Transcript Ohio Perinatal Quality Collaborative

Ohio Perinatal Quality
Collaborative
Ohio Public Health Association –
Ohio Vital Statistics Conference
November 6, 2014
Objectives
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Participants will be able to describe the structure and
purpose of the Ohio Perinatal Quality Collaborative (OPQC).
Participants will be able to describe the work OPQC and
ODH/Office of Vital Statistics has done to improve birth data
documentation in the Integrated Perinatal Health Information
System (IPHIS), Ohio’s birth registry.
Participants will be able to describe the Top Variables and
New 2014 Variables found in the Ohio Birth Registry/IPHIS.
What is the Mission of OPQC?
Reducing prematurity-related adverse
outcomes for babies in Ohio
Goal:
Through collaborative use of
improvement science methods, Reduce
preterm births and improve outcomes
of preterm newborns in Ohio as quickly
as possible.
OPQC Is A Voluntary Organization of Ohio
Stakeholders Who Care About Fetal & Infant Health
The OPQC Charter Teams {24 Neo + 20 OB}
Cleveland
Toledo
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• Promedica Toledo Children’s Hospital (NEO)
• Promedica Toledo Hospital (OB)
• St. Vincent Mercy Medical Center (NEO & OB)
Cleveland Clinic (NEO)
Fairview Hospital (NEO & OB)
Hillcrest Hospital (NEO & OB)
MetroHealth Medical Center (NEO &OB)
University Hospital – MacDonald Women’s Hospital (OB)
University Hospital – Cleveland – Rainbow Babies (NEO)
Akron
• Akron Children’s Hospital (NEO & OB)
• Akron General Medical Center (OB)
• Summa Health System (NEO & OB)
• Dayton Children’s Medical Center (NEO)
• Miami Valley Hospital (OB)
Cincinnati
•St. Elizabeth Health Center(NEO)
Canton
Dayton
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Youngstown
• Aultman Hospital (NEO & OB)
Columbus
Cincinnati Children’s Hospital Medical Center (NEO)
Good Samaritan Hospital (NEO & OB)
Mercy Anderson Hospital (OB)
University Hospital – Cincinnati (NEO & OB)
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Mount Carmel East (NEO & OB)
Mount Carmel St. Ann’s (NEO & OB)
Mount Carmel West (NEO & OB)
Nationwide Children’s Hospital (NEO)
Doctor’s Hospital (Nationwide NEO)
Grant Hospital (Nationwide NEO)
Riverside Methodist Hospital (OB+ Nationwide
• NEO)
Ohio State University Medical Center (NEO & OB)
~ HALF OF OHIO BIRTHS OCCUR IN THESE 20
OB CENTERS
The Ohio Perinatal Quality Collaborative
Obstetrics
39-Week
Scheduled
Deliveries
without
medical
indication
INCREASE
BIRTH
DATA
ACCURACY
& Online
modules
Neonatal
Steroids for
women at risk for
preterm birth
Blood Stream
Infections:
High reliability
of line
maintenance
bundle
(240/7 - 33 6/7)
Done  Transition to BC
Surveillance
Spread to all
maternity
hospitals in
Ohio
2014:
Progesterone to
Reduce Preterm
Birth Risk
Use of
human milk
in infants
22-29 weeks
GA
2014:
Neonatal
Abstinence
Syndrome
OCHA NAS
in 6 CH’s
OPQC Maternity Hospitals 2013
X Charter sites
XPilot sites
Wave 1 sites
XWave 2 sites
Wave 3 sites
Ashtabula
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Toledo
St. Lukes;
Fulton County Health Center
Mercy St. Charles
Bay Park
Hillcrest
Lake East
Lake
West
U.H. Geauga
Metro Health
UH Case
EMH RMC Lakewood
Parma CommunityMacDonal
General
Memorial
Southwest d
Firelands
Health
General
Trumbull
Mercy Lorain St.
Fairview
Care
Memorial
Medina
Mercy Tiffin
John
St.Joseph
General
Fisher-Titus
Akron Children’s MFM St. Elizabeth
Shelby
MedCt
Summa Health System
Health Center
Aultman Orville
rWooster
Blanchar Bellevue
Van Wert
Lima
Memorial
Robinson
Memorial
d Valley
St. Rita’s
Akron General
Samaritan
County Hospital
Ravenna
Lima
Northside
MedCentral Mercy Canton
Wyandot Memorial
Summa Barberton
Mansfield
Medical
Mercer County Southview
East Liverpool
Knox
Mary
Community
Springfield
Union
Aultman
Marion General
Rutan
Good
McCulloug
Mt. Carmel East
Samaritan
h- Hyde
Pomerene
Galion
Mt. Carmel St. Ann’sGrady
Sp
Trinity
Premier
Atrium
Memorial
Wilson
Miami
Genesis
Coshocton
Mt.
