Welcome!

The Ohio Perinatal Quality Collaborative & Ohio

Department of Health Vital Statistics

39-Week Dissemination Action Period Call

October 3, 2012

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8:00 am

Welcome and Roll Call Susan Ford

8:05am Review of Key Driver Diagrams Susan Ford

8:15 am Data for Improvement

Dr. Jay Iams

8:20 am The use of EMR’s in Abstracting Birth Data

Mary Stevie, MS RN The Christ Hospital

8:35 am Open Team Discussion and Sharing Lessons Learned

All Teams

8:50 am

Monthly Progress Reports, Online Tutorial Overview and Next Steps

Beth White

Agenda

39 Week Dissemination Participating Sites

• Ashtabula County Medical Ashtabula, Ohio

• Southview Hospital Dayton, Ohio

• Genesis Bethesda Zanesville, Ohio

• Bay Park Hospital Oregon, Ohio

• Blanchard Valley Hospital Findlay, Ohio

• Mercy Regional Medical Center Lorain, Ohio

• Southern Ohio Medical Center Portsmouth, Ohio

• Kettering Medical Center Dayton, Ohio

• Good Samaritan Hospital Dayton, Ohio

• Fairfield Medical Center Lancaster, Ohio

• Bethesda North Hospital Cincinnati, Ohio

• Christ Hospital Cincinnati, Ohio

• Mercy Medical Center Canton, Ohio

• St. Rita’s Hospital Lima, Ohio

• Tripoint Lake Health Painesville, Ohio

Improving Accuracy of Ohio Birth Data

By Dec 2012, improve birth

certificate accuracy and

timeliness so that key

variables** will be transmitted accurately in

95% of records w/in 10 days of

birth (**gestational age,

induction, ANCS use and breastfeeding

at discharge)

Key Drivers Interventions Aim

IPHIS (BC) fields include

essential and specific information/definitions

Identify key clinical contact for birth data team . Identify all sources of birth data. Clarify needs/process

with practices

ODH and OPQC module (TBD)

Collaborative/Site visits by state quality coordinators to identify key changes

Identification and spread of best practices for data

entry and verification

Site uses training plan for data collectors

Implementation site data verification process

Coaching/reinforcement by OPQC and state quality coordinators

Clarify definitions and instructions

Develop and use training materials Plan for training of new staff

(if turnover)

Use of site audit process for data quality

Use ODH quality feedback to identify gaps

Strong communication between clinical team and

birth data staff

Project Aim: In one year, reduce by 60%, the number of women in Ohio of 36.0 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)

OPQC OB Key Driver Diagram: 39 week scheduled delivery project Goal: Assure that all initiation of labor or caesarean sections on women who are not in labor occur only when obstetrically or medically indicated (cite ACOG)

Key Drivers

Awareness of risks & expected benefit of

near-term delivery by patients and consumers

Dating criteria: optimal estimation of

gestational age

Hospital and physician practice policies that

facilitate ACOG criteria

Awareness of risks & expected benefit of

near-term delivery by clinician

Culture of safety and improvement

• 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 deliveries at 36.0

to 38.6 weeks gestation • Document discussion with patient about the above • Both patient and MD sign consent statement for scheduled delivery

between 36.0 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/Peds • Document discussion with patient about risk/benefits of near-term

delivery • Promote need for early dating to practitioners and consumers

• 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 data criteria

0

5

10

15

20

25

3020

06-Q

1 (n

=246

4)

2006

-Q2

(n=2

469)

2006

-Q3

(n=2

604)

2006

-Q4

(n=2

414)

2007

-Q1

(n=2

352)

2007

-Q2

(n=2

326)

2007

-Q3

(n=2

418)

2007

-Q4

(n=2

340)

2008

-Q1

(n=2

398)

2008

-Q2

(n=2

368)

2008

-Q3

(n=2

263)

2008

-Q4

(n=2

152)

2009

-Q1

(n=2

016)

2009

-Q2

(n=2

084)

2009

-Q3

(n=2

058)

