Ohio Perinatal Quality Collaborative

Ohio Public Health Association –Ohio Vital Statistics Conference

November 6, 2014

Objectives

• 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.

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 OhioStakeholders Who Care About Fetal & Infant Health

The OPQC Charter Teams {24 Neo + 20 OB}

• Cincinnati Children’s Hospital Medical Center (NEO)• Good Samaritan Hospital (NEO & OB)

• Aultman Hospital (NEO & OB)

• Akron Children’s Hospital (NEO & OB)• Akron General Medical Center (OB)

• Cleveland Clinic (NEO)

• Dayton Children’s Medical Center (NEO)

• Fairview Hospital (NEO & OB)• Hillcrest Hospital (NEO & OB)

• Mercy Anderson Hospital (OB)

• MetroHealth Medical Center (NEO &OB)

• Miami Valley Hospital (OB)

• Mount Carmel East (NEO & OB)

• Nationwide Children’s Hospital (NEO)• Doctor’s Hospital (Nationwide NEO)• Grant Hospital (Nationwide NEO)

• Promedica Toledo Children’s Hospital (NEO)• Promedica Toledo Hospital (OB)

• Riverside Methodist Hospital (OB+ Nationwide NEO)

• St. Vincent Mercy Medical Center (NEO & OB)

• Summa Health System (NEO & OB)

• Ohio State University Medical Center (NEO & OB)• University Hospital – Cincinnati (NEO & OB)

• University Hospital – Cleveland – Rainbow Babies (NEO)

• University Hospital – MacDonald Women’s Hospital (OB)

• Mount Carmel West (NEO & OB)• Mount Carmel St. Ann’s (NEO & OB)

Cleveland

Akron

Youngstown•St. Elizabeth Health Center(NEO)

Canton Dayton

Cincinnati

Toledo

Columbus

~ HALF OF OHIO BIRTHS OCCUR IN THESE 20 OB CENTERS

Obstetrics Neonatal

39-Week Scheduled Deliveries without medical

indication

Steroids for women at risk for

preterm birth (240/7 - 33 6/7)

Done Transition to BC Surveillance

Spread to all

maternity hospitals in

Ohio

2014: Progesterone to Reduce Preterm

Birth Risk

Blood Stream Infections:

High reliability of line

maintenance bundle

Use of human milk in infants

22-29 weeks GA

2014:Neonatal

Abstinence Syndrome

OCHA NAS in 6 CH’s

Henry County

WoodCounty

Bluffton

Mercy Tiffin

Mary Rutan

Atrium

McCullough- Hyde

Fort Hamilton

Holzer Medical

Berger Health

Licking Memorial

Doctor’s

Coshocton

East Liverpool

Firelands

Trinity

Fisher-Titus

Samaritan

Wooster

Union

Lakewood

Lake WestU.H. Geauga

Galion

Toledo

Mercy St. Vincent

Miami Valley Hospital

Mercy Anderson

UH Cincinnati

Good Samaritan TriHealth

Aultman

St. ElizabethHealth Center

Akron General

Akron Children’s MFMSumma Health System

Mt. Carmel East

Mt. Carmel West

Mt. Carmel St. Ann’s

Riverside Methodist

OSU

Fairview

UH Case MacDonald

HillcrestMetro Health

The Christ Hospital

Bay Park

St. Rita’s Lima

Blanchard Valley

Southview

Good Samaritan Premier

Kettering

BethesdaNorth

Southern Ohio

Fairfield Lancaster

Genesis Bethesda

Mercy Canton

Lake East

Ashtabula

OPQC Maternity Hospitals 2013 X Charter sites XPilot sites Wave 1 sites XWave 2 sites Wave 3 sites

Community Hospital & Wellness Center

Van Wert County Hospital

Mercer County Community

Wilson Memorial

Highland District

Madison County

Marietta Memorial

O’Bleness Memorial

SE Ohio Reg. mrd.Ctr

Northside Medical

Trumbull Memorial

Pomerene

MedCentral Mansfield

Marion General

Southwest General

St. John MedCtr

Memorial Health Care Mercy Lorain

Bellevue

• St. Lukes; Mercy St. Charles

Adena HealthSystem

Dublin Methodist

Grady Memorial

Robinson MemorialRavenna

Lima Memorial

Wyandot Memorial

Defiance Regional Medical Center

Memorial Hospital Memorial Union County

Community Memorial

Knox

Sp

Aultman Orville

East Ohio RegMC

St.Joseph

Clinton Memorial,Wilmington

Mercy Fairfield

Wayne

Medina General

Summa Barberton

EMH RMC Parma Community General

Fulton County Health Center

Springfield

Shelby

BC Data Varies By:BC Data Varies By:•HospitalHospital•Maternal DisMaternal Dis•CredentialsCredentials•State State

Variation between IPHIS and hand collected data

• 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

Different from Charters •Used Birth Registry data instead of hand collected•Site Visits by BEACON QI Coordinators•Monthly Calls•Periodic Learning Meetings•Collaboration w/ ODH + ODH Office of Vital Statistics + CDC

Dissemination of The 39 Week Delivery Project

Done in Waves

•Piloted in 15 Sites 2012

•3 Subsequent Waves with Staggered Start Dates

•Jan 2013 Apr 2014

•Ohio Birth Registrars are excited to participate

Ohio inductions < 39 weeks without a medical indication

10

Bill Callaghan, MD MPHCenters 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)

OPQC & ODH met with Hospital’s Clinical and Data Teams for half day covering:

•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

Site Visits to Hospitals

Top IPHIS Variables

Variables of the Month:

• Breastfeeding

at Discharge

• 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?

• RN obtains history from mom on admission to L&D. Mom states “breast” when asked if breast or bottle feeding.

Breastfeeding at discharge

Not breastfeeding at discharge

• 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

Not breastfeeding at discharge

Team Take Aways

• 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

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

• 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