here - Ohio Perinatal Quality Collaborative

here - Ohio Perinatal Quality Collaborative

Dissemination of An Obstetrical
Quality Improvement Initiative
Using the Ohio Birth Certificate
Carole Lannon MD MPH
Quality Improvement Lead, Ohio Perinatal Quality Collaborative (OPQC)
For Jay Iams,MD OB Clinical Lead, the clinical teams, project staff, faculty and colleagues of OPQC
Disclosures: None
No Commercial Affiliations, Grants, Speaker’ s Bureaus, Consultancies, Stock etc
Taking
Dissemination of An Obstetrical
Quality Improvement Initiative
To Scale,
Using the Ohio Birth Certificate
Carole Lannon MD MPH
Quality Improvement Lead, Ohio Perinatal Quality Collaborative (OPQC)
For Jay Iams,MD OB Clinical Lead, the clinical teams, project staff, faculty and colleagues of OPQC
Disclosures: None
No Commercial Affiliations, Grants, Speaker’ s Bureaus, Consultancies, Stock etc
The Ohio Perinatal Quality Collaborative
Conceived in 2007, took first breaths with CMS Transformation grant 2008


20 Ohio Maternity Hospitals (47% births in Ohio)
24 Ohio level III Neonatal Units (all)

Key partners:





Ohio Medicaid
Ohio Department of Health
Ohio chapters of American College Obstetrics and Gynecology, American
Academy of Pediatrics
March of Dimes
“OPQC Central”


