Presentation for the Ohio Senate Finance Health Sub-Committee. April, 2013

Transcription

1 Presentation for the Ohio Senate Finance Health Sub-Committee April, 2013

2 NCH: Our Strategic Plan 2

3 NCH: Keep Me Well Aspiration Ensure that Children with Special Healthcare Needs achieve their full potential Children with Special Healthcare Needs + = Accountable Care Organization Full Potential 3

4 NCH: At a Glance 4 th largest (beds) 4 th busiest (patient visits) 38-county service area in central and Southeast Ohio One of the largest neonatal networks in the country serving >4,000 babies a year Top 10 Pediatric Research Institute for NIH funding 8,800 total employees including >1,100 medical staff Patients from every state and 28 countries 4

5 Visits/Discharges NCH:>1 million annual patient visits 1,200,000 1,000,000 Total Inpatient Discharges and Outpatient Visits 939, ,546 1,003,069 1,053, , , , , , , , , , , ,

6 NCH: Expanding Locations 42 Locations in central Ohio 26 Locations throughout the state

7 Partners For Kids Structure Physician-Hospital Organization, PFK, formed in Ohio taxable, not for profit private entity Joint venture between Nationwide Children s Hospital, its employed physicians and contracted community physicians Approximately 95 employed and 180 community PCPs, 480 employed and 50 contracted community specialists (approximately 900 physicians in total) Ohio Department of Insurance considers PFK to be an intermediary organization ---accepts financial risk but not a health plan. Must maintain reserves and stop loss coverage. 7

8 Ohio Market--PFK LUCAS WILLIAMS FULTON DEFIANCE WOOD HENRY PAULDING PUTNAM HANCOCK VAN WERT ALLEN AUGLAIZE HARDIN MERCER SHELBY LOGAN CHAMPAIGN DARKE MIAMI UNION CLARK MONTGOMERY MADISON PREBLE GREENE FAYETTE BUTLER WARREN CLINTON DELAWARE FRANKLIN PICKAWAY ROSS HAMILTON HIGHLAND PIKE CLERMONT BROWN ADAMS SCIOTO LAKE ASHTABULA OTTAWA GEAUGA CUYAHOGA SANDUSKY ERIE LORAIN TRUMBULL HURON PORTAGE SENECA MEDINA SUMMIT MAHONING ASHLAND WYANDOT CRAWFORD RICHLAND WAYNE STARK COLUMBIANA MARION HOLMES CARROLL MORROW TUSCARAWAS JEFFERSON Central KNOX COSHOCTON HARRISON LICKING GUERNSEY MUSKINGUM BELMONT NOBLE FAIRFIELD MONROE MORGAN PERRY HOCKING VINTON JACKSON GALLIA LAWRENCE Southeast ATHENS MEIGS WASHINGTON Contracted with 3 Medicaid Managed Care Plans (currently) covering just under 300,000 lives in urban and rural Ohio (34 counties) Contracted with all 5 Managed Care Plans for

9 PFK: Evolutionary Growth Contracting Strategy Patient Membership Managed Care Strategy Accountable Care Org. (Population Health) 0 9

10 PFK: Flow of Funds Ohio Department of Jobs & Family Services Plan A Plan B Plan C ODJFS pays the Medicaid Managed Care Plans an age-sex adjusted per member amount each month for all CFC members in their regions PFK provides care coordination, population health initiatives, credentialing, network management Plan passes the capitation for members 18 and under less a small amount for administration (reporting, member service, claims processing) $ $ $ $ Nationwide Children s Hospital paid per member per month capitation payments NCH employed physician group paid per member per month capitation payments Community member physicians paid % over Medicaid Other providers (nonmembers) paid % of Medicaid PAA 10

11 PFK: Financial Incentives Primary Care Pay for Performance Access Practice Improvement Medical Home recognition, quality collaboratives Paying for Quality Outcomes Selected HEDIS measures Well Child Visits Immunizations Asthma medication 11

