PQCNC: OPQC Presentation

8/9/2019 PQCNC: OPQC Presentation

1/18

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


2/18

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


3/18

Our Impact on Ohio

47% of all births occurred in OPQC hospitals

64% of preterm births (


4/18

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



5/18

OPQC NICU Participants


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


6/18

OPQC Obstetric Participants


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


7/18

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


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


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


9/18

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


10/18

OPQC OB Initiative:

Are we making a difference?

Birth Certificate Data for OPQC Hospitals


11/18

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


14/18

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


15/18

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



16/18

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?



17/18


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?


Documents

PQCNC: OPQC Presentation