Project Management and QI Support, Anderson Center for Health Systems
Excellence, Cincinnati Children’s Hospital Medical Center
& Secure Central De-identified Data Processing.
The Ohio Perinatal Quality Collaborative
(OPQC)
Mission:
Through collaborative use of
improvement science methods, reduce
preterm births and improve outcomes
of preterm newborns in Ohio as
quickly as possible.
OPQC 20 Charter Hospitals
Rate of Scheduled Births Without Documented
Indication at 360 – 386 Weeks’
In The Initial OPQC 39 Week Project
Hand Collected Data 2008  2010
OPQC Sites
Ohio Birth Certificate Data
2006  May 2011
39-Week Project: Full Term Gains
Impact: About 28, 000 more babies born full-term and ~1400 NICU admissions avoided.
“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”.
Bill Callaghan, MD MPH
Centers for Disease Control and Prevention
December 1, 2011
Charge: scale to remaining 95 maternity hospitals in
~two years
OPQC 15 Pilot Hospitals
Infants born 36-38 weeks w/o
medical indication
Birth Data Accuracy
(enables use of birth certificate as QI tool)
• Methods:
– Recruitment by ODH Vital Statistics and respected OB
colleague
– Site visits to each hospital
• ODH Vital Statistics staff and QI coach meet with both birth data and
clinical staff
– Process flow diagram
– Review of three state birth certificate records with medical record
– Focus on 13 key variables in birth certificate (e.g. gestational age)
– Adapted Breakthrough Series
• Face-to-face Learning Session
• Monthly webinars with data feedback
• Coaching support
Rates of Scheduled Birth Without Medical Indication in 15 Pilot Sites
Special cause
(n=193)
(n=222)
(n=240)
(n=212)
(n=215)
(n=174)
(n=209)
(n=179)
(n=199)
(n=213)
(n=207)
(n=196)
(n=182)
(n=178)
(n=178)
(n=137)
(n=155)
(n=181)
(n=179)
(n=171)
(n=165)
(n=146)
(n=175)
(n=147)
(n=119)
(n=125)
(n=153)
(n=144)
(n=062)
(n=060)
(n=087)
(n=089)
(n=083)
(n=085)
(n=079)
(n=074)
(n=063)
(n=083)
(n=062)
(n=058)
(n=085)
(n=089)
(n=080)
(n=078)
(n=082)
(n=103)
(n=109)
(n=086)
(n=078)
(n=067)
(n=097)
(n=074)
(n=086)
(n=087)
(n=091)
(n=093)
2006-Q1
2006-Q2
2006-Q3
2006-Q4
2007-Q1
2007-Q2
2007-Q3
2007-Q4
2008-Q1
2008-Q2
2008-Q3
2008-Q4
2009-Q1
2009-Q2
2009-Q3
2009-Q4
2010-Q1
2010-Q2
2010-Q3
2010-Q4
2011-Q1
2011-Q2
2011-Q3
2011-Q4
2012-Q1
2012-Q2
2012-Q3
2012-Q4
2006-Q1
2006-Q2
2006-Q3
2006-Q4
2007-Q1
2007-Q2
2007-Q3
2007-Q4
2008-Q1
2008-Q2
2008-Q3
2008-Q4
2009-Q1
2009-Q2
2009-Q3
2009-Q4
2010-Q1
2010-Q2
2010-Q3
2010-Q4
2011-Q1
2011-Q2
2011-Q3
2011-Q4
2012-Q1
2012-Q2
2012-Q3
2012-Q4
Percent with no m edical indication
30
Ma rch 2012:
Lea rning Session
for 15 pi l ot sites
25
20
15
10
5
Sep. 2008:
39-Week
project
begins
0
Source: Ohio Department of Health, Vital Statistics
Quarterly Percent
Baseline Average Percent
Control Limits
Percent with no m edical indication
40
Births induced at 36-38 weeks with no
apparent medical indication for early delivery,
by quarter, 2006-2012
Hospital A
Births induced at 36-38 weeks with no apparent
medical indication for early delivery, by quarter,
2006-2012
Hospital B
35
60
50
March 2012: Learning
Session for 15 pilot
sites
40
30
20
10
Sep. 2008:
39-Week
project begins
0
Source: Ohio Department of Health, Vital Statistics
Quarterly Percent
Baseline Average Percent
Teams that achieved the greatest success had:
• Engaged leadership from both obstetricians and hospital administration
• Close communication between birth data and clinical staff.
Control Limits
Birth Registry Data
• Reaching the 75 remaining maternity hospitals:
– Recruit teams by ODH and OPQC Ob
– Replace site visit with webinars/coaching
– Build community with face-to-face learning session, monthly
webinars
– Encourage regular birth data and clinical staff meetings
– Use audit form to compare birth record with medical record
– ODH to develop online modules for training re: birth data
collection and entry
the remaining ~75 maternity hospitals
STEP WEDGE DESIGN (3-month lag)
Historical
2013
J
F M A
M J
J
2014
A S O N D J
F M A M J
J
A S O N D
Wave 1 (n-20-25) 0 0 … 0 0 X X
X
X
X X X X X S
S S S
S S
S S S S S
S
S
Wave 2 (n-20-25) 0 0 … 0 0 0 0
0
X
X X X X X X X X S S
S S
S S S S S
S
S
Wave 3 (n=20-25) 0 0 … 0 0 0 0
0
0
0 0 X X X X X X X X
X S
S S S S S
S
S
S
0= Baseline, X= Intervention, S= Sustain
Heather Kaplan, MD MSCe
CERTs project PI
Agency for Healthcare Research and Quality
Sites of current Ohio maternity hospitals in 39 week project
OPQC
Working together to improve outcomes for
women and newborns in Ohio
20
15
10
5
0
30
20
10
0
50
40
30
20
10
0
20
30
0
40
30
20
10
0
0
20…
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30
20
10
0
2006-…
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0
2006-…
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10
0
20…
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40
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20
40
30
20
10
0
2006…
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20