12 PFK Care Coordination Tools Accountable Care Organization Outreach Collaborative Learning NCQA PCMH Certification Increased Access Data Sharing Distance Medicine Web Tools Home Care Technology Partnerships with Other Organizations Standardizing Care Financial Incentives MOC Credit 12

13 Akron Children s Hospital Nationwide Children s Hospital Partners for Kids Global Goal: To Achieve the Triple Aim Better health (healthier children) Better quality health care Centers for Medicare and Medicaid Innovation Health Care Innovation Award * Reduced costs through quality improvement *The project described was supported by Funding Opportunity Number CMS-1c from Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. 13

14 Health Care Innovation Award Awarded $13.1M over 3 years to: Expand the PFK Model New Geography: Akron Region New Population: ABD Children Pilot Specific Clinical/Population Health Interventions Behavioral Health Complex Care Prematurity 14

15 SPECIFIC AIMS: HCIA Initiative: PFK Expansion A. Cost = By 6/2015: Reduce per member per month by 1.1% for TANF and 2.0% for Disabled Reduce 60 day PFK behavioral health readmissions by 30% from 9.8 to 6.9% Decrease hospital days of tube fed children by 10% Reduce Summit County neonatal days by 10% B. Quality = By 6/2015: Increase completed 30 day outpatient PFK medical follow up after behavioral health hospitalization from 29% to 65% by 6/2015 Proactive care plan implemented for children with feeding impairment and neurodevelopment disorders from 0% to 85% C. Increase Health = delivery By 6/2015: of progesterone to pregnant Decrease women Columbia with Impairment prior preterm Scores birth from in discharge Summit to 60 days post County discharge by by 20% 15% for >75% of PFK patients admitted for treatment of psychiatric diagnoses Increase by 10% proportion of tube fed kids between 5%ile & 95%ile for weight on growth chart each year Decrease preterm birth rate to 11.6% from 13.3% in Summit County. KEY DRIVERS Payment Reform Care Coordination/Case Management Improvement Science and Implementation Health Information Technology Patient, Family, Community Engagement SECONDARY DRIVERS Risk Model & Contracting Patient Centered Medical Home Specialty Network Performance & Extenders Data Capture, Analysis & Reporting Home Care Technologies INTERVENTIONS Managed Care Orgs/PFK Contracts Pay 4 Performance Contracts Quality Collaboratives Resource Consultation Line Care Coordination and Plans Telemedicine Clinic Home Progesterone Promotion Cervical Screening Parent Training, Advocates GLOBAL AIMS: Expand PFK model to reduce costs, improve care and enhance outcomes for Medicaid children in Ohio 15

16 Ohio Market--Akron WILLIAMS DEFIANCE PAULDING VAN WERT MERCER DARKE PREBLE BUTLER HAMILTON FULTON PUTNAM MONTGOMERY HENRY ALLEN AUGLAIZE SHELBY MIAMI WARREN CLERMONT WOOD HANCOCK LOGAN BROWN HARDIN CHAMPAIGN CLARK GREENE CLINTON LUCAS HIGHLAND MADISON FAYETTE ADAMS OTTAWA WYANDOT UNION SANDUSKY SENECA MARION ASHLAND CRAWFORD RICHLAND WAYNE STARK East Central DELAWARE FRANKLIN PICKAWAY ROSS PIKE SCIOTO MORROW ERIE HURON KNOX LICKING FAIRFIELD JACKSON HOCKING VINTON GALLIA LORAIN PERRY MEDINA HOLMES COSHOCTON MUSKINGUM ATHENS MEIGS CUYAHOGA MORGAN SUMMIT TUSCARAWAS GUERNSEY NOBLE WASHINGTON LAKE GEAUGA PORTAGE CARROLL HARRISON BELMONT MONROE ASHTABULA TRUMBULL MAHONING COLUMBIANA JEFFERSON Northeast Central Pediatric Medicaid population of 183,000 CFC and 6,400 ABD lives within the 12 county expansion region. LAWRENCE 16

