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Transforming Our Future

Jeffrey D. Horbar MD Chief Executive and Scientific Officer Vermont Oxford Network Jerold F. Lucey Professor of Neonatal Medicine University of Vermont Burlington, VT Dr. Jeffrey Horbar is a board-certified neonatologist and clinical scientist with extensive experience in clinical research and its application to the improvement of

neonatal care. He is currently the Jerold F. Lucey Professor of Neonatal Medicine at the University of Vermont College of Medicine, Chief Executive and Scientific Officer of Vermont Oxford Network and Co-Editor of the Neonatal Review Group of the Cochrane Collaboration. Dr. Horbar has been responsible for the development of the Vermont Oxford Network Database which is used by over 950 NICUs around the world to monitor and improve outcomes for high risk infants and their families. Annual Quality Congress Plenary Session, Saturday, October 3, 2015 Transforming Our Future Objective: Challenge 2 key assumptions about the opportunities to minimize mortality and morbidities in neonatal care and the importance of deep family engagement to accomplish this goal.


Jeffrey D. Horbar MD

October 3, 2015 1

Welcome Members of the Worldwide


VON Annual Quality Congress 2015Sheraton Hotel & Towers

Chicago IL

Jeffrey D. Horbar

Professor of Pediatrics University of Vermont

Chief Executive and Scientific OfficerVermont Oxford Network

Disclosure

I am the Chief Executive and Scientific Officer of the Vermont Oxford Network.

I will not be discussing the unlabeled use of any commercial product.

Vision

To build a worldwide community of practice dedicated to providing every newborn infant and family with the best possible and ever improving medical care.

1000 Newborn Units

32 Countries

2 million infants69 million patient days

90% of VLBW infants in US



October 3, 2015 2

Over 500 teams since 1995

Parents as Team Members and Faculty

60

70

80

90

100

110

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130

BE

NE

FIT

ME

TR

IC

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Year

POD GroupEntire VON

Courtesy Joe Kaempf, MDAdapted from Kaempf JW et al. JAMA Pediatrics 2015;169:459‐465

10 Units in NICQ POD Improved 34%

Benefit Metric includes 8 major morbidities

STATES TOGETHER

Edward DonovanFaculty Leader

Roni ChristopherQuality Improvement Facilitator

Rochelle NelsonParent Leader

Wide Variation Among States in 2014Mortality

NEC

CLD

Late Infection

Severe ROP

Severe IVH

State Transfer Networks

II

I

I

I

I

I

I

II

II

II

II

III

III

III

IV

I

I

III

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October 3, 2015 3

Practices in Switzerland and VONInfants 501 to 1500 gm 2010 to 2012

0%

20%

40%

60%

80%

100%

AntenatalSteroids

DR CPAP Ventilation Surfactant Human Milk

Switzerland US

Adams M, Bucher HU, Roth‐Kleiner M et al. VON Annual Quality Congress 2015

Royal Jubilee Maternity ServiceBelfast, N Ireland

Chairman’s Award

Daniele Ehret MD, MPHDirector of Global Health, VON

Vermont Oxford Network Volunteers

Global Health at VON

Professor Bogale WorkuExecutive Director

Ethiopian Pediatric Society

Drs. Asrat, Goitom, and HailuAttending Neonatologists

Addis Ababa, Ethiopia

Welcome to our Ethiopian Colleagues

Our ChallengeTo dramatically reduce

if not entirely eliminate

the major morbidities

for VLBW infants.

Relative Changes 2004 to 2014

‐50%

‐40%

‐30%

‐20%

‐10%

0%

Infection sROP sIVH Death PVL NEC CLD Ptx



October 3, 2015 4

Death or Morbidity for VLBW Infants

44%

68,173 VLBW Infants in 2014

Morbidities in 2014

0%

5%

10%

15%

20%

25%

30%

35%

Infection

sIVHsROP

PTX PVL

CLD

NEC

Morbidities in 2014

CLD 2800

Infection 2500

NEC 680

Severe ROP 600

Severe IVH 430

PVL 420

PTX 400Risk adjusted estimates based on infants 501 to 1500 grams at 932 NICUs in 2014

Avoidable Morbidity for Infants and Families

1000 NICUs Improving Together!

Jeffrey D. Horbar, MD

[email protected]

Thank You!



