VICTORIAN MATERNITY SERVICES PERFORMANCE INDICATOR PROJECT

1
VICTORIAN MATERNITY SERVICES PERFORMANCE
INDICATOR PROJECT
2
Background

• In 2001 the Victorian Health Department
  recommended that a set of performance indicators
  be developed for public maternity hospitals.
• Why only public?- private hospitals data not in
  public domain.

3
Mandatory reporting

• HEALTH DEPT DIRECTIVE
• All Victorian Public Maternity Hospitals are
  required to report annually their performance
  indicators.

4
Background

• Project team worked for about 6 months -
  literature search, stakeholder consultation and
  field testing AU 200,000
• Ten indicators were selected.
• Three reports so far 2003, 2004, 2005.

5
Rationale

• Implementing the indicators is expected to
  enable comparison about performance between
  similar units, and over time
• Promote discussion within and between hospitals
  about the results
• Promote discussion about what level of
  performance should be achieved
• Promote discussion about how results may be
  improved.

6
10 INDICATORS

• 5 outcomes indicators- data collected centrally
  by DHS
• 5 process indicators data collected by
  institutions and reported to DHS
• Annual reports

7
Victorian Maternity Services Performance
Indicators- outcomes indicators

• Outcomes for standard primiparae
• Rate of transfer of term infants to SCN or NICU
  for reasons other than birth defect
• Rate of initiation of antenatal corticosteroids
  to women delivered or transferred lt34 weeks
• Rates of planned and achieved VBAC
• Corrected GA standardised perinatal mortality
  ratio

8
Victorian Maternity Services Performance
Indicators- process indicators

• domiciliary care referral
• appropriate smoking cessation advice
• appropriate breastfeeding support
• timely antenatal clinic attendance
• interpreter services

9
Data Source- outcomes indicators

• Victorian Perinatal Data Collection Unit database
• Established 1982
• Legally required (all hospitals, public and
  private)
• Approx 100 items on each birth

10
Data Source- process indicators

• Individual public hospitals- resource
  implications, but no additional funds

11
Victorian maternities, 2005

• PUBLIC
• 45000 (70)

• PRIVATE
• 20000 (30)

12
Births in Victoria 2005

• Total maternities 64,946
• Level III (gt5000) x 3 20
• Level II (gt1000) x 16 48
• 400-999 x 21 23
• 100-399 x 23 7
• lt100 x 33 2

13
Spontaneous vaginal births Victoria 2005

• Public 60.2
• Private 38.1

14
Victoria 2005

• PUBLIC HOSPITALS
• SVD 61.2
• ELEC C/S 13.2
• EM C/S 14.0
• Forceps 5
• Vacuum Ext 6.2

• PRIVATE HOSP
• SVD 44.6.1
• ELEC C/S 23.1
• EM C/S 14.5
• Forceps 8.5
• Vacuum Ext 9.2

15
(No Transcript)
16
MSPI REPORT

• Sent to all hospitals- CEOs, Clinical directors
• Available to public on DHS website

17
M.S.P.I. 1

• Outcomes for Standard primiparae
• Induction of labour
• Caesarean rates
• 3rd 4th degree tears

18
Standard Primipara

• First birth
• 20-34 yo
• Free of obstetric and medical complications
• Singleton, cephalic
• 370 - 416 weeks gestation
• Non-SGA infant

19
Inductions in standard primiparae 2004
2004 Statewide public rate 17.2,
private 24.9 2003 Statewide public rate 22.0
2002 Statewide public rate 22.6  
20
Caesarean section rate, standard primiparae 2004
2004 Statewide public rate 18.5   private
26.5 2003 Statewide public rate 19.0   2002
Statewide public rate 17.1  
21
3rd and 4th degree tears, standard primiparae
2004 (Hospitals with 350 confinements)
2004 Statewide public rate 4.3, private 2.5
2003 Statewide public rate 4.4 2002
Statewide public rate 3.3   
22
MSPI 2,3,4,5

• Rate of transfer of term infants to SCN or NICU
  for reasons other than birth defect.
• Rate of initiation of a course of corticosteroids
  to women delivered or transferred lt34 weeks
  gestation.
• Rates of planned and achieved VBAC.
• GA standardised perinatal mortality ratio.

23
Rate of term infants transferred or admitted to
SCN or NICU for reasons other than birth defect
2004 /2005
2004 Statewide public rate 10.1   2002/2003
Statewide public rate 10.9 per cent  
24
Antenatal corticosteroids for women lt 34 weeks
2004/2005
2004 95.1 2003 92.4 2002 89.8
25
Planned VBAC 2004
2004 Statewide public rate 28.2  
private 20 2003 Statewide public rate
27.3   2002 Statewide public rate 32.7
26
Achieved VBAC rates among women who plan for
VBAC 2004
2004 Statewide public rate 55.0
private 48.0 2003
Statewide public rate 50.0 2002 Statewide
public rate 50.1
27
GASPMR excluding ToPs and deaths due to CM, five
years pooled data, 2004
Statewide private 77 (95 CI 74-90)
28
Victorian Maternity Services Performance
Indicators- process indicators

• domiciliary care
• appropriate smoking cessation advice
• appropriate breastfeeding support
• timely antenatal clinic attendance
• interpreter services

29
Rate of referral to postnatal domiciliary care
2004/5 Hospitals with 100 confinements
2004/5 Statewide public rate 90  2003
Statewide public rate 89  2002 Statewide
public rate 88
30
Rate of women offered appropriate antenatal
interventions re smoking 2004/5


31
Number of WHO Ten steps achieved 2004/05
2004/05 state average 8.9/10 2003
8.5/10 2002
8/10
32
Rate of women who wait more than 30 minutes for
hospital antenatal clinic services 2004/05
2004/05 22.0   2003/04 16.4 2002/03 33.7
33
Rate of women of NESB who are (a) assessed for
interpreter requirements and (b) provided
appropriate services 2004/05
(a)
(b)
2004 (a) Assess interpreter requirements 99.7
(b) Provision of interpreter services 89.5
  2003 (a) 95.1 (b) 86.9   2002 (a) 91.9
(b) 42.1
34
What have we found?

• High rates of inductions, C/S for standard
  primips
• Much variation between institutions
• Huge differences between private and public
• High rates of compliance with some E/B practices-
  antenatal corticosteroids, smoking cessation
  advice
• Plenty of room for improvement!
• And..

35
What have we learned?

• Its been possible to
• Develop, implement and maintain over time
• a set of 10 performance indicators across
  Victorian public maternity hospitals
• publish and circulate widely,
• without riots or resignations, or an epidemic
  of performance anxiety!

36
Where to from here?

• WCH Assn of ANZ have been commissioned by
  National Safety Quality commission to develop a
  set of MSPI for maternity hospitals, public and
  private.

37
ANZ MSPIP - draft set, 2006

• Induction of labour for selected primiparae
• Spontaneous vaginal birth for selected primiparae
  
• Caesarean section rates for selected primiparae
• Episiotomy rates for first births
• Third and fourth degree tears for first births
• Blood loss 1000 mls following a vaginal
  delivery
• Apgar score 6 at 5 minutes for live term
  infants
• Smoking cessation advice during pregnancy
• Supporting breastfeeding

38
Thank you!