 36.1 and 38.6 weeks
Physician awareness campaign: what are the reason(s) for
scheduled delivery?
Maximize access to Delivery and OR for optimal scheduling
Facilitate scheduling policies that respect ACOG criteria
Prenatal caregivers receive feedback from postnatal caregivers
about neonatal outcomes of scheduled deliveries
Ensure complete and accurate handoffs Ob/OB and Ob/PedsDocument discussion with patient about risk/benefits of near-term
delivery
Promote need for early dating to practi tioners and consumers
Awareness of risks &
expected benefit of near-
term delivery by clinician
Key Drivers
Goal: Assure that all initiation of labor orcaesarean sections on women who are not in labor
occur only when obstetrically or medically indicated
Hospital and physician
practice policies that
facilitate ACOG criteria
Interventions
Culture of safety
and improvement
Continuous monitoring of data & discussion of this effort in
staff/division meetings.
Project outcomes posted on units and websites.
Develop ways to include staff and physician input about
communications and handoffs
Connect with organizational initiatives on safety and use
existing approaches as possible
Empower nurses /schedulers to require dating criteria
Awareness of risks &
expected benefit of
near-term delivery by
patients and
consumers
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OPQC OB Initiative: Our hand
collected dataOPQC hospitals
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Gestat ona age d str but on of b rths at OPQC member hosp ta s, by month,
January 2006 to March 2010
0
10
20
30
40
50
60
70
Jan-06
Mar
-06
May
-06
Jul-0
6
Sep-06
Nov-06
Jan-07
Mar
-07
May
-07
Jul-0
7
Sep-07
Nov-07
Jan-08
Mar
-08
May
-08
Jul-0
8
Sep-08
Nov-08
Jan-09
Mar
-09
May
-09
Jul-0
9
Sep-09
Nov-09
Jan-10
Mar
-10
Percen
t
Full erm (39-41 weeks) Near erm (36-38 weeks)
Poin
s beyond
he ver
ical dashed line are based on preliminary da
a and are likely
o change
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OPQC OB Initiative:
Are we making a difference?
Birth Certificate Data for OPQC Hospitals
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Ohio births at 36-38 weeks gestation following induction, with no apparent medical indication
for delivery, by OP C member status, January 2006 to March 2010
0
10
1
20
2
Jan-06
Mar
-06
May
-06
Jul-0
6
S-06
N-06
Jan-07
Mar
-07
May
-07
Jul-0
7
S-07
N-07
Jan-08
Mar
-08
May
-08
Jul-0
8
S-08
N-08
Jan-09
Mar
-09
May
-09
Jul-0
9
S-09
N-09
Jan-10
Mar
-10
Perc
ent
N n-OP C Median, non-OP C OP C Median, OP C
Points beyond the verti
al dashed line are based on preli
inary data and are li
ely to change
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How we collaborate
Monthly review of the data
Monthly action period calls
Site visits 1:1 coaching as needed
Use of the listserv and other
communication methods
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Key Changes=Improvement
16 teams have a written scheduled delivery policy that outlinesacceptable reasons to delivery before 39 weeks
We created a consumer flyer to educate on our AIM and it wastranslated into 6 languages
19 teams have a formal peer review process requiring a physician to
adequately explain why he/she delivered before 39 weeks 3 hospitals have actively reached out to the private practice
physicians groups to improve communication processes forscheduling
7 teams changed their scheduling workflow, i.e. dedicated faxmachines, mitigation processes for questionable appointments,etc
All of the teams have, at minimum, adopted a procedural standardfor scheduling inductions
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Our Collaborative Makes an Impact
OPQC wins the SMFM Award of ResearchExcellence in 2010 and the March 2010 issueof JCOG detailed this work
2009, we were recognized as a best practice for
Improving the Grade by the National Office ofthe March of Dimes
We have received a March of Dimes grant todisseminate this work to non-OPQC hospitals in2010
We are presenting our NICU project at PAS nextweek
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Future Projects
Antenatal Steroids
Care of P-PROM
Progesterone
Late Preterm 34-36 Regionalization
Breast Feeding
MgSO4 prophylaxis
Smoking
Substance Abuse
Prematurity related
Variation in currentpractice
Existing practiceguideline
Measurableoutcome
Enthusiasm byparticipants
..a statewide improvement collaborative
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What we are thinking about: How doesOPQC include more Ohio perinatalproviders?
How do we capture lessons learned?
Scheduled deliveries at the other 101 Ohiomaternity hospitals?
NICU-associated infections in other Ohio
NICUs or other NICU populations?
..a statewide improvement collaborative
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..a statewide improvement collaborative
We continue to align our work with
regulations:Ohio House Bill 197
Scheduled Births Before 39 Weeks
Antenatal Steroids Appropriate Birth Site for VLBW Infants
Cesarean Birth Rate in 1st Time Mothers
Others
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Questions?
..a statewide improvement collaborative