October 3, 2015 5

Roger F. Soll

Henry Wallace Professor of NeonatologyUniversity of Vermont College of Medicine

PresidentVermont Oxford Network

EditorCochrane Neonatal Review Group

Oxygen –Getting it Right!

Evolving Evidence for Safe Oxygen Saturation –

Tradeoffs at the Tips & Tails

Barbara K. Schmidt Professor of Pediatrics Kristine Sandberg Knisely Chair in Neonatology

Senior ScholarCenter for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPerelman School of Medicine

Staff NeonatologistChildren’s Hospital of PhiladelphiaPhiladelphia PA

Discussion

Oxygen –Getting it Right!

Evidence Into Action-What is a

Clinician to Do?

Content ExpertsJames I. Hagadorn

Assistant Professor of PediatricsUCONN School of MedicineAttending NeonatologistConnecticut Children’s Medical CenterHartford, CT

David W. Sink

Assistant Professor of PediatricsUCONN School of MedicineAttending NeonatologistConnecticut Children’s Medical CenterHartford, CT



October 3, 2015 6

Improvement StoryBharath Srivatsa

NeonatologistNorthside HospitalNeonatology Associates of Atlanta PCPediatrix Medical GroupAtlanta, Georgia

Discussion

Gorm Ole Greisen

Professor and Consultant Neonatologist

Department of NeonatologyRigshospitalet and Copenhagen University

Copenhagen, Denmark

Discussion

Madge E. Buus-Frank

Executive Vice PresidentDirector of Quality Improvement and Education

Vermont Oxford Network

BreakPlease return promptly at



October 3, 2015 7

Parent Presence Builds Brains

Effects of Mother’s Voice and Heartbeat Sounds on Brain

Development of Preterm Infants

Amir LahavAssistant Professor of PediatricsHarvard Medical SchoolBoston, MA

Visiting Professor / ScientistDepartment of PediatricsWomen & Infants HospitalProvidence, RI

Discussion

Parent Presence Builds Brains

The H-HOPE Randomized Controlled Trial:

A Maternally Administered Multi-Sensory Intervention

Rosemary White-TrautDirector of Nursing ResearchThe Children’s Hospital of WisconsinMilwaukee, WI

Professor EmeritaDept. Of Women, Children and Family Health ScienceUniversity of Illinois at ChicagoCollege of NursingChicago, IL

Discussion



October 3, 2015 8

Improvement StoryClaire L. Smith

Consultant NeonatologistRoyal Infirmary of EdinburghScotland, UK

Discussion

Lunch on Your Own – orPre-Registered Lunch Networking

Sessions

Breakout Sessions Convene Promptly!

VON Learning FairRiver Exhibit Hall

Level 1

Saturday October 3, 2015 Breakout Sessions 2:00 PM – Note Locations

• NEC Modi Michigan A

• CHND Perioperative QI Pallotto Erie

• Alarming Challenge! Vartanian / Nemshak Chicago 10

• Cerebral Oximetry Greisen Mayfair

• NAS Couplet Care Whalen Michigan B

• Enhanced Simulation Bender Superior B

• Small Babies / Big Unit Atwater Chicago 9

• DR of the Future Lee Sheraton 2

• Family‐Integrated Care Cohen Sheraton 1

• Family & Outcomes Saigal Ontario

• Failure Mode Analysis DR Loren Huron

• Hands‐On Measurement Suresh Gold Coast

• Solving the Value Equation Horbar Superior A

• DR Management Micro‐Prem Dunn Sheraton 3

• Optimizing Non‐invasive Vent Carlo Chicago 8

• Actionable Genes / Interpretation Bernard Missouri

• Medical Genomes Kingsmore Illinois

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