17 Why expand the PFK-Model to northeast Ohio? The innovative arrangement provides resources and incentives to advance health and wellness Partnership between Akron Children's and Nationwide Children s is a continuation of the collaborative approach to the benefit of kids Akron Children s Hospital is well positioned to assume accountability for the pediatric Medicaid population in its service territory 17

18 Akron Children s Hospital Largest pediatric provider in Northeast Ohio 2 Hospital campuses Akron & Youngstown 20+ Primary care office locations 60+ Specialty care locations School health program in over 100 schools within 13 school districts Owns & operates 141 NICU beds in 5 locations, including 3 adult care hospitals in Akron and Youngstown 18

19 Akron Children s Hospital (Continued) Provides services to patients in a 28 county region covering northeast Ohio and western Pa. Over 700,000 patient encounters in ,500 employees 750+ medical staff Magnet Recognition for Nursing Excellence Recently received an A+ rating from Fitch Rating 19

20 Akron Children s Hospital: Care Infrastructure 20

21 Status of Akron Expansion Established Akron Children s Health Collaborative, LLC to hold the at risk contracts with the MCOs Performed strategic assessment to determine model roll out: Plan, initially, to assume risk in sub-region (4 counties with 100,000 pediatric Medicaid enrollees, with remaining 8 counties coming on at a later date) 21

22 Status of Akron Expansion (Continued) Plan, initially, to assume risk for CFC pediatric population; eventually adding ABD pediatric enrollees. Plan to launch contract negotiations in May/June Clinical/population health initiatives underway: Complex Care Initiative Care Coordination of Children with feeding tubes and neurological disorders Behavioral health- Parent Partner Program Prematurity Prevention Progesterone Promotion 22

23 Additional HCIA Focus Areas SPECIFIC AIM Cost Care Decrease hospital days per 10,000 member months for tube fed patients from 24.8 to 22.3 days for 12-month period ending 6/30/2015* Proactive Care Coordination will be provided for 85% of children with feeding impairment and Neurodevelopment Disorders from a baseline of 0% by 6/30/2015 Health Increase by 10% annually the proportion of NCH/ACH tube fed kids between the 5 th percentile & 95 th percentile for weight on standard CDC growth charts GLOBAL AIM Improve Health of children at risk with tube feedings or other technologies KEY DRIVERS Virtual Care Management Support infrastructure Tertiary Care (Hospital-based care) Home Management Support Complex Care INTERVENTIONS PCP Training on Complex Care Resources provided to PCPs for Complex Care Patients Centralized Medical Care Coordination as needed in cooperation with PCP Family-Centered Care Planning G tube insertion/removal protocol Scheduled formula evaluations Home visits for tube mechanics and training Telemedicine Tube Advice Self Management resources (e.g. Home medication list) for Care Plan 23

24 Additional HCIA Focus Areas Complex Care Pts in 5-95 Wt %ile Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb % Population of Patients Within 5th-95th Weight Percentile 90% % Patients with Feeding Tubes Whose Weights Are within 5th-95th Percentile Chart Type: p-chart 85% 80% 75% 70% 65% 60% 55% 50% Dates Patients within Weight Range Baseline Mean(s) Baseline Periods Control Limits Goal(s) T-F Pts with Wt for Month