2009

-Q4

(n=1

965)

2010

-Q1

(n=1

833)

2010

-Q2

(n=1

763)

2010

-Q3

(n=1

899)

2010

-Q4

(n=1

802)

2011

-Q1

(n=1

661)

2011

-Q2

(n=1

687)

2011

-Q3

(n=1

871)

2011

-Q4

(n=1

623)

2012

-Q1

(n=1

651)

2012

-Q2

(n=1

586)

Perc

ent w

ith n

o m

edic

al in

dica

tion

Births induced at 36-38 weeks with no apparent medical indication for early delivery, by quarter, 2006-2012

Aggregate results for 15 pilot sites

Quarterly Percent Baseline Average Percent Control Limits

Source: Ohio Department of Health, Vital Statistics

March 2012: Learning

Session for 15 pilot sites

Sep. 2008: 39-Week

project begins

Goal

January 2010 Ohio Hospital

Compare begins online reporting

0

5

10

15

20

25

3020

06-Q

1 (n

=246

4)

2006

-Q2

(n=2

469)

2006

-Q3

(n=2

604)

2006

-Q4

(n=2

414)

2007

-Q1

(n=2

352)

2007

-Q2

(n=2

326)

2007

-Q3

(n=2

418)

2007

-Q4

(n=2

340)

2008

-Q1

(n=2

398)

2008

-Q2

(n=2

368)

2008

-Q3

(n=2

263)

2008

-Q4

(n=2

152)

2009

-Q1

(n=2

016)

2009

-Q2

(n=2

084)

2009

-Q3

(n=2

058)

2009

-Q4

(n=1

965)

2010

-Q1

(n=1

833)

2010

-Q2

(n=1

763)

2010

-Q3

(n=1

899)

2010

-Q4

(n=1

802)

2011

-Q1

(n=1

661)

2011

-Q2

(n=1

687)

2011

-Q3

(n=1

871)

2011

-Q4

(n=1

623)

2012

-Q1

(n=1

652)

2012

-Q2

(n=1

669)

2012

-Q3

(n=1

372)

Perc

ent w

ith n

o m

edic

al in

dica

tion

Births induced at 36-38 weeks with no apparent medical indication for early delivery, by quarter, 2006-2012

Aggregate results for 15 pilot sites

Quarterly Percent Baseline Average Percent Control Limits

Source: Ohio Department of Health, Vital Statistics

March 2012: Learning

Session for 15 pilot sites

Sep. 2008: 39-Week

project begins

January 2010 Ohio Hospital

Compare begins online reporting

Goal

EMR software systems used in our 15 pilot sites

53%

13%

34%

EMR system

EPIC

OBTV

other

Other: Centricity, Meditech, Navicare Watchchild, Horizon Patient Folder-McKesson, Soarian.

New EMR Implementation

New EMR system inuse less than 1 year

current system inuse 1 year or more

27% Changed (to EPIC) EMR in

past year

First things first…..

• Is the necessary data being documented in your EMR?

• Is this a standardized process? (Is the data ALWAYS pulled from the same place by the same person(s)?)

• WHERE is the data being entered into the EMR?

Where in your EMR do you document gestational age?

0% 20% 40% 60% 80% 100%

EMR automatically calculates

Pregnancy tab

Triage/Admission tab

EMR “Interoperability”

• EMR system same as the rest of the hospital

• Same EMR used by both hospital and

outpatient/OB offices

70%

30%

samethroughoutthehospital

differentthroughoutthehospitalsystems

20%

40%

40%,

all on sameEMR

somepractices onsame EMRno practiceson sameEMR

• New EMR implementation?

• What challenges have you encountered ? How were they overcome?

• What part does your EMR play to assist in birth data abstraction?

Team Discussion

Monthly Progress Report Chart Audits

Birth Certificate Online Education Modules are Coming!

• Share your stories about birth

certificate data collection! • Tell us about lessons you have learned

to make IPHIS as accurate as it can be at your hospital!

• Be part of making the online modules applicable to the real world of maternity care!

• Volunteer to pilot test the online modules!

