Hypertension in Pregnancy (HIP) Initiative. June 2017 Learning Session: Celebration & Sustainability

Transcription

1 Hypertension in Pregnancy (HIP) Initiative June 2017 Learning Session: Celebration & Sustainability

2 Welcome! Please join by telephone to enter your Audio PIN on your phone or we will be unable to un-mute you for discussion. If you have a question, please enter it in the Question box or Raise your hand to be unmuted. This webinar is being recorded. Please provide feedback on our post-webinar survey. 2

3 Agenda June 29, 2017 HIP Initiative Announcements Celebrating our Success HIP Initiative-wide Data Dr. Bill Sappenfield Tips for Sustainability Dr. Karen Harris FPQC HIP Sustainability Strategy HIP Resources Q&A 3

4 HIP Announcements This is our last HIP webinar The last month of prospective data collection was April (you can submit and receive Quarterly sustainability reports, which we will cover today) All HIP resources will remain available on the web (FPQC.org). We are still happy to consult with clinical questions and provide assistance 4

5 Physician MOC Great way to get your physicians involved in the project! Requirements: Diplomate of ABOG Actively participate in HIP Submit a statement addressing how project benefits patients, impacts practice, and how you participated For more information contact: fpqc@health.usf.edu 5

6 HIP Algorithm Change In follow up to recent questions regarding rapid lowering of blood pressure, we are modifying the algorithm because there is no specific recommendation on the rate of decrease. Continuous fetal monitoring should be used during antihypertensive medication titration to assess fetal well-being in all women with a gestational age beyond fetal viability as determined at your local center.* Further, therapy goals are for the prompt reduction* of blood pressure to a level associated with a decreased risk of cerebrovascular accidents or loss of cerebral autoregulation. [John R. Barton, Ann Emerg Med. 2008;51:S16-S17] *FPQC modification. 6

7 HIP Algorithm Change cont. 7

8 Final Initiative Data HOW FAR WE VE COME 8

9 Percent of Women Figure 1. Percent of Women with persistent new-onset severe HTN who were treated within 1 hour 100% 90% 90% Max. Value 75 th Percentile 80% 70% 60% 67% 71% 67% Median 25 th Percentile Min. Value 50% 48% 47% 40% 30% 20% 20% 10% 0% Baseline Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Apr-17 Goal 9

10 Figure 2. Percent of All Reporting Hospitals that treated women with persistent new-onset severe HTN within 1 hour 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 7% 15% 28% 31% 38% 50% 50% 63% 76% 63% 69% 62% 43% 50% 38% 9% 9% Baseline Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Apr to 100% of women treated within 1 hour 1 to 74% of women treated within 1 hour No women treated within 1 hour 10

11 Percent of Women Figure 3. Percent of Women with persistent new-onset severe HTN whose case was debriefed 100% 90% 80% 70% 60% 55% Max. Value 75 th Percentile Median 25 th Percentile Min. Value 50% 40% 40% 30% 20% 10% 0% 15% 23% 0% 0% 0% Baseline Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Apr-17 Goal 11

12 Figure 4. Percent of All Reporting Hospitals that debriefed cases of HTN 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 4% 4% 9% 12% 9% 19% 21% 28% 46% 33% 53% 59% 93% 69% 29% 63% 55% 38% 22% 25% 10% Baseline Q1-16 Q2-16 Q3-16 Q4-16 Q Apr to 100% of cases debriefed 1 to 74% of cases debriefed No cases debriefed 12

13 Percent of Women Figure 5. Percent of Women with persistent new-onset severe HTN who received discharge education material 100% 90% 80% 80% 94% 100% 90% 100% Max. Value 75 th Percentile Median 25 th Percentile 70% Min. Value 60% 50% 40% 39% 30% 20% 20% 10% 0% Goal Baseline Q1-16 Q2-16 Q3-16 Q4-16 Q Apr-17 13

14 Figure 6. Percent of All Reporting Hospitals where women received discharge education material 100% 90% 80% 70% 60% 50% 40% 26% 28% 27% 53% 58% 72% 75% 69% 92% 75 to 100% of women received discharge education material 1 to 74% of women received discharge education material 30% 20% 10% 0% 46% 39% 28% 22% 28% 19% 3% 3% 3% 8% Baseline Q1-16 Q2-16 Q3-16 Q4-16 Q Apr-17 No women received discharge education material 14

15 Figure 11. Structural Measures 1 5 at Baseline 100% 90% 97% 94% 97% Hypertension Protocol: Percent of hospital that have hypertension in pregnancy policies and procedures 80% 70% 70% EHR Integration: Percent of hospitals where Severe Preeclampsia processes are integrated into the EHR 60% 50% 40% 30% 20% 48% 40% 61% Patient, Family, Staff Support: Percent of hospitals that have developed OB specific resources and protocols to support patients, family and staff through major OB complications Multidisciplinary case reviews: Percent of hospitals that have policy and process to perform multidisciplinary systemslevel reviews on all cases of severe maternal morbidity 10% 0% 8% 12% Baseline (n=32) 8% May 13, 2017 (n=32) Hypertension discharge education for all patients: Percent of hospitals that have policy and process to provide preeclampsia discharge education for all patients 15