25 Additional HCIA Focus Areas Behavioral Health SPECIFIC AIMS Cost: By 6/2015 Reduce 60 day PFK behavioral health readmissions by 30% from 9.8 to 6.9% Quality: By 6/2015 Increase 30 outpatient follow up after behavioral health hospitalization from 29 to 65% Health: By 6/2015 Decrease Columbia Impairment Scores from discharge to 60 days post discharge by 15% for >75% of PFK patients admitted for treatment of psychiatric diagnoses GLOBAL AIM: KEY KEY DRIVERS Mental Health and Primary Care Access Payment Reform Care Coordination/Case Management Improvement Science and Implementation Health Information Technology Patient, Family, Community Engagement HCIA NCH PFK INTERVENTIONS Consultation Line Pediatric Psychiatry Network PCP Collaboratives ADHD Collaborative Building Mental Wellness Telehealth Telepsychiatry Teletherapy, e-therapy Healthspot Pay 4 Performance Contracts Managed Care Orgs/PFK Contracts Second opinion program for medication use Care Coordination Public awareness and education Triple P Program Prevent Psychiatric Youth Crises Parent Partner Initiative 25

26 Additional HCIA Focus Areas Behavioral Health 26

27 Additional HCIA Focus Areas Behavioral Health Parent Partners Intervention Primary goal Provide support to parents and families coping with children with behavioral problems Secondary goals Assist parents in identifying their own needs and concerns Education and teach skills focused on coping, self-care, crisis management, problem solving, and personal skill development Provide emotional support and facilitate sharing of experiences and social connections to other parents Facilitate the empowerment of parents in decision-making 27

28 Key Policy Consideration: Shared Savings Bending the cost curve is a key goal of the PFK model and the HCIA initiative, one component of the Triple Aim Increasing health and reducing costs will drive down the per member per month payments to Medicaid MCOs and collaborating organizations such as PFK A shared savings program would ensure that costs and payments are not reduced to a level so low that PFK or Akron can no longer deliver on the Triple Aim 28

29 Capitation Rate PFK Cost Sharing Model 29

30 Experience and Supporting Data 30

31 Physician Incentive Bonus Payment Comparison Quality Quarter Comparison Immunizations Age 13 Immunizations Age 2 Well Child Visits Years Well Child Visits 3-6 Years Well Child Visits 15 Months Q1 Quality Compliance Q2 Quality Compliance Q3 Quality Compliance 31

32 Managing Risk Monthly Management Report Analysis Excludes Pharmacy 32

33 Managing Risk Monthly Management Report Analysis PFK Resumed Financial Risk (Oct 11) Risk Period Comparison 2008 Q Q4 - % Incr/ 2009 Q Q2 Decr Scripts Per 1,000 MM % Average Cost/Script $46.25 $ % State Assumed Financial Risk (Feb 10) PMPM Cost $23.27 $ % 33

34 Managing Risk Monthly Management Report Analysis Retail Pharmacy: Generic vs. Brand Name Drugs Average Cost Per Script Brand Name Drugs: $82 Generic Drugs: $14 34

35 Managing Risk Monthly Management Report Analysis Pharmacy Analysis---Plan A vs All Other Plans Plan A vs All Other Plans Plan A vs All Other Plans CE + SE Region PFK Pharmacy Plan A Caresource All Other Plans Caresource Plan A Drug Class Caresource Plan A All Other All Other Plans Avg Cost Scripts Avg Cost Avg Cost Per Scripts/ Plans Scripts/ (in order of PMPM cost) PMPM pmpm Cost PMPM Cost per /1000 Cost Per Script Script 1,000 MM 1,000 MM script MM Behavioral Health $9.89 $10.08 $ $ Asthma $4.34 $3.54 $87.52 $ Diabetes Control $1.15 $0.83 $ $ Antiadrenergic Agents $0.71 $0.58 $44.70 $ rd Generation Cephalosporins $0.45 $0.80 $39.65 $ Glucocorticoids $0.62 $0.58 $34.75 $ Topical Anti-Infectives $0.50 $0.57 $65.90 $ Growth Hormones $0.69 $0.32 $2, $1, Immune Globulins $0.67 $0.28 $2, $1, Antihistamines $0.44 $0.35 $12.64 $ Subtotal: Top 10 Drug Classes $19.47 $17.94 $91.18 $ All Other Drug Classes $8.75 $8.64 $30.81 $ Grand Total $28.22 $26.58 $56.72 $

