Presentation for the Ohio Senate Finance Health Sub-Committee April, 2013
NCH: Our Strategic Plan 2
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
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
Visits/Discharges NCH:>1 million annual patient visits 1,200,000 1,000,000 Total Inpatient Discharges and Outpatient Visits 939,376 959,546 1,003,069 1,053,019 824,619 800,000 723,407 763,943 664,380 600,000 576,362 615,246 530,691 400,000 200,000 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 5
NCH: Expanding Locations 42 Locations in central Ohio 26 Locations throughout the state
Partners For Kids Structure Physician-Hospital Organization, PFK, formed in 1994. 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
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 2013 8
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 PFK: Evolutionary Growth 350000 300000 250000 200000 150000 100000 50000 Contracting Strategy Patient Membership Managed Care Strategy Accountable Care Org. (Population Health) 0 9
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 fee-forservice @ % over Medicaid Other providers (nonmembers) paid fee-forservice @ % of Medicaid PAA 10
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
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
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-1c1-12-0001 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
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
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
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
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
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
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 2012 4,500 employees 750+ medical staff Magnet Recognition for Nursing Excellence Recently received an A+ rating from Fitch Rating 19
Akron Children s Hospital: Care Infrastructure 20
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
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
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
Additional HCIA Focus Areas Complex Care Pts in 5-95 Wt %ile 154 133 172 168 164 174 173 189 223 217 223 207 219 209 247 245 233 258 229 237 241 245 231 236 263 263 252 243 265 252 260 276 257 302 278 260 274 280 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% 2010 2011 2012 2013 Dates Patients within Weight Range Baseline Mean(s) Baseline Periods Control Limits Goal(s) T-F Pts with Wt for Month 239 218 264 280 280 293 294 315 363 339 353 343 359 339 384 389 380 402 376 400 414 399 402 407 425 430 426 407 440 392 404 442 414 460 452 400 449 467 24
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
Additional HCIA Focus Areas Behavioral Health 26
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
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
Capitation Rate PFK Cost Sharing Model 29
Experience and Supporting Data 30
Physician Incentive Bonus Payment Comparison Quality Quarter Comparison 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Immunizations Age 13 Immunizations Age 2 Well Child Visits 12-18 Years Well Child Visits 3-6 Years Well Child Visits 15 Months Q1 Quality Compliance Q2 Quality Compliance Q3 Quality Compliance 31
Managing Risk Monthly Management Report Analysis Excludes Pharmacy 32
Managing Risk Monthly Management Report Analysis PFK Resumed Financial Risk (Oct 11) Risk Period Comparison 2008 Q4-2011 Q4 - % Incr/ 2009 Q2 2012 Q2 Decr Scripts Per 1,000 MM 503 491-2% Average Cost/Script $46.25 $57.32 24% State Assumed Financial Risk (Feb 10) PMPM Cost $23.27 $28.17 21% 33
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
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 $143.32 $154.74 69.0 65.2 Asthma $4.34 $3.54 $87.52 $85.30 49.6 41.5 Diabetes Control $1.15 $0.83 $174.29 $166.41 6.6 5.0 Antiadrenergic Agents $0.71 $0.58 $44.70 $38.84 15.9 15.0 3rd Generation Cephalosporins $0.45 $0.80 $39.65 $73.64 11.2 10.9 Glucocorticoids $0.62 $0.58 $34.75 $33.47 17.9 17.2 Topical Anti-Infectives $0.50 $0.57 $65.90 $67.98 7.5 8.4 Growth Hormones $0.69 $0.32 $2,207.75 $1,832.80 0.3 0.2 Immune Globulins $0.67 $0.28 $2,614.61 $1,878.40 0.3 0.2 Antihistamines $0.44 $0.35 $12.64 $11.32 35.1 30.5 Subtotal: Top 10 Drug Classes $19.47 $17.94 $91.18 $92.44 213.5 194.1 All Other Drug Classes $8.75 $8.64 $30.81 $33.55 283.9 257.6 Grand Total $28.22 $26.58 $56.72 $58.86 497.5 451.6 35
Managing Risk PFK Trend of NICU Acuity & Cost NICU MSDRG ALOS Avg Cost/Case Avg Paid/Day MSDRG 794 2.45 $2,360 $963 MSDRG 793 7.98 $11,031 $1,383 MSDRG 789 11.87 $23,703 $1,997 MSDRG 792 6.23 $7,135 $1,146 MSDRG 791 17.43 $30,282 $1,737 MSDRG 790 39.58 $90,478 $2,286 1 NICU cases identified using OBBO definition (page 25) Source: PFK Claims Database 36
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 4 470 PFK Cases 30-59 Days # of Cases Total Days Accrued NICU 16 645 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 208 196 8/20/2012 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 30-59 Days # of Cases Total Days Accrued NICU 29 1,166 Non-NICU 7 284 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 61 62 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
Population Management Asthma Specific Aim To reduce asthma ED visit (45.8/K) and inpatient hospitalization (2.15/K) rates by 9% from 2008-2010 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
Population Management Asthma 39
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
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% 2008 2009 2010 2011 2012 AFIX Rates Source: ODH AFIX Data, Annual Review of NCH Primary Care Centers, Network Average 10.0% 0.0% 2009/10 2010/11 2011/12 2012/13 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
Population Management Health Supervision Patient Centered Medical Home 42
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, 2020. 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
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 35 30 25 20 15 10 5 0 Gestational Age @ Delivery Gestational Age @Earliest 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 GA @ Delivery GA @ 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 31 28 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 1/7 16 15 12 13 12 21 13 18 18 5 18 10 9 18 23 6 11 44
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 782 128 16.37% Pike 344 53 15.41% Lawrence 318 47 14.78% Muskingum 1,076 156 14.50% Ross 860 122 14.19% Fayette 367 52 14.17% Hocking 305 42 13.77% Franklin 17,989 2,452 13.63% Noble 171 23 13.45% Meigs 201 27 13.43% Washington 479 64 13.36% Guernsey 455 60 13.19% Athens 508 66 12.99% Scioto 903 115 12.74% Belmont 339 43 12.68% Morgan 138 17 12.32% Perry 431 53 12.30% Crawford 466 55 11.80% Morrow 382 45 11.78% Vinton 128 15 11.72% Union 612 71 11.60% Madison 415 47 11.33% Logan 524 59 11.26% Jackson 388 43 11.08% Fairfield 1,679 183 10.90% Licking 1,935 209 10.80% Pickaway 554 59 10.65% Jefferson 490 51 10.41% Delaware 2,109 213 10.10% Knox 696 70 10.06% Harrison 121 12 9.92% Monroe 95 9 9.47% Coshocton 447 40 8.95% Gallia 285 24 8.42% Grand Total 36,992 4,725 12.77% 45
2012 Q3 (Prelim) 2012 Q2 2012 Q1 2011 Q4 2011 Q3 2011 Q2 2011 Q1 2010 Q4 2010 Q3 2010 Q2 2010 Q1 2009 Q4 2009 Q3 2009 Q2 2009 Q1 Population Management Prematurity Infant Deaths/1,000 Births 20 18 16 14 12 10 8 6 4 2 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 Q1-2012 Q3 is Preliminary) 46
LOS (Days) Population Management Prematurity Length of Stay Data for Grant NICU NAS Patients 200 150 NAS Patients Discharged from GMC October 2009- Current Methadone Protocol Morphine Protocol 100 71.5 days 18.8 days 50 21.1 days 0 Date 47
Hours of ino Use Population Management 4700 mos old with T21 and CAVC admitted for cardiac surgery 11/30/11 600 Nitric Oxide Use Reduction Project ino Use in the CTICU 2011-2012 ytd Trisomy 21 AVSD repair Prematurity 500 400 10 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 300 200 NB TA, PA HRHS 5 mo PS 100 0 10 20 30 12/01/2012 11/24/2012 11/08/2012 10/30/2012 10/30/2012 10/27/2012 10/24/2012 10/22/2012 10/19/2012 10/17/2012 10/16/2012 10/10/2012 08/31/2012 08/24/2012 08/15/2012 08/13/2012 08/03/2012 08/01/2012 07/22/2012 07/12/2012 07/12/2012 07/10/2012 07/09/2012 07/03/2012 06/29/2012 06/03/2012 06/01/2012 05/29/2012 05/24/2012 05/18/2012 05/17/2012 05/05/2012 04/25/2012 04/19/2012 04/05/2012 03/08/2012 03/06/2012 03/06/2012 02/15/2012 02/13/2012 02/07/2012 02/03/2012 01/27/2012 01/24/2012 01/24/2012 01/17/2012 Patient 48
Hours of ino Use Prematurity 1600 Nitric Oxide Use Reduction Project ino Use in the PICU 2011-2012 ytd Red indicates a death 1400 1200 1000 Trisomy 21, ECMO (2 ino runs) 14 yo sepsis 800 600 46 yo CF ALL, BMT, Pneumonia 400 200 0 1 2 3 4 5 6 7 8 9 10 11 01/04/2012 01/09/2012 02/03/2012 02/14/2012 02/16/2012 Patient *03/05/2012 03/08/2012 04/07/2012 04/12/2012 05/15/2012 08/26/2012 09/11/2012 11/04/2012 11/13/2012 11/14/2012 11/26/2012 12/08/2012 49