Welcome! Kick Off Group Webinar. Wave 3

Transcription

1 Welcome! Kick Off Group Webinar Wave 3 Decreasing births < 39 weeks gestation without medical indication and improving birth registry accuracy project Ohio Perinatal Quality Collaborative Ohio Department of Health, Office of Vital Statistics Ohio Hospital Association August 20, 2013

2 Please! MUTE your phone when you are not speaking This will eliminate background noise, such as side conversations and phones ringing. You may mute and unmute your phone by pushing the mute button or by pressing *6 on your phone. Do not put your phone on HOLD Your on-hold message or music disrupts the call so that others cannot be heard

3 OPQC Mission Through collaborative use of improvement science methods, reduce preterm births and improve outcomes of preterm newborns in Ohio as soon as possible.

4 Agenda August 20, 2013 Time Topic Presenter 12:00 pm Welcome and OPQC Introductions Beth White 12:05 pm Team roll call and Introductions Beth White 12:10 pm Ohio Perinatal Quality Collaborative (OPQC) : History and moving forward Jay Iams, MD Kelly Friar, and Judy Nagy 12:20 pm The Project timeline, Team activities and Team composition Beth White 12:30 pm Aggregate Wave 1 hospital data: Where are we starting? 12:40 pm Using quality improvement strategies to make changes: The Model for Improvement 12:50 pm What s next? Scheduling your individual hospital call Your team s Aim statement Completion of your Systems Inventory Validation of Team Members Jay Iams, MD Carole Lannon, MD Beth White

5 Wave 3 Teams Adena Regional Medical Center Aultman Orrville Hospital Clinton Memorial Hospital Community Memorial Hospital Dublin Methodist Hospital EMH Healthcare Fulton County Health Center Grady Memorial Hospital Joint Twp. District Memorial Hosp. Knox Community Hospital Lima Memorial Hospital MedCentral-Shelby Hospital Medina Hospital Memorial Hospital of Union County Mercy Health Fairfield Hospital Parma Community General Hospital Promedica Defiance Regional Hospital Robinson Memorial Hospital Salem Community Hospital Southeastern Ohio Regional Med. Ctr. Springfield Regional Medical Center St. Joseph Health Center Summa Barberton Hospital Wayne Health Care Wyandot Memorial Hospital

6 McCullough- Hyde Atrium Fort Hamilton OPQC Hospitals Participating in <39 Week Project X Charter sites X Pilot sites X Wave 1 sites X Wave 2 sites Community Hospital & Wellness Center Van Wert County Hospital Mercer County Community Promedica St. Lukes; Promedica Flower Southview Henry County St. Rita s Lima Good Samaritan Premier Wilson Memorial Kettering Bluffton ProMedica Toledo Mary Rutan Miami Valley Hospital Madison County Wood County Mercy St. Charles Bay Park Mercy St. Vincent Mt. Carmel West Mercy Tiffin Mt. Carmel St. Ann s Riverside Methodist Memorial Health Care Blanchard Valley Doctor s Firelands Mercy Lorain Marion General Mt. Carmel East Fisher-Titus Bellevue Hospital OSU Fairfield Lancaster Samaritan Galion Metro Health Lakewood St. John Medical Center Wooster MedCentral Health Mansfield Genesis Bethesda Licking Memorial Fairview Mercy Canton Union Hillcrest Pomerene O Bleness Memorial Southwest General Aultman Coshocton UH Case MacDonald Lake East Lake West U.H. Geauga Trumbull Memorial St. Elizabeth Akron Children s MFM Health Center Summa Health System Akron General Ashtabula East Liverpool Trinity East Ohio Regional Medical Center Northside Medical The Christ Hospital Bethesda North Mercy Anderson UH Cincinnati Good Samaritan TriHealth Berger Health Marietta Memorial Highland District Southern Ohio Holzer Medical

7 OPQC <39 Week + Birth Certificate Accuracy Dissemination Project Wave 3 Fulton County Health Center Wauseon Defiance Regional Medical Center Community Memorial Hicksville Joint Twp. District Memorial Hosp. St. Mary s Springfield Regional Medical Center Wayne Healthcare Greenville Mercy Fairfield Lima Memorial Memorial Hospital Union County, Marysville Clinton Memorial, Wilmington Wyandot Memorial Upper Sandusky Knox Community Mount Vernon Grady Memorial Delaware Dublin Methodist EMH RMC Elyria Med.Ctr.Hlth. System Shelby Adena HealthSystem Chillicothe Parma Community General Medina General Aultman Orville Robinson Memorial Ravenna Summa Barberton SE Ohio Reg. Med. Ctr. Cambridge St. Joseph Health Center, Warren Salem Community

8 OPQC History OPQC formed in 2007 First collaborative funded with start up grant from US DHHS CMS: OB and NEO working together was influential in receiving support 23 of 24 Ohio NICUs working together 1 st OB project: 39 Wk Project in 20 maternity units = 47% of Ohio births Second group OB = 15 pilot hospitals with ODH/Vital Statistics Added birth certificate accuracy Third group OB = 3 waves: Wave 1: 24 hospitals: January 2013 Wave 2: 22 hospitals: April 2013 Wave 3: 26 hospitals: July 2013 = YOU!

