New York State Perinatal Quality Collaborative (NYSPQC): Promoting Infant Safe Sleep to Reduce Infant Mortality December 20, 2016
December 20, 2016 2 Presenters Kristen Lawless, MS Program Director, NYSPQC New York State Department of Health Deborah Campbell, MD, FAAP Chief, Division of Neonatology Children s Hospital at Montefiore Clinical Advisor, NYSPQC Pat Heinrich, RN, MSN Executive Project Director, NICHQ Clinical and Quality Improvement Advisor, NYSPQC
December 20, 2016 3 Presentation Objectives Provide an overview of the NYSPQC, including its mission, structure, and focus areas Describe the NYSPQC Hospital-based Safe Sleep Project Review progress of the NYSPQC Hospitalbased Safe Sleep Project Discuss initiative successes and challenges Answer questions from meeting attendees
December 20, 2016 4 New York State Perinatal Quality Collaborative (NYSPQC)
December 20, 2016 5 NYSPQC Mission & Strategy To provide the best and safest care for women and infants by preventing and minimizing harm through the translation of evidence-based practice guidelines to clinical practice. This is achieved through collaboration amongst participants and the utilization of quality improvement science.
December 20, 2016 6 NYSPQC Resources The NYSPQC is an initiative of the New York State Department of Health (NYSDOH), which provides unique and important resources: Infrastructure and leadership Connections to other state agencies for programmatic and data needs Medicaid Vital Records Hospital Acquired Infections Statewide health information network Web-based Available for centralized data collection Statewide partnerships Established relationships with hospitals and community-based organizations
December 20, 2016 7 NYSPQC Structure Adapts the Institute for Healthcare Improvement (IHI) model for Idealized Perinatal Care and Breakthrough Series Methodology as a framework to guide improvement This strategy has been executed with the assistance of a long standing partnership with NICHQ Utilizes NYS well-established system of perinatal regionalization Collaborates with NYS birthing hospitals and various other organizations
December 20, 2016 8 Collaborating for Success 8
December 20, 2016 9 NYSPQC Past Focus Areas Reducing scheduled deliveries without a medical indication before 39 weeks gestation Improving identification/management of maternal hemorrhage/hypertension Reducing central line associated blood stream infections in NICUs
December 20, 2016 10 NYSPQC Current Focus Areas Optimizing enteral nutrition practices in NICUs to improve infant growth Improving access to and utilization of antenatal corticosteroid treatment Improving safe sleep practices to reduce infant mortality
December 20, 2016 11 NYSPQC Safe Sleep Project
December 20, 2016 12 Infant Sleep Related Mortality The ~90 infants who will die in New York State this year due to sleeping in an unsafe environment are enough to fill five kindergarten classes
December 20, 2016 13 NYSPQC Safe Sleep Project Focuses on improving safe sleep practices to reduce infant mortality Implements the national IM-CoIIN infant safe sleep activities NYS hospitals participating in the NYSPQC Safe Sleep Project are the state s stakeholders in the national CoIIN Safe Sleep Network
December 20, 2016 14 NYSPQC Safe Sleep Project Improvements in safe sleep practices are being achieved by: Ensuring all infant caregivers (i.e., new moms or guardians) have documentation of safe sleep education documented in the medical record; Establishing consistent modeling of a safe sleep environment for all infants without a medical contraindication during the birth hospitalization; and Discussing caregiver (i.e., new moms or guardians) understanding of infant safe sleep education prior to discharge from the birth hospitalization.
December 20, 2016 15 NYSPQC Safe Sleep Project Project began in September 2015 76 out of 125 (60.8%) NYS birthing hospitals participating in the initiative: 17 Regional Perinatal Centers (RPCs) 25 Level III birthing hospitals 13 Level II birthing hospitals 21 Level I birthing hospitals
December 20, 2016 16 Progress to Date
December 20, 2016 17 Documentation of Safe Sleep Education Form
December 20, 2016 18 Measure 1: Percent of medical records with documentation of safe sleep education Percent % 100 95 90 85 80 75 70 65 60 55 50 90.3 92.6 90.8 91.8 93.1 92.8 94.0 94.4 96.6 94.8 96.1 96.1 96.8 97.3
December 20, 2016 19 Crib Check Tool
December 20, 2016 20 Percent % Measure 2: Percent of infants, sleeping or awakeand-unattended in crib, in a safe sleep environment 100 95 90 85 80 75 70 65 60 55 50 Safe Sleep Envir* Supine Safe Clothing Head Flat No Objects *A safe sleep environment is defined as infants who were positioned supine, in safe clothing, with head of crib flat and no objects in the crib
December 20, 2016 21 Percent % Measure 2: Percent of infants, sleeping or awakeand-unattended in crib, in a safe sleep environment, by unit type 100 90 80 70 60 50 40 30 20 10 0 Well baby Room in NICU
December 20, 2016 22 Caregiver Survey
December 20, 2016 23 Percent % Measure 4: Percent of primary caregivers indicating they understand safe sleep practices* 100 95 90 85 80 75 70 65 60 55 50 Understand safe sleep* Alone Back Crib No Objects *Understanding safe sleep practices is defined as reporting that infants should sleep alone, on their back, in a crib, with the crib free of objects
December 20, 2016 24 Percent % Measure 4: Percent of primary caregivers indicating they understand safe sleep practices, by caregiver race/ethnicity 100 95 90 85 80 75 70 65 60 55 50 Hispanic Asian Black White Other
December 20, 2016 25 Percent % Measure 4: Percent of primary caregivers indicating they understand safe sleep practices, by caregiver insurance type 100 90 80 70 60 50 40 30 20 10 0 Medicaid Private Other
December 20, 2016 26 Measure 4: Percent of primary caregivers indicating they understand safe sleep practices, by caregiver education level Percent % 100 95 90 85 80 75 70 65 60 55 50 Less Than High School High School More Than High School
December 20, 2016 27 Summary Improvement has been seen in all project measures Between September 2015 and September 2016: The percent of medical records with documentation of education increased 8%; The percent of infants in a safe sleep environment has increased by 33%; and The percent of caregivers who understand safe sleep practices increased by 15%.
