Quality Improvement Pilot Indicator Project

1. Quality ImprovementPilot Indicator Project William M. Sappenfield, MD, MPH Lindsay S. Womack, MPH Humberto López Castillo, MD, MEd, MSc

2. Contents The FPQC—Partnering to improve health care quality for mothers and babies Our stakeholders Statewide QI Indicators Anatomy of a QI Indicator Report

3. VisionAll of Florida’s mothers and infants will have the best health outcomes possible through receiving high quality evidence-based perinatal care.

4. Mission • Advance perinatal health care quality and patient safety for all of Florida’s mothers and infants through the collaboration of all FPQC stakeholders in the development of joint quality improvement initiatives, the advancement of data-driven best practices and the promotion of education and training.

5. What has the FPQC recently done?

6. Reduction of Non-medically Indicated Deliveries

7. Reduction of Catheter-associated Blood Infections • Detailed results between 2011 and 2013 indicate that: • 150 catheter-associated blood infections were avoided • 18 lives were saved • Length of stay was reduced by more than 1,199 days • Over US$ 7.9 million were saved

8. What is the fpqc currently working on?

9. What is the FQQC currently working on? Obstetric Hemorrhage Initiative (OHI) The Golden Hour Part I: Delivery Room Management Early Elective Deliveries (EED) Antenatal Steroids Quality Indicator Project

10. Obstetric Hemorrhage Initiative (OHI) Percent of Deliveries in all Hospitals Which Blood Loss Was Quantified for Vaginal Deliveries

11. The Golden Hour Part I: Delivery Room ManagementNICU Admission TemperatureGoal: 80% with NICU admission temperature of 36.5°-37.5°C

12. FPQC QI Pilot Indicator Project Funding provided by • Purpose • To pilot potential hospital perinatal health care QI measures • To pilot potential hospital data quality measures

13. Our QI Indicator Stakeholders Hospitals State Organizations ACOG District XII AHCA AWHONN Florida Blue Florida Dept. of Health Florida Hospital Assoc. Humana March of Dimes • Broward Health • Florida Hospital Orlando • South Miami • St. Joseph's • Tampa General • UF Health Jacksonville • Winnie Palmer

14. Antenatal Steroid Use for Infants 24-33 Weeks 19 of Florida’s VON Hospitals, 2012 Median = 77

15. Statewide QI Indicator Examples • New statewide quality indicator database (NY) • Enhance birth certificate database (OH) • Early linkage of data (CA) • Birth certificate • Hospital discharge • Submitted hospital data

16. CMQCC Data Linkage Algorithm

17. QI Pilot Indicator Project’s Goals To demonstrate the feasibility of such a system in Florida To discern whether there is adequate support for such a system among essential stakeholders To provide concrete examples of Florida hospital data to demonstrate the QI potential

18. Development Process at a Glance

19. Initial Proposed QI Indicators Developed so far Next in line