9 Working with a Collaborative Like OPQC Improves Care Variations in outcomes among hospitals are real Variations can be measured Interdisciplinary team work and support from leadership are closely tied to positive change in health care. Networking works. Sharing lessons learned increases speed of change and credibility. Not just working harder

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11 Adverse Outcomes + NICU Admission at Weeks Gestation Scheduled Births Without Medical Indication 4 Recent Studies Clark Tita* Kamath* Oshiro % * Cesarean Births Only

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13 Jan-06 Mar-06 May-06 Jul-06 Sep-06 Nov-06 Jan-07 Mar-07 May-07 Jul-07 Sep-07 Nov-07 Jan-08 Mar-08 May-08 Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Nov-09 Jan-10 Mar-10 May-10 Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12 Jul-12 Sep-12 Nov-12 Percent Percent distribution of Ohio full-term and near-term births, by month January 2006 to December OPQC inception Since OPQC inception, 30,000 expected near-term births statewide were delayed to full-term Baseline averages were calculated from the initial 24 months, January 2006 to December Near-term (36-38 weeks) Full-term (39-41 weeks) Baseline, near-term Baseline, full-term

14 Effects of the OPQC 39 Week Scheduled Birth Project September 2008 November ,000 births shifted to weeks Conservative Estimate = 3% fewer near term NICU admissions: N = x $40,000 per NICU Admission = $36,000,000 savings in 4 years

15 OPQC: Decreasing births < 39 weeks gestation without medical indication and Improving birth registry accuracy 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 Aim In 9 months, reduce to 5% or less, the number of women in Ohio of 37.0 to 38.6 weeks gestation for whom delivery is scheduled in the absence of appropriate medical indication Revised: Key Drivers Awareness of risks & expected benefit of scheduled delivery prior to 39.0 weeks by patients and other 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 Interventions 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 37.0 to 38.6 weeks gestation Document discussion with patient about the above Both patient and MD sign consent statement for scheduled delivery between 37.0 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

16 OPQC: Decreasing births < 39 weeks gestation without medical indication and Improving birth registry accuracy project Aim In 9 months, improve birth registry accuracy so that focused variables** will be transmitted accurately in 95% of records (** Pre-pregnancy and Gestational Diabetes; Prepregnancy and Gestational hypertension; Induction of Labor; ANCS; OB estimate of GA) Revised: Key Drivers Strong communication between clinical team and birth data staff Trained clinical and birth data teams Audit Process for data verification Appreciation of the Importance of the Birth Registry information IPHIS (BR) fields include essential and specific information/definitions Identification and spread of best practices for data entry and verification Interventions Identify a key clinical contact for birth data team Identify all sources of birth data Identify process for flow of data into the birth registry (IPHIS) system Ensure birth data team has access to necessary clinical data Utilize ODH and OPQC online education modules for training of birth data and nursing staff Ensure clear understanding of birth registry variables Ensure clear understanding by birth data team of medical terminology related to birth registry variables Coaching/reinforcement by OPQC and state quality coordinators Use medical record to IPHIS quality review feedback to identify gaps Continuous monitoring of Birth Registry data reports Clarify IPHIS definitions and instructions Group and individual webinars and 1:1 support by state quality coordinators to identify key changes

17 The Vital Role of the Birth Registry IPHIS: Integrated Perinatal Health Information System Ohio s birth registry software

18 Variation between IPHIS and hand collected data When the project was spread in 2011, improving birth registry accuracy was added IPHIS data was the only data used to document improvement in <39 weeks scheduled deliveries 15 pilot hospitals tested and studied changes to decrease early scheduled deliveries and increase birth registry documentation accuracy

19 2006-Q1 (n=2464) 2006-Q2 (n=2469) 2006-Q3 (n=2604) 2006-Q4 (n=2414) 2007-Q1 (n=2352) 2007-Q2 (n=2326) 2007-Q3 (n=2418) 2007-Q4 (n=2340) 2008-Q1 (n=2398) 2008-Q2 (n=2368) 2008-Q3 (n=2263) 2008-Q4 (n=2152) 2009-Q1 (n=2016) 2009-Q2 (n=2084) 2009-Q3 (n=2058) 2009-Q4 (n=1965) 2010-Q1 (n=1833) 2010-Q2 (n=1763) 2010-Q3 (n=1899) 2010-Q4 (n=1802) 2011-Q1 (n=1661) 2011-Q2 (n=1687) 2011-Q3 (n=1871) 2011-Q4 (n=1623) 2012-Q1 (n=1652) 2012-Q2 (n=1670) 2012-Q3 (n=1811) 2012-Q4 (n=1709) Percent with no medical indication Births induced at weeks with no apparent medical indication for early delivery, by quarter, Aggregate results for 15 pilot sites March 2012: Learning Session for 15 pilot sites Sep. 2008: 39-Week project begins 0 Source: Ohio Department of Health, Vital Statistics Quarterly Percent Baseline Average Percent Control Limits