16 HIP OUTCOME MEASURES INITIATIVE-WIDE 16

17 Percentage of Severe Hypertension Figure 1. Percentage of Severe Hypertension/Preeclampsia- Quarterly 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 2014 Q Q Q Q Q2 Year Quarter 2015 Q Q4 2016* Q1 2016* Q2 2016* Q3 17

18 Percentage of Severe Maternal Morbidity Figure 2. Percentage of Severe Maternal Morbidity Among Women with Severe Hypertension/Preeclampsia - Quarterly 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2014 Q Q Q Q Q Q Q4 2016* Q1 2016* Q2 2016* Q3 Year Quarter 18

19 Figure 3. Percentage of Severe Maternal Morbidity (Excluding Blood Transfusions) Among Women with Severe Hypertension/Preeclampsia- Quarterly Percentage of Severe Maternal Morbidity (Excluding Blood Transfusions) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2014 Q Q Q Q Q2 Year Quarter 2015 Q Q4 2016* Q1 2016* Q2 2016* Q3 19

20 Figure 4. Percentage of Leading Types of Severe Maternal Morbidity among Women with Severe Hypertension /Preeclampsia (Q1-Q3, 2016) Percentage of Severe Maternal Morbidity 25% 20% 15% 10% 5% 0% Blood Transfusion Eclampsia Acute Renal Failure Adult Respiratory Distress Syndrome Pulmonary Edema 20

21 FPQC Perinatal QI Indicator Project Provides hospital-specific QI reports every 6 months compared to all FL delivery hospitals. Provides reports on 8 indicator topics Birth certificates, discharge and linked data used for hospital reports Currently 38 hospitals are participating Currently accepting new hospitals 21

22 Congrats on a highly successful initiative. You have made a difference in the care of new mothers and babies!!! 22

23 HIP Quality Improvement Recognition Awards GOLD 2 Hospitals SILVER 1 Hospital BRONZE 6 Hospitals All 5 Process Measure goals met 4 of the 5 Process Measure goals met 3 of the 5 Process Measure goals met + HIP policies/protocols in place, and a policy/process to provide preeclampsia discharge education for all obstetric patients Congratulations! 23

24 SUSTAINING POSITIVE HIP CHANGES 24

25 The challenge is not starting, but continuing after the initial enthusiasm has gone Vretveit (2003) Making temporary quality improvement continuous: A review of the research relevant to the sustainability of quality improvement in healthcare

26 Definitions Sustainability: Holding the gains and evolving as required, definitely not going back Spread: the learning which takes place in any part of the organization is actively shared and acted upon by all parts of the organization Knowledge that is generated anywhere in the system becoming common knowledge across the system resulting in continuous improvement action

27 27

28 How do we do? Sustainability is the result of effective preparation and implementation Sustainability will not just happen ; you need to plan for it and build it in from the start.

29 Suggestions Give high priority to organizational development and system change Staff must be trained, confident and competent in the new way of working No substitute for lack of capability and understanding of the need to reshape the provision of health care services

30 The Rogers Curve 30

31 The Rogers Curve Starting with enthusiasts is a good way of making progress but those at the far end of Rogers curve will help you to understand what can go wrong Sustainability plans should use that information

32 Don t just focus on the benefit to the patients Remember the benefits to organization and individual Create an attraction to change We all change naturally; at our own pace with our own rationale Think about how you can make your change more naturally attractive to others

33 Ongoing processes to monitor performance must be developed and implemented. Implementers need time to create, monitor, and improve care processes Frontline individuals Know what needs to be changed, Understand where the fault lines are Are best positioned to identify solutions Senior leaders: must provide clear, direct communication and support to those on the front lines 33

34 Create a Flow Diagram Does it reflect what really happens after your QI work - Who is doing each activity? Where, and Why? Review the process with your team for sustainability: Are the steps in the process supported with system changes? Could you make it easier for the team to remember steps? Are there opportunities to simplify or streamline the process? 34

35 Factors Impacting Sustainability 35

36 Where does it go wrong? Lack of planning Not thinking systems change Insufficient resources New challenges Unforeseen barriers Was not truly successful/incomplete to begin with 36

37 Hear from you WHAT WILL YOU BE DOING TO SUSTAIN GAINS MADE DURING THE HIP INITIATIVE? 37

38 HIP SUSTAINABILITY DATA CHECK-INS 38

39 Background Other quality collaboratives have learned that change is better sustained if monitored. However, only monitor key measures and only periodically to reduce data burden/fatigue. Based on these checks, hospitals can better address sustainability. 39

40 The Plan FPQC generally expects all hospitals to participate to support each other with sustainability. Only HIP data measures gained from chart audits will continue. Initially data will be collected for two quarters and then semi-annually. The FPQC will coordinate collection and maintain reporting for all hospitals. 40

41 The Plan FPQC will collect data for two quarters in In 2018, the FPQC will collect data semi-annually. Hospitals will abstract the first 10 records for acute onset hypertension for each time period. For example: This October, you will submit data for Q3, 2017 (July, August, Sept) by October 1 st. In June 2018, you will submit data for January to June, 2018 by July 1 st. Hospital reports will be generated by the FPQC at the end of each period. 41

42 HIP RESOURCES 42

43 Q & A If you have a question, please enter it in the Question box or Raise your hand to be un-muted. We can only unmute you if you have dialed your Audio PIN (shown on the GoToWebinar side bar). 43

44 RECRUITMENT BEGINS NEXT WEEK! 44

45 THANK YOU! Technical Assistance: