Georgia Hospital Association October 22, 2014

1. The Georgia Perinatal Quality Collaborative: Applying QI Strategies to Improve Perinatal Outcomes Georgia Hospital Association October 22, 2014

2. 3 Babies Will Die today In Georgia

3. Infant Health Perinatal Health in Georgia Maternal Health In 2012, Georgia ranked 49th nationally for maternal mortality – with 35.5 deaths per 100,000 births. Georgia ranked 37th nationally for infant mortality – with 6.8 deaths per 1000 live births in 2012. Black, non-Hispanic infants were2.5 times more likely to die than White, non-Hispanic infants. From 1993 – 2006, Black, Hispanic and Asian women accounted for 41% of all births nationwide , and for 62% of pregnancy-related deaths. The rate of SIDS in Georgia remained stagnant between 2007-2011. Preconception health such as diabetes, hypertension, cardiac issues and obesity increase risk of maternal death and LBW babies. Birth defects are the 2nd most common cause of infant death in GA, but the no. 1 most common cause in the US. In 2010, 19.9% of women smoked within the 3 months prior to pregnancy, and 8.3% of moms smoked in the final 3 months of pregnancy in 2010. Tobacco exposure during pregnancy and secondhand smoke after delivery is a risk factor for preterm birth, sleep-related death and poor lung development In 2010, only 55.2% of Georgia mothers started breastfeeding after delivery.*

5. Infant Mortality Clusters within Georgia, 2002-2006

6. Maternal Risk Factors for Infant Mortality by Cluster

7. Looking at trends from across the state Approx. 1 in 5 births spaced < 2 years apart in 2012 >17% of infant deaths in 2011 were due to prematurity or LBW 9.4 % of births were LBW in 2012 11 % of births were preterm in 2012

8. Georgia Perinatal Quality Collaborative All perinatal stakeholders in Georgia coming together to improve health and birth outcomes for all Georgia mothers and babies Vision To establish and maintain a robust statewide perinatal data and quality improvement system that engages stakeholders in evidence-based practices to improve health outcomes for mothers and babies throughout Georgia. Mission

9. The GAPQC Journey Summer 2014 July 2013 May 2013 Oct. 2012 Review lessons learned, identify new projects, begin recruiting for Phase II of PQC. 2011- 2012 Pilot Launch. Steering committee formed, Mission & Vision created, projects selected Formal creation of GAPQC Summer 2011 Stakeholder engagement began, review of other state PQCs Vision began to germinate for creation of PQC

10. The GAPQC Steering Committee Co-Chairs: Catherine Bonk, MD, MPH, (OB/Gyn) and David Levine, MD, (Neo) DPH Support: SeemaCsukas, MD, PhD, MCH Director, Theresa Chapple-McGruder, PhD, Director of MCH Epidemiology, Maria Fernandez, Infant Mortality Director Physicians Community Partners and Professional Organizations • Mike Armand, MD, Dekalb(NEO) • David Carlton, MD, Emory & Grady (NEO) • Armando Castillo, MD, NE GA Health System (NEO) • Jane Ellis, MD, Grady (OB/GYN) • Jameela Harper, MD, NE GA Health System (OB/GYN) • Demetrice Hill, MD, Columbus Regional (OB/GYN) • Lucky Jain, MD, Emory & Grady (NEO) • Ravi Patel, MD, Emory & Grady (NEO) • Mitch Rodriguez, MD, Medical Ctr of Central GA, (NEO) • ChampaWoodham, MD, Medical Ctr of Central GA, (OB/GYN) • Pat Cota, Exec. Dir, Georgia OBGyn Society • FoziaEskew, Early Intervention Coordinator, GA AAP • Lynne Hall, QI Consultant, GHA • Sarah Owens, Immediate Past President, American College of Nurse Midwives (GA) • Sheila Ryan, State Director, March of Dimes • Kim Sumpter, Community Outreach, The United Way of Greater Atlanta • Rick Ward, Exec. Dir., GA AAP • Sarah Dyer, Director, Maternal Services, NE Georgia Health System

