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AIM UPDATESGillian Burkhardt
October 26th, 2019
NMPC Annual Meeting
ObjectivesUnderstand the goal of the AIM program
Review the implementation of NM AIM program
Review the data from the NM AIM program
Disclosures I have no disclosures
What is AIM?
Goal: To eliminate preventable maternal mortality and severe morbidity at every US birthing center 2015
2019
Joined 2018
AIM National
Build national collaboration among states around maternal mortality and morbidity
Improve data capacity
Strengthen community partnership
Approach maternal health with an equity lens
Expanded focus in maternal mortality and morbidity (opioid use disorder, rural health challenges, etc.)
Safety bundles
Safety bundles
Make it easy to do the right thing
Hardwire a culture of safety into practiceEducation, training, order sets, protocols,
the environment
We must know the differenceBuild measurement into the process
NEW TJC STANDARDS on HTN and PPHCOMING IN JULY 2020 to a survey near you….
It Worked in California
22.7
28.6
18
28.2
0
5
10
15
20
25
30
35
AIM Bundle Group Comparison Group
Change in Postpartum Hemorrhage Rate among CA Hospitals With and Without AIM Bundle
Baseline Hemorrhage Rate Post-intervention Hemorrhage Rate
P=0.771
Main, EK et al. Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. AJOG; March 2017.
Obstetric Hemorrhage Safety Bundle
Readiness: (every unit) Hemorrhage Cart / with Procedural Instructions (balloons, compression stiches) Rapid access to hemorrhage medications (kit or equivalent)
Recognition: (every patient) Assessment of hemorrhage risk (prenatal, on admission, ongoing in labor & PP) Measurement of CUMMULATIVE blood loss Active Management of 3rd Stage (oxytocin after birth)
Response: (every hemorrhage) Unit-standard, stage-based OB Hemorrhage Emergency Management Plan
w/checklist Support program for patients, families and staff
Reporting / Systems Learning: (every unit) Establish a culture of Huddles for high-risk patients and post-event debriefings Review all stage 3 hemorrhages for systems issues
IMPROVING PERINATAL HEALTH ECHO
Linking NM hospitals through Project ECHO to roll out the OB Hemorrhage Bundle
ECHO SESSIONS1st and 3rd Monday12:00-1:00
Introductions
Lecture/Didactic Presentation15-20-minute presentation by expert/specialist on an issue related to improving perinatal health
Case PresentationsParticipants present real cases (patient and systems) to discuss with the network and receive advice from subject matter experts and community No Protected Health Information (PHI) (i.e. no names, initials, birthdate (except year), address/city/tribe
Use ECHO ID when referring to patient
Wrap-up
The ECHO Model is “all-teach, all-learn”
Case presentation
Requested of all enrolled sites
Patient or systems focus
Identify specific clinical/systems/bundle implementation question related to case
Facilitated discussion including feedback from entire network
Recommendations are consolidated with formal feedback provided to presenting site and network
IPH EHCO Curriculum
Enrolled sites
Lincoln County Medical Center
Holy Cross
University of New Mexico
Mimbres Memorial Hospital
Rehoboth McKinley Christian Health Care Services
Gerald Champion
Miners Colfax Medical Center
Lovelace Westside Hospital
San Juan Region Medical Center
Presbyterian Hospital
Lovelace Women’s Hospital
Presbyterian Santa Fe
Christus St. Vincent's Regional Medical Center
Gallup IHS**
Shirprock IHS**
0.90%
0.70%
0.80%
0.80%
0.80%
0.80%
0.80%
0.90%
1.10%
0.50%
1.00%
1.20%
0.70%
0.40%
1.10%
0.70%
0.70%
0.70%
0.80%
0.00% 0.20% 0.40% 0.60% 0.80% 1.00% 1.20% 1.40%
Alaska (10)
California (172)
Florida (51)
Georgia (53)
Illinois
Indiana (24)
Maryland
Michigan
NPIC
Nebraska (30)
New Jersey
New Mexico (10)
Oklahoma (33)
Premier (50)
Tennessee (13)
Texas (215)
Trinity (30)
Utah (30)
Virginia (54)
West Virginia
Severe Maternal Morbidity Among ALL Delivering Women(COLLABORATIVE TIME - prior to AIM participation)
Structure measures
46.20%
76.90%
46.20%
92.30%
69.20%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Patient family support Debriefs Multidisciplinary CaseReviews
Hemorrhage Cart Hemorrhagepolicy/procedure
Process Measures
49.20%
70%
75%
59.20%
52.50%
85.80% 85%
67.50%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Provider education Nurse education Hemorrhage RiskAssessement
QBL measurement
Q2 Q3
AIM TEAM
Curriculum Team
• Gillian Burkhardt*
• Eve Espey
• Abigail Reese
• Katrina Nardini
• Tamara Rendon
• Octavia Djanquaye
Data Team
Ellen Interlandi*
Katie Avery
Eirian Coronado
Jean Howe
Melissa Schiff
Trevor Quiner
Gillian Burkhardt
Abigail Reese
Gillian Burkhardt: Co-state lead
Abigail Reese: Co-state lead
Eve Espey: Co-medical director, AIM state lead
Katie Avery: DOH
Eirian Coronado: DOH
Katrina Nardini: ACNM
Tamara Rendon: AWHONN
Ellen Interlandi: NM Hospital Association
Melissa Schiff
Trevor Quiner
AIM State Executive Team
Partners
AND YOU!
Where do we go next?
Afternoon breakout sessions
12:55 – 1:25: Where do we go next? What does your facility/community need from
the IPH ECHO?
What does your facility/community need from the NMPC?
1:25-1:55 and 1:55-2:25: Breakout groups Large conference room: QBL
Small conference room: Defining a debrief
Atrium: PPH sims