200…
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2006-…
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2012-…
40
40
30
20
10
0
200…
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40
30
20
10
0
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0
200…
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40
30
20
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0
200…
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60
60
40
20
60
40
20
30
20
10
01/01/06
02/01/06
03/01/06
04/01/06
05/01/06
06/01/06
07/01/06
08/01/06
09/01/06
10/01/06
11/01/06
12/01/06
01/01/07
02/01/07
03/01/07
04/01/07
05/01/07
06/01/07
07/01/07
08/01/07
09/01/07
10/01/07
11/01/07
12/01/07
01/01/08
02/01/08
03/01/08
04/01/08
05/01/08
06/01/08
07/01/08
08/01/08
09/01/08
10/01/08
11/01/08
12/01/08
01/01/09
02/01/09
03/01/09
04/01/09
05/01/09
06/01/09
07/01/09
08/01/09
09/01/09
10/01/09
11/01/09
12/01/09
01/01/10
02/01/10
03/01/10
04/01/10
05/01/10
06/01/10
07/01/10
08/01/10
09/01/10
10/01/10
11/01/10
12/01/10
01/01/11
02/01/11
03/01/11
04/01/11
05/01/11
06/01/11
07/01/11
08/01/11
09/01/11
10/01/11
11/01/11
12/01/11
01/01/12
02/01/12
03/01/12
04/01/12
05/01/12
06/01/12
07/01/12
08/01/12
09/01/12
10/01/12
11/01/12
12/01/12
(n=1807)
(n=1890)
(n=1996)
(n=1881)
(n=2017)
(n=1970)
(n=2046)
(n=2111)
(n=1988)
(n=1967)
(n=1858)
(n=2086)
(n=1910)
(n=1768)
(n=2110)
(n=1889)
(n=2005)
(n=2027)
(n=2065)
(n=1991)
(n=1945)
(n=1968)
(n=1880)
(n=1962)
(n=1832)
(n=1878)
(n=1892)
(n=2023)
(n=1959)
(n=1840)
(n=2075)
(n=1964)
(n=1898)
(n=1835)
(n=1727)
(n=1852)
(n=1696)
(n=1637)
(n=1853)
(n=1729)
(n=1730)
(n=1683)
(n=1775)
(n=1687)
(n=1741)
(n=1688)
(n=1548)
(n=1718)
(n=1604)
(n=1456)
(n=1668)
(n=1599)
(n=1649)
(n=1591)
(n=1720)
(n=1666)
(n=1631)
(n=1642)
(n=1556)
(n=1669)
(n=1564)
(n=1420)
(n=1629)
(n=1553)
(n=1582)
(n=1699)
(n=1683)
(n=1738)
(n=1615)
(n=1590)
(n=1605)
(n=1604)
(n=1492)
(n=1484)
(n=1559)
(n=1475)
(n=1642)
(n=1680)
(n=1688)
(n=1678)
(n=1643)
(n=1714)
(n=1596)
(n=1427)
Percent with no medical indication
Births induced at 36-38 weeks with no apparent medical indication for early
delivery, by month, 2006-2012
OPQC Aggregate
16
14
Sep. 2008: 39Week project
begins
12
10
8
6
4
2
0
Source: Ohio Department of Health, Vital Statistics
Monthly Percent
Baseline Average Percent
Control Limits
Quarterly Percent
Baseline Average Percent
Source: Ohio Department of Health, Vital Statistics
Control Limits
2012-Q4 (n=1513)
2012-Q3 (n=1811)
2012-Q2 (n=1670)
25
2012-Q1 (n=1652)
2011-Q4 (n=1623)
2011-Q3 (n=1871)
2011-Q2 (n=1687)
2011-Q1 (n=1661)
2010-Q4 (n=1802)
2010-Q3 (n=1899)
2010-Q2 (n=1763)
2010-Q1 (n=1833)
2009-Q4 (n=1965)
2009-Q3 (n=2058)
2009-Q2 (n=2084)
5
2009-Q1 (n=2016)
2008-Q4 (n=2152)
2008-Q3 (n=2263)
2008-Q2 (n=2368)
2008-Q1 (n=2398)
2007-Q4 (n=2340)
2007-Q3 (n=2418)
2007-Q2 (n=2326)
2007-Q1 (n=2352)
2006-Q4 (n=2414)
2006-Q3 (n=2604)
2006-Q2 (n=2469)
2006-Q1 (n=2464)
Percent with no medical indication
Births induced at 36-38 weeks with no apparent medical indication for early
delivery, by quarter, 2006-2012
Aggregate results for 15 pilot sites
30
March 2012:
Learning
Session for 15
pilot sites
20
15
10
Sep. 2008:
39-Week
project begins
0
01/01/06
02/01/06
03/01/06
04/01/06
05/01/06
06/01/06
07/01/06
08/01/06
09/01/06
10/01/06
11/01/06
12/01/06
01/01/07
02/01/07
03/01/07
04/01/07
05/01/07
06/01/07
07/01/07
08/01/07
09/01/07
10/01/07
11/01/07
12/01/07
01/01/08
02/01/08
03/01/08
04/01/08
05/01/08
06/01/08
07/01/08
08/01/08
09/01/08
10/01/08
11/01/08
12/01/08
01/01/09
02/01/09
03/01/09
04/01/09
05/01/09
06/01/09
07/01/09
08/01/09
09/01/09
10/01/09
11/01/09
12/01/09
01/01/10
02/01/10
03/01/10
04/01/10
05/01/10
06/01/10
07/01/10
08/01/10
09/01/10
10/01/10
11/01/10
12/01/10
01/01/11
02/01/11
03/01/11
04/01/11
05/01/11
06/01/11
07/01/11
08/01/11
09/01/11
10/01/11
11/01/11
12/01/11
01/01/12
02/01/12
03/01/12
04/01/12
05/01/12
06/01/12
07/01/12
08/01/12
09/01/12
10/01/12
11/01/12
12/01/12
(n=826)
(n=769)
(n=869)
(n=764)
(n=834)
(n=871)
(n=852)
(n=866)
(n=886)
(n=805)
(n=795)
(n=814)
(n=764)
(n=713)
(n=875)
(n=715)
(n=783)
(n=828)
(n=806)
(n=854)
(n=758)
(n=832)
(n=763)
(n=745)
(n=775)
(n=778)
(n=845)
(n=780)
(n=844)
(n=744)
(n=785)
(n=756)
(n=722)
(n=749)
(n=686)
(n=717)
(n=645)
(n=643)
(n=728)
(n=687)
(n=668)
(n=729)
(n=682)
(n=689)
(n=687)
(n=674)
(n=625)
(n=666)
(n=596)
(n=582)
(n=655)
(n=612)
(n=573)
(n=578)
(n=622)
(n=621)
(n=656)
(n=587)
(n=580)
(n=635)
(n=556)
(n=513)
(n=592)
(n=547)
(n=557)
(n=583)
(n=599)
(n=669)
(n=603)
(n=554)
(n=509)
(n=560)
(n=530)
(n=528)
(n=594)
(n=504)
(n=588)
(n=578)
(n=602)
(n=653)
(n=556)
(n=588)
(n=513)
(n=412)
Percent with no medical indication
Births induced at 36-38 weeks with no apparent medical indication for early
delivery, by month, 2006-2012
Aggregate results for 15 pilot sites
30
25
Sep. 2008: 39Week project
begins
20
15
10
5
0
Source: Ohio Department of Health, Vital Statistics
Monthly Percent
Baseline Average Percent
Control Limits