Improving The Grade

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• 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
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• Through collaborative use of improvement science
  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
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Our Impact on Ohio

• 47 of all births occurred in OPQC hospitals
• 64 of preterm births (lt37 weeks) occurred in
  OPQC hospitals
• 82 of births lt34 weeks (preterm excluding late
  preterm) occurred in OPQC hospitals
• 80 of births 30-33 weeks occurred in OPQC
  hospitals and were likely influenced by our OPQC
  NICU infection interventions
• 87 of births 22-29 weeks occurred in OPQC
  hospitals (target of NICU infection project)

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• 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, CMS HAI research agenda
• Improved care
• 1000 women per year move from 36-37 weeks to
  term

..a statewide improvement collaborative
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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, Doctors Campuses) - 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
..a statewide improvement collaborative
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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
..a statewide improvement collaborative
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OPQC OB Initiative Our hand collected dataOPQC
hospitals
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OPQC OB Initiative Are we making a
difference?Birth Certificate Data for OPQC
Hospitals
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How we collaborate

• Monthly review of the data
• Monthly action period calls
• Site visits
• 11 coaching as needed
• Use of the listserv and other communication
  methods

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Key ChangesImprovement

• 16 teams have a written scheduled delivery policy
  that outlines acceptable reasons to delivery
  before 39 weeks
• We created a consumer flyer to educate on our AIM
  and it was translated 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 for scheduling
• 7 teams changed their scheduling workflow, i.e.
  dedicated fax machines, mitigation processes for
  questionable appointments, etc
• All of the teams have, at minimum, adopted a
  procedural standard for scheduling inductions

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Our Collaborative Makes an Impact

• OPQC wins the SMFM Award of Research Excellence
  in 2010 and the March 2010 issue of JCOG detailed
  this work
• 2009, we were recognized as a best practice for
  Improving the Grade by the National Office of
  the March of Dimes
• We have received a March of Dimes grant to
  disseminate this work to non-OPQC hospitals in
  2010
• We are presenting our NICU project at PAS next
  week

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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 current practice
• Existing practice guideline
• Measurable outcome
• Enthusiasm by participants

..a statewide improvement collaborative
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• What we are thinking about How does OPQC include
  more Ohio perinatal providers?
• How do we capture lessons learned?
• Scheduled deliveries at the other 101 Ohio
  maternity hospitals?
• NICU-associated infections in other Ohio NICUs or
  other NICU populations?

..a statewide improvement collaborative
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We continue to align our work with
regulationsOhio House Bill 197

• Scheduled Births Before 39 Weeks
• Antenatal Steroids
• Appropriate Birth Site for VLBW Infants
• Cesarean Birth Rate in 1st Time Mothers
• Others

..a statewide improvement collaborative
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• Questions?

..a statewide improvement collaborative