20 Two most important lessons learned from the first 35 hospitals Support from administration and medical staff leadership is essential to success Collaboration between clinical and clerical staff is key to improving birth registry data accuracy

21 Bill Callaghan, MD MPH Centers for Disease Control and Prevention December 1, 2011 The focus of healthcare for women and infants over the next century depends on the quality of the data collected by those who fill out the birth certificates.

22 Mark Your Calendars Wave 3 Timeline Group Webinars/Action Period calls followed by individual hospital webinars Tuesdays: August 20th and September 17 th and October 15 th at Noon Face to Face Learning Session in Columbus Monday November 18: approximately 9:00 am to 4:00 pm Group Webinars/Action Period calls Tuesdays: December 17 th, and January 21 st, and February 18 th and March 18 th at Noon

23 Your Improvement Team! OB Lead Physician or Midwife Administrative Staff Member Director/Manager of Maternity Services Clinical Nurse Labor and Delivery Birth Certificate Abstractor(s) QI Department representative

24 What does Wave 3 hospitals data look like as we begin? Where are we starting?

25 Percent with no medical indication 2006-Q1 (n=1067) AGGREGATE DATA FROM THE 26 WAVE 3 HOSPITALS BY QUARTERS from Q2 (n=1128) 2006-Q3 (n=1132) 2006-Q4 (n=1111) 2007-Q1 (n=1121) 2007-Q2 (n=1113) 2007-Q3 (n=1103) 2007-Q4 (n=1065) 2008-Q1 (n=1077) 2008-Q2 (n=1282) 2008-Q3 (n=1315) 2008-Q4 (n=1163) 2009-Q1 (n=1103) 2009-Q2 (n=1079) 2009-Q3 (n=1125) 2009-Q4 (n=1008) 2010-Q1 (n=0940) 2010-Q2 (n=0944) 2010-Q3 (n=0979) 2010-Q4 (n=0946) 2011-Q1 (n=0926) 2011-Q2 (n=0989) 2011-Q3 (n=1027) 2011-Q4 (n=0942) 2012-Q1 (n=0998) 2012-Q2 (n=1016) 2012-Q3 (n=1091) 2012-Q4 (n=1015) 2013-Q1 (n=1034) 2013-Q2 (n=0945) Births induced at weeks with no apparent medical indication for early delivery, by quarter, Aggregate of 26 Wave 3 sites Sep. 2008: 39-Week project begins Source: Ohio Department of Health, Vital Statistics Quarterly Percent Baseline Average Percent Control Limits

26 Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do

27 Polling Question: Have you ever attempted a selfimprovement project? (e.g. exercise program, lose weight, clean up desk clutter, spend less time at work) Yes No

28 The Model for Improvement AIM

29 If you don t know where you are going, any road will get you there. -Lewis Carroll What will your Aim be for this project?

30 Aim Statement What are we trying to accomplish? S - Specific M - Measurable A Actionable R Relevant T Time bound

31 39 weeks/birth Registry Accuracy Aims In 9 months, reduce to 5% or less, the number of women in Ohio at 37 to 38 6/7 weeks gestation for whom delivery is scheduled in the absence of appropriate medical indication In 9 months, improve birth registry accuracy so that a set of key variables will be transmitted accurately to Vital Statistics in 95% of a sample of records

32 Homework Aim Worksheet Aim Worksheet The team (your site): Intends to: By (date): for (population): Because:

33 The Model for Improvement Measures

34 If you don t measure your performance, how would you know whether you ve improved? Why Measure?

35 How Will We Measure Improvement? Birth Registry Data (Scheduled Inductions by Gestational Age) Comparison of 10 medical records with IPHIS entries each month

36 The Model for Improvement Changes

37 If you don t know where you are going, any road will get you there. -Lewis Carroll What will your Aim be for this project?

38 What s next? Scheduling your individual hospital call Your team s Aim statement Completion of your Systems Inventory Completion of Team Members Worksheet Next group webinar: Tuesday, 9/17/13 at noon

39 Homework Aim Worksheet Aim Worksheet The team (your site): Intends to: By (date): for (population): Because:

40 Resources OPQC web site: OPQC Beth White, RN, CNS, BEACON Quality Improvement Coordinator Stephanie Wilson, Project Specialist

41 OPQC, ODH and Your Hospital: Working together to improve outcomes for women and newborns in Ohio Questions?