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Welcome!
The Ohio Perinatal Quality Collaborative & Ohio
Department of Health Vital Statistics
39-Week Dissemination Action Period Call
October 3, 2012
Please don’t put us on HOLD! • To avoid the technical difficulties from background
noise, today all participants will be muted until the lines are opened for questions and discussion.
• If you have a question or comment: – You can use *6 to come off of MUTE and
then *6 to place your call back on MUTE once again.
– OR…. – Type your question or comment in the chat box
located on the upper right corner of your screen.
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 @ [email protected] • Beth White @ [email protected]
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