11. Maternal Health

12. Chronic Disease is a High Risk Factor for Maternal and Infant Outcomes

13. Obesity in Georgia • >50% of women are overweight or obese; 1/3 are obese* • 48% of reproductive-aged women are overweight or obese;26% are obese† • > 40% of pregnant women are overweight or obese* *Retrieved from BRFSS (2011) †Retrieved from PRAMS (2010)

14. Only 12% of women indicated a desire to have a child in the next year,* but more than 20% are having a baby in <2 years % of total live births * Based on recent Medicaid/CHIP Health Care Quality survey

15. States with highest rate of repeat teen pregnancy

16. While 6:10 women want to space their pregnancies, 6:10 women also are not using the most effective birth control to achieve their goals * * Based on recent Medicaid/CHIP Health Care Quality survey

17. Maternal Health: Opportunities What about supporting high risk women (teens, preexisting chronic conditions) to better plan and space their pregnancies?

18. Maternal Health: QI Strategy Improve maternal and infant health outcomes by increasing rate of immediate post-partum LARC insertion to help high risk women better control chronic conditions and achieve birth planning goals Aim • Address policies and processes that impact women receiving preferred birth control option at discharge • Increase training and awareness in the inpatient and outpatient setting for providers, clinicians and others • Provide patient-focused and sensitive education and counseling • Leverage changes in Medicaid reimbursement to expand LARC access to women who may not have received LARCS previously Key Drivers DCH and DPH Collaboration on QI project sponsored by CMS. Kick off begins in November for nine-month cycle. Collaborative Opportunity

19. Infant Health

20. 10 Leading Causes of Infant DeathGeorgia, 2002-2006

21. Georgia’s NBS program panel expansion Congenital heart defects are the most common birth defect. By expanding the panel to include screening, we can have an impact on: • Infant, child and adolescent mortality rates • Healthcare utilization and costs for children with special healthcare needs

22. Three new screens added to the panel 20 Inborn Metabolic errors 3 Hemoglobinopathies 4 Other Metabolic errors (includes SCID) 2 Endocrine disorders 1 Audiology screen for hearing impairment 1 CCHD screen detects 12 conditions

23. Infant Health: QI Strategy Improve support hospitals in the implementation of CCHD as part of newborn screening to increase awareness, identification and treatment of children born with congenital heart defects. Aim • Address policies, staffing models, supply chain considerations and procedures to support efficient implementation and reduce rejections of NBS cards. • Identify and implement best practices for short-term and long-term training of physicians, clinicians and other staff • Provide patient-focused and sensitive education and counseling to families Key Drivers Both Children’s National Medical Center and the University of Minnesota have issued toolkits to support CCHD screening implementation. Georgia is developing a toolkit that integrates best practices from both to support the implementation in Georgia, across a variety of hospital settings. Collaborative Opportunity

24. Infant Health: Opportunities * Based on toolkit from California toolkit

25. Why Join GAPQC? • Working together we accomplish more: • Bringing together neonatologists and ob/gyns, we can address the spectrum of factors that impact perinatal outcomes. • Larger numbers let us pool resources, see more changes and outcomes more quickly. • We can attract other stakeholders and partners – combining the clinical interventions with patient/family education we can address the variety of issues that impact outcomes. • The better our outcomes and the larger our reach, the more we are able to demonstrate our value to payors, funding sources and communities

26. GaPQC Timeline July 1, 2014 - June 30, 2015 Implementation & Reporting Planning Design July 15 Sept Oct. Nov. Jan. 2 Education sessions Full day Kickoff Session Launch recruitment effort and Phase II QI Project planning begins GA AAP Meeting Education Session Next Wave Recruited and Project Planning Launched Finalize project planning Ongoing Monthly Conference Calls to Review Data and Plan PDSA Cycles

27. Recruitment Goal: Statewide Collaborative with All Perinatal Stakeholders No. of Hospitals: 5 12-18 25-40 41+ Pilot 2016 2017 2015 Kick-Off Educational Session: January 2015 Atlanta, GA Application Deadline: November 25

28. For more information, contact Maria.Fernandez@dph.ga.gov or call 404-657-2852