Transcript Slide 1

Using California Maternity Data
to Drive Quality Improvement
Elliott Main, MD
Jeffrey Gould, MD MPH
Medical Director, CMQCC
main@
.org
Medical Director, CPQCC
[email protected]
Clinical Professor, OB/GYN
UC San Francisco, and
Stanford University
Professor, Pediatrics and
Neonatology
Stanford University
1
California Maternal Quality Care Collaborative
CMQCC is a multi-stakeholder organization that drives
improvement in maternal and infant outcomes through
rapid-cycle data analytics and collaborative actions.

Development and validation of perinatal quality
metrics and QI tools

Lead (with partners) maternal quality and safety
collaboratives

QI implementation to scale: all 260 CA maternity
hospitals

All driven by the California Maternal Data Center
: Transforming Maternity Care
CMQCC Key Partner/Stakeholders
State Agencies:
 MCAH, Dept Public Health
 OSHPD Healthcare Information Division
 Office of Vital Records (OVR)
 Regional Perinatal Programs of California (RPPC)
 DHCS, Medi-Cal
Public and Consumer Groups
 California Hospital Accountability and Reporting Taskforce (CHART)
 California HealthCare Foundation
 Kaiser Family Foundation
 March of Dimes (MOD)
Professional groups
 American College of Obstetrics and Gynecology (ACOG)
 Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
 American College of Nurse Midwives (ACNM),
 American Academy of Family Physicians (AAFP)
Key Medical and Nursing Leaders
 Universities and Hospital Systems
 Kaisers, Sutter, Sharp, Dignity, Scripps, Providence, Public hospitals,
: Transforming Maternity Care
CMQCC Key Partner/Stakeholders
(con’t)
Hospital Associations:
 California Hospital Association / HQI
 Regional Hospital Associations
Payers
 Aetna
 Anthem Blue Cross
 Blue Shield
 Cigna
 Health Net
Purchasers
 CALPERS (State and local government employees and retirees)
 Medi-Cal (for managed care plans)
 Pacific Business Group on Health/ Silicon Valley Employers Forum
 Cover California (ACA entity)
: Transforming Maternity Care
CMQCC Perinatal QI Toolkits
Adopted Nationally
: Transforming Maternity Care
Success: Collective Action
Leaders
Public
Health
Quality
measures
Public
advocates
Public
Reporting
EED
Datadriven QI
Evidence
Payment
Incentives
: Transforming Maternity Care
Final angle
to complete
initiative
: Transforming Maternity Care
NQF National Consensus Standards for
Perinatal Care 2013 (16 measures)
OB/
Mom
Mom/
Baby
•
•
•
•
•
#0469
#0470
#0471
#0472
#0473
Elective delivery prior to 39 weeks
Episiotomy rate
NTSV Cesarean rate, aka “low-risk” first births
Prophylactic antibiotics for Cesarean birth (< 1 hr)
DVT prophylaxis for women having a Cesarean birth
•
•
•
•
•
•
•
#0475
#0476
#0477
#0480
#0716
#1402
#1746
Hepatitis B Vaccine for all newborns
Rate of antenatal steroids for under 34 week births
Infants under 1500g (VLBW) not delivered at Level III
Exclusive breastfeeding at hospital discharge
Healthy Term Newborn (aka Unexpected Newborn Complications)
Newborn Hearing Screening
Intrapartum GBS antibiotic prophylaxis
=Measures that are highest value (Quality + Savings)==CMS
JC Core Measure Set
Leapfrog Group Measures
The CMQCC Maternal
Data Center (CMDC)
Data  Action
What is the CMDC?
Low-burden/High-value
A Rapid-Cycle one-stop shop to support hospitals’
obstetric quality improvement initiatives and
service line management
 Overall hospital obstetric performance measures (>40)
 Benchmarking statistics--to
compare your hospital to
regional, state, and like-hospital peers
 Facilitating reporting to Leapfrog, HEN, and CMS IQR
 Provider-level statistics—to assess variation within a
hospital
: Transforming Maternity Care
CMQCC Maternal Data Center
PDD--Discharge
Diagnosis File
(ICD9 codes)
Birth Certificate File
(Clinical Data)
Q MONTH: Upload electronic
files for ALL CA births
CMQCC Data Center
CHART REVIEW
(or EHR dump)
<39wk EED
Antenatal Steroids
Process measures
Immediately calculates
all the Measures
REPORTS
Benchmarks against other hospitals
Sub-measure reports
Mantra: “If: you
use it, they
will improve
it”
Transforming
Maternity
Care
Support
Data QI
CMQCC Maternal Data Center:

Beyond N/D: Understand your rates to drive QI
 What
 Drill
is in the numerator?
down to individual cases
 Sub-measures

Supports QI collaboratives
 Outcome

and process measures
Release for public reporting:
 First-Birth
Cesarean, Episiotomy, VBAC rates
(CHART)
 Levels:
Hospital, Medical Group, Health Plan
: Transforming Maternity Care
Low-Risk First-Birth (Nuliparous Term Singleton Vertex) CS Rate
80%
(endorsed by NQF, TJC PC-02, CMS, HP2020)
Among 249 California Hospitals: 2011-2012
70%
(Source: CMQCC--California Maternal Data Center
combining primary data from OSHPD and Vital Records)
60%
Extreme Hospital Level Variation!
50%
Range: 10.0—75.8%
Median: 27.0%
Mean: 27.7%
40%
30%
National
Target =23.9%
20%
36% of CA hospitals
meet national target
0%
1
6
11
16
21
26
31
36
41
46
51
56
61
66
71
76
81
86
91
96
101
106
111
116
121
126
131
136
141
146
151
156
161
166
171
176
181
186
191
196
201
206
211
216
221
226
231
236
241
246
10%
July 24, 2013
13
CMQCC Data-Driven QI: NTSV CS
Pilot Hospital for PBGH/RWJ CS Collaborative
35%
32.9%
33.6%
NTSV CS Rate
31.2% 31.8%
33%
30%
28.3%
28%
QI Project
Started:
Jan 16
25%
23%
24.3%
25.0%
23.4%
20%
National Target for NTSV CS = 23.9%
18%
15%
2011
2012
2013
Jan-14
Feb-14
Mar-14
: Transforming Maternity Care
Apr-14
May-14
14
CMQCC Data-Driven QI: NTSV CS
Pilot Hospital for PBGH/RWJ CS Collaborative
35%
32.9%
33.6%
NTSV CS Rate
31.2% 31.8%
33%
30%
28.3%
28%
QI Project
Started:
Jan 16
25%
23%
24.3%
25.0%
23.4%
20%
National Target for NTSV CS = 23.9%
18%
15%
2011
2012
2013
Jan-14
Feb-14
Mar-14
: Transforming Maternity Care
Apr-14
May-14
15
CMQCC Data-Driven QI: NTSV CS
Pilot Hospital for PBGH/RWJ CS Collaborative
35%
32.9%
33.6%
33%
30%
Keys
for Success:
28%
31.2% 31.8%
NTSV CS Rate
28.3%
25.0%
1. 25%
Evidence-based QI QI Project
24.3%
23.4%
Started:
Plan based on
Jan 16
23%
rapid-cycle data
2. 20%
Local leadership
National Target for NTSV CS = 23.9%
3. 18%
Hospital-Provider
alignment
15%
2011
2012
2013
Jan-14 Feb-14 Mar-14 Apr-14 May-14
4. Modest incentives
(shared savings) : Transforming Maternity Care
16
Data Quality Measures
Sample Hospital 3
: Transforming Maternity
Thank You!
[email protected]
: Transforming Maternity Care