36 Managing Risk PFK Trend of NICU Acuity & Cost NICU MSDRG ALOS Avg Cost/Case Avg Paid/Day MSDRG $2,360 $963 MSDRG $11,031 $1,383 MSDRG $23,703 $1,997 MSDRG $7,135 $1,146 MSDRG $30,282 $1,737 MSDRG $90,478 $2,286 1 NICU cases identified using OBBO definition (page 25) Source: PFK Claims Database 36

37 PFK Care Coordination PFK Population at NCH as of 1/07/2013 PFK Cases >60 Days # of Cases Total Days Accrued NICU 15 1,652 Non-NICU PFK Cases Days # of Cases Total Days Accrued NICU Non-NICU 2 86 Grand Total 37 2,853 PFK Encounters inhouse over 60 days as of 1/7/13 First Name Last Name Admit Date Faciity Payor Benefit Plan Chief Complaint Current LOS 5/1/2012 NCH Plan A GASTROSCHISIS 251 6/13/2012 NCH Plan B 6/25/2012 NCH Plan C ABDOMINAL DISTENTION BPD; STRIDOR; SUBGLOTTIC STENOSIS /20/2012 NCH Plan C PREMATURITY 140 8/31/2012 NCH Plan C PREMATURITY 129 Discharge Plan or Other Comments This member is slowly working on feeding. He will likely be inpt for some time to come. Is no longer vent dependent. Nasal cannula oxygen only. Will geta G tube in a few days. Will transfer to FFS after to discharge due to her being placed with a foster family. Discharge not imminent. Family has applied for waiver and was denied. The decision is being appealed. Will go home with nursing and mist collar. Discharge in approximately a week. This baby continues to have feeding issues. Will not have significant home going needs. Discharge estimate at 2 weeks depending on feeding progress. This member will be going home with a g tube. He is medically ready to go home as of 1/11/13 but will likely be discharged in 7 days due to need for parent teachings to be completed. Total Population at NCH as of 1/07/2013 Total Cases >60 Days # of Cases Total Days Accrued NICU 37 4,396 Non-NICU 11 1,213 8/31/2012 NCH Plan B FEVER 129 9/1/2012 NCH Plan B EXTREME PREMATURITY 128 9/22/2012 NCH Plan B NEW BORN\ 107 Parents will not consent g tube placement. Reviewed by Ethics Committee. Neonatologist states child must have G tube in order to be discharged. Discussion with Protective Services Franklin County has custody and member will transition to FFS Medicaid after discharge. Member continues to have constant death spells and d/c is not imminent. This member is working on feeding and will not have significant home going needs. Approximately 1-2 weeks out from discharge. Total Cases Days # of Cases Total Days Accrued NICU 29 1,166 Non-NICU Grand Total 84 7,059 9/29/2012 NCH Plan B NEURO EVAUATION 100 Palliative care is involved. This member is not expected to survive. 10/15/2012 NCH Plan A SHORT BOWEL, WEIGHT LOSS 10/23/2012 NCH Plan B PRE TERM 76 10/24/2012 NCH Plan A FOLLOW-UP RHABDOID TUMOR 84 This member has been re-admitted for short bowel issues. He is very ill. Discharge is not imminent. Not likely to have significant home going needs. Currently on nasal cannula oxygen. No estimated discharge date yet. 75 Member not expected to survive. Palliative care involved. Source: EDW 10/25/2012 NCH Plan B PREMATURITY 74 Member is on a vent. Long stay expected. 11/6/2012 NCH Plan A PREMATURITY NAS 11/7/2012 NCH Plan C GASTROSCHISIS Due to NAS Children's Services is involved. No discharge estimate at this time. This member will be inpatient for many months. Will likely transfer to the GI unit at some point. 11/8/2012 NCH Plan C PRE-TERM 60 Discharge is several months off according to care coordination team. 11/8/2012 NCH Plan A HYPOPLASTIC LEFT HEART SYNDROME 60 Being evaluated for heart surgery. Discharge not estimated at this time. 37