Online Module Overview Based on Lessons Learned from YOU,

at our site visits to each hospital.

• Why is the birth certificate important to the healthcare of women and newborn infants?

• What are the variables in the Ohio birth certificate and what do they mean?

• Where are select birth certificate variables found in the medical record?

• How can I know that I have accurately entered data into IPHIS?

• How can I improve the data entry process at my hospital?

Make Sure the Birth Certificate Online Modules are the Best!

If you are willing to participate in a small or bigger way in the development of these modules, we want YOU! Please send your name and contact information to: • Susan Ford @ susan.ford@uhhospitals.org • Beth White @ bethewhite@aol.com

Next Steps…

Thank you!

Next month’s call will be Wednesday, November 7th at 8:00 am

Please don’t forget to submit your Monthly Progress Report if you have not

already done so!

0

5

10

15

20

25

3020

06-Q

1 (n

=253

)

2006

-Q2

(n=2

66)

2006

-Q3

(n=2

45)

2006

-Q4

(n=2

40)

2007

-Q1

(n=2

19)

2007

-Q2

(n=2

44)

2007

-Q3

(n=2

23)

2007

-Q4

(n=2

27)

2008

-Q1

(n=2

25)

2008

-Q2

(n=2

11)

2008

-Q3

(n=1

81)

2008

-Q4

(n=2

05)

2009

-Q1

(n=1

85)

2009

-Q2

(n=2

24)

2009

-Q3

(n=1

82)

2009

-Q4

(n=2

19)

2010

-Q1

(n=1

84)

2010

-Q2

(n=1

97)

2010

-Q3

(n=1

87)

2010

-Q4

(n=1

88)

2011

-Q1

(n=1

83)

2011

-Q2

(n=2

09)

2011

-Q3

(n=1

98)

2011

-Q4

(n=1

87)

2012

-Q1

(n=2

13)

2012

-Q2

(n=1

92)

2012

-Q3

(n=1

52)

Perc

ent w

ith n

o m

edic

al in

dica

tion

Births induced at 36-38 weeks with no apparent medical indication for early delivery, by quarter, 2006-2012

Hospital A

Quarterly Percent Baseline Average Percent Control Limits

Source: Ohio Department of Health, Vital Statistics

March 2012: Learning

Session for 15 pilot sites

Sep. 2008: 39-Week

project begins

Jan 2010 Ohio Hospital

Compare begins online

reporting

0

5

10

15

20

25

30

35

4020

06-Q

1 (n

=193

)

2006

-Q2

(n=2

22)

2006

-Q3

(n=2

40)

2006

-Q4

(n=2

12)

2007

-Q1

(n=2

15)

2007

-Q2

(n=1

74)

2007

-Q3

(n=2

09)

2007

-Q4

(n=1

79)

2008

-Q1

(n=1

99)

2008

-Q2

(n=2

13)

2008

-Q3

(n=2

07)

2008

-Q4

(n=1

96)

2009

-Q1

(n=1

82)

2009

-Q2

(n=1

78)

2009

-Q3

(n=1

78)

2009

-Q4

(n=1

37)

2010

-Q1

(n=1

55)

2010

-Q2

(n=1

81)

2010

-Q3

(n=1

79)

2010

-Q4

(n=1

71)

2011

-Q1

(n=1

65)

2011

-Q2

(n=1

46)

2011

-Q3

(n=1

75)

2011

-Q4

(n=1

47)

2012

-Q1

(n=1

19)

2012

-Q2

(n=1

24)

2012

-Q3

(n=1

22)

Perc

ent w

ith n

o m

edic

al in

dica

tion

Births induced at 36-38 weeks with no apparent medical indication for early delivery, by quarter, 2006-2012

Hospital B

Quarterly Percent Baseline Average Percent Control Limits

Source: Ohio Department of Health, Vital Statistics

March 2012: Learning

Session for 15 pilot sites

Sep. 2008: 39-Week

project begins

Jan 2010 Ohio Hospital

Compare begins online

reporting

Goal