Carmel
West
Memorial Valley
OSU
Bethesda
Memorial Hospital
Dublin
East Ohio RegMC
Hospital
Wayne
Riverside
Methodist
Madison
Methodist
Kettering
SE Ohio Reg. mrd.Ctr
Licking
County Memorial Union
Doctor’s
Memorial
County
Fort
Fairfield
Clinton Memorial,
Hamilton
O’Bleness Memorial
Lancaster
Wilmington
Adena
HealthSystem
Mercy Fairfield
Mercy Anderson
The Christ Hospital
Marietta Memorial
Bethes
UH Cincinnati
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Berger Health
North
Good Samaritan TriHealth
Community
Hospital &
Wellness
Center
Mercy
St.
Henry County
Vincent
Defiance Regional Medical
Center
Wood
Community Memorial
County
Bluffton
Highland District
Southern
Ohio
Holzer
Medic
al
BC Data Varies By:
• Hospital
• Maternal Dis
• Credentials
• State
Variation between IPHIS and hand
collected data
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Improving birth registry accuracy was added
when the project was spread in 2011
IPHIS data was the only data used to document
improvement in <39 weeks scheduled deliveries
15 pilot hospitals tested and studied changes to
decrease early scheduled deliveries and
increase birth registry documentation accuracy
Dissemination of The 39 Week Delivery Project
Done in Waves
Different from Charters
• Piloted in 15 Sites 2012
• 3 Subsequent Waves
• Used Birth Registry data
with Staggered Start
Dates
• Jan 2013  Apr 2014
• Ohio Birth Registrars are
excited to participate
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instead of hand collected
Site Visits by BEACON QI
Coordinators
Monthly Calls
Periodic Learning Meetings
Collaboration w/ ODH +
ODH Office of Vital
Statistics + CDC
Ohio inductions < 39 weeks
without a medical indication
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Bill Callaghan, MD MPH
Centers for Disease Control and Prevention
December 1, 2011
“The focus of
healthcare for women
and infants over the
next century depends
on the quality of the
data collected by those
who fill out the birth
certificates.”
39 weeks/Birth Registry Accuracy Aims
• In 9 months, reduce to 5% or less, the
number of women in Ohio of 37.0 to 38.6
weeks gestation for whom delivery is
scheduled in the absence of appropriate
medical indication
• In 9 months, improve birth registry
accuracy so that focused variables* will be
transmitted accurately in 95% of records
(*Pre-pregnancy and Gestational Diabetes; Pre-pregnancy and Gestational
hypertension; Induction of Labor; ANCS; OB estimate of GA)
Site Visits to Hospitals
OPQC & ODH met with Hospital’s Clinical and
Data Teams for half day covering:
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Importance of the birth certificate data
Process flow map detailing Abstraction
of Birth Data and Submission into IPHIS
5-8 “audits” of previously submitted Birth Certificates
compared with the Patient Chart
Top IPHIS Variables
Variables of the Month:
• Breastfeeding
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at Discharge
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Is the infant being breast-fed
before discharge from the
hospital?
• “Breast-fed” is the action of
breast- feeding or pumping
(expressing) milk.
• **Exclusive breast feeding is
not required to check “yes”.
Infant may be intermittently fed
both breast milk and formula at
discharge.
It is NOT the intent or plan to
breast- feed.
POLL:
Breastfeeding at Discharge?
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RN obtains history from
mom on admission to
L&D. Mom states
“breast” when asked if
breast or bottle feeding.
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Infant is in the Special
Care Nursery and is on
NG feeds. Mom is
pumping her breasts to
supply milk for her baby.
 Breastfeeding at
discharge
 Breastfeeding at
discharge
 Not breastfeeding at
discharge
 Not breastfeeding at
discharge
Team Take Aways
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Better understanding from Clinicians regarding
requirements for birth certificate data collection
Numerous areas documented throughout the
patient chart for several of the variables;
documentation not always consistent
Data personnel did not always have a clear
understanding of variables; often had difficulty
finding the data in the patient chart
New IPHIS Variables 2014
Variable
IPHIS TAB
1. Pregnancy/Ultrasound Dating
Prenatal
2. Previous Cesarean Delivery
Pregnancy Risk Factors
3. Intrauterine Growth Restriction (IUGR)
Pregnancy Risk Factors
4. Renal (Kidney) Disease
Pregnancy Risk Factors
5. Cholestasis
Pregnancy Risk Factors
6. Blood Group Allo-Immunization
Pregnancy Risk Factors
7. Prior Non-Pregnant Surgery
Pregnancy Risk Factors
8. HIV - Human Immunodeficiency Virus
Pregnancy Infections
9. Progesterone
Pregnancy Progesterone
10. Obstetric estimate of gestational age (updated)
Newborn
11. Exclusive breast milk feeding through entire stay
Newborn
12. Critical Congenital Heart Disease Screening/Pulse
Oximetry (CCHD)
CCHD Tab
Education for New IPHIS
Variables
• OPQC – OHD VS webinars
• November 14th & 17th from 12N – 1pm
• Additional webinars to be added in December
• Regional site trainings coming in 2015
Summary
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Birth Registry Data is important!! Hospitals
want their data to accurately reflect the
work they are doing.
OPQC and ODH – VS working together were able to
assist hospitals in improving their data accuracy;
team work makes the dream work!
Ohio is a frontrunner in this type of Quality
Improvement work; other states are interested in
learning from and working with us!
Questions/Comments