38 Population Management Asthma Specific Aim To reduce asthma ED visit (45.8/K) and inpatient hospitalization (2.15/K) rates by 9% from baseline for PFK patients living in Franklin County by 2013 Key Drivers Address long-term prevention/control during encounters triggered by acute illness Optimize outpatient care Increase asthma optimization encounters Patient education Optimize home management Interventions Inpatient: Resident Education Asthma Action Plan Key Questions ED: Facilitate PCC Follow-up PCN: Asthma Action Plan Key Questions/Standard H&P ED Rate Reduction Asthma Specialty Clinic ED: First Dose Steroids Quickly PFK/AAP Collaborative Easy Breathing (with Akron) {tentative} Asthma Clinic (Pulm & All/Imm) Inpatient: AIRES project Asthma Class Asthma Edutainment AKA Mentoring Program Don t Leave Without Them Touchscreen Asthma Education Asthma Express Columbus City Schools: DOT ICS therapy Trigger control NCH influenza immunization program Community Asthma Initiative (tentative) 38

39 Population Management Asthma 39

40 Population Management AIM Health Supervision Immunization Key Driver Diagram Key Drivers Interventions WIC Immunization Program Improve the Immunization Rate for two year old children being seen by the NCH Primary Care Network from the 2011 baseline by four percentage points from 84% to 88% Note: Average of individual rates for all 10 recommended childhood immunizations (Dtap, Hep B, HiB, IPV, MMR, PCV, VZV, Hep A, Roto, Flu) Source: NCH EDW Increase Demand for Immunizations Enhance Immunization Access Maximize opportunities to immunize Provider Based Interventions Culture Change to one of ownership of outcomes Patient Carried immunization schedule Reminders for WCC appts call/letter/text/etc. Outreach to patients identified as behind Day Care Centers requiring complete vaccination. Immunize during any visit Alternative sites- Home Visits, Schools, Daycares Implement health maintenance module within EPIC LPIP / Pended orders (RN/MA) for needed immunizations Provide performance feedback- Immunization rates by PCC Provide performance feedback- Missed opportunities by Physician PCMH Project? WCC vs. Immunization? 40

41 Population Management Health Supervision Improving Immunizations 94% 92% 90% 88% 86% 84% 82% 80% 78% NCH Primary Care Network Immunization Rates 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% Distinguishing From Benchmarks Influenza Vaccination Rates 76% 74% 72% AFIX Rates Source: ODH AFIX Data, Annual Review of NCH Primary Care Centers, Network Average 10.0% 0.0% 2009/ / / /13 US Ohio NCH Source: CDC Reporting for US and OH population immunization results, NCH EPIC for all patients presenting to NCH Outpatient/ Inpatient clinics during Sept March of respective influenza season 41

42 Population Management Health Supervision Patient Centered Medical Home 42

43 Population Management Prematurity SMART AIM To achieve the Ohio Department of Health goal of an preterm birth rate of 9.6% from 13.6% in Franklin County by Dec. 31, KEY DRIVERS Influencing the onset of preterm labor Reducing Social Stress Early access to prenatal care in the first trimester Increase safe spacing between pregnancies Progesterone Promotion Project Cervical screening COSBI Nurse Family Partnership MOMS2B Centering Program Presumptive Eligibility Improve the Pregnancy Care Connection system GLOBAL AIM Reduce infant mortality rate in Franklin County Smoking Cessation Open new clinic slots Safe spacing education 43