December 20, 2016 28 Still Room for Improvement Hispanic and Black caregivers understand safe sleep practices less frequently than White caregivers Caregivers insured by Medicaid or other insurance understood safe sleep less frequently compared to those with private insurance Caregivers with lower levels of education understood safe sleep less frequently than those with more than a high school education
December 20, 2016 29 Successes and Challenges
December 20, 2016 30 Success: CBO Safe Sleep Project Six NYS Maternal & Infant Community Health Collaborative (MICHC) organizations engaged in CBO Project Survey administered to caregivers by home visiting organizations to assess the effectiveness of safe sleep education on caregivers practices in the home setting
December 20, 2016 31 Success: Safe Sleep Project Collaborations among participating hospitals and stakeholder organizations Hospital policies and procedures put into place, or updated as appropriate Safe sleep education and documentation built into birthing hospitals electronic medical records (EMR) systems
December 20, 2016 32 Working to Reduce Disparities Successes: Tailored Tests of Change
December 20, 2016 33 Tailored Tests of Change Developing changes what s different? Evidence Theories, questions, hunches Linked to aim Involve key players Tailored Nolan, K. et al. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2 nd Edition. New York, NY: Jossey Bass
December 20, 2016 34 Tailored Tests of Change Language Religiosity Cultural norms Health beliefs Literacy.. Revisiting Safe Sleep Recommendations for African American Infants: Why Current Counseling is Insufficient. Gaydos, L.M., Blake, S.C., Gazmararian, J.A. et al. Matern Child Health J (2015) 19: 496. doi:10.1007/s10995 014 1530 z file:///users/patriciacheinrich/downloads/revisiting%20safe%20sleep%20recommen dations%20for%20african American%20Infants %20Why%20Current%20Counseling%20is%20Insufficient.%202014.pdf
December 20, 2016 35 Success: Tailored Changes Consideration given to cultural beliefs, and resources tailored as appropriate NYSDOH collaborations with various state agencies (OCFS, OASAS, WIC, etc.) Consistent safe sleep messaging Various educational materials developed and translated into multiple languages
December 20, 2016 36 Success: Media Campaign Goal is to increase awareness among parents and other caregivers about infant safe sleep, through the development of: Posters Brochures Magnets Clings Crib cards Videos
December 20, 2016 37 Success: Safe Sleep Video https://www.youtube.com/watch?v=b4m9pcu4lmc&feature=youtu.be
December 20, 2016 38 Success: Safe Sleep Video https://www.youtube.com/watch?v=rccyzwg2n20&feature=youtu.be
December 20, 2016 39 Success: Engaging Prenatal Providers Commissioner letter sent to obstetricians and nurse midwives statewide Educate and reinforce safe sleep messages prior to delivery
December 20, 2016 40 Success: Engaging Providers After Birth Commissioner letter sent to: Pediatricians Family practitioners Nurse practitioners Reinforce safe sleep message that has been provided previously in different settings
December 20, 2016 41 Success: NYS Public Health Law New York State Public Health Law was amended in July 2016 to include language that requires birthing hospitals and birthing centers to distribute infant safe sleep information to all maternity patients.
December 20, 2016 42 Challenges Changes to EMR systems can take time Grandparents - You slept on your stomach, and you re fine Cultural barriers
December 20, 2016 43 Challenges Financial issues can t afford a crib, bassinet, etc. No room in apartment/trailer/home for crib Evolving thoughts and research on swaddling
December 20, 2016 44 Questions & Discussion
December 20, 2016 45 NYSPQC Safe Sleep Project Team Marilyn Kacica, MD, MPH Susan Slade Chris Kus, MD, MPH Kristen Lawless Eileen Shields Kuangnan Xiong, PhD Amanda Roy Solita Jones Lusine Ghazaryan, MD, MPH Brandi Wells Kathy Harris Mari Sepowski Pat Heinrich, RN, MSN (NICHQ) Emma Smizik (NICHQ) Emma Hopkinson (NICHQ)
December 20, 2016 46 NYSPQC Clinical Expert Work Group Neonatology Deborah Campbell, MD, FAAP Children s Hospital at Montefiore Martha Caprio, MD New York University Langone Medical Center Adriann Combs, BS, RN Winthrop University Hospital Pat Heinrich, RN, MSN NICHQ Michael Horgan, MD Albany Medical Center Edmund LaGamma, MD Maria Fareri Children's Hospital at Westchester Medical Center Timothy Stevens, MD, MPH Golisano Children s Hospital at University of Rochester Medical Center
December 20, 2016 47 Contact New York State Perinatal Quality Collaborative Empire State Plaza Corning Tower, Room 984 Albany, NY 12237 Ph: 518 / 473-9883 F: 518 / 474-1420 NYSPQC@health.ny.gov www.nyspqc.org
December 20, 2016 48