44 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Population Management Prematurity Progesterone Promotion Project 40 Gestational Age at Delivery vs Earliest Preterm Birth Gestational Delivery Gestational PTB Feb-11 Mar-11 Apr- 11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Delivery Earliest PTB #Participa nts 35 3/7 37 3/7 36 4/7 35 3/7 36 4/7 33 3/7 37 4/7 37 4/7 34 4/7 35 4/7 37 4/7 36 3/7 36 4/7 35 3/7 36 4/7 37 4/7 35 3/7 31 1/ /7 27 1/7 28 2/7 27 2/7 28 1/7 30 2/7 33 3/7 28 3/7 26 1/7 28 2/7 29 2/7 28 1/7 30 3/7 24 2/7 27 1/

45 Source: ODH Birth Certificates Prematurity 88 Total Providers = OB Provider= 63 = Family Practice Provider= 17 Nurse Practioner or Midwife= 8 Map of 2011 Births <37 Gestational Weeks By County of Residence (All Payors, CE & SE Regions) 2011 Births (CE + SE Regions) Births <37 Total Gestational Births Weeks County (Sorted by %) % <37 Gestational Weeks Marion % Pike % Lawrence % Muskingum 1, % Ross % Fayette % Hocking % Franklin 17,989 2, % Noble % Meigs % Washington % Guernsey % Athens % Scioto % Belmont % Morgan % Perry % Crawford % Morrow % Vinton % Union % Madison % Logan % Jackson % Fairfield 1, % Licking 1, % Pickaway % Jefferson % Delaware 2, % Knox % Harrison % Monroe % Coshocton % Gallia % Grand Total 36,992 4, % 45

46 2012 Q3 (Prelim) 2012 Q Q Q Q Q Q Q Q Q Q Q Q Q Q1 Population Management Prematurity Infant Deaths/1,000 Births Progesterone Roll-Out (June 2009) Franklin County Infant Mortality Rate OBBO Initiation (Aug 2009) Safe Spacing Roll-Out (July 2009) Apnea Initiative (Jan 2012) Note: Infant Mortality represents the count of total infant deaths and the count of total births in a given month. Infant deaths are NOT linked to unique births. Black IM Rate White IM Rate Total IM Rate Franklin County Infant Mortality Source: Ohio Department of Health Vital Statistics (2011 Q Q3 is Preliminary) 46

47 LOS (Days) Population Management Prematurity Length of Stay Data for Grant NICU NAS Patients NAS Patients Discharged from GMC October Current Methadone Protocol Morphine Protocol days 18.8 days days 0 Date 47

48 Hours of ino Use Population Management 4700 mos old with T21 and CAVC admitted for cardiac surgery 11/30/ Nitric Oxide Use Reduction Project ino Use in the CTICU ytd Trisomy 21 AVSD repair Prematurity mo with tricuspid atresia, TGA, VSD with TAPVC underwent DKS, BPG 1/17 (Galantowicz). Complicated by H flu, rhinovirus. 16 yo idiopathic coagulopathy & PE Newborn TOGV 6 yo comple x CHD 10 mo HPLHS 37 wk, cardio myop athy NB TA, PA HRHS 5 mo PS /01/ /24/ /08/ /30/ /30/ /27/ /24/ /22/ /19/ /17/ /16/ /10/ /31/ /24/ /15/ /13/ /03/ /01/ /22/ /12/ /12/ /10/ /09/ /03/ /29/ /03/ /01/ /29/ /24/ /18/ /17/ /05/ /25/ /19/ /05/ /08/ /06/ /06/ /15/ /13/ /07/ /03/ /27/ /24/ /24/ /17/2012 Patient 48

49 Hours of ino Use Prematurity 1600 Nitric Oxide Use Reduction Project ino Use in the PICU ytd Red indicates a death Trisomy 21, ECMO (2 ino runs) 14 yo sepsis yo CF ALL, BMT, Pneumonia /04/ /09/ /03/ /14/ /16/2012 Patient *03/05/ /08/ /07/ /12/ /15/ /26/ /11/ /04/ /13/ /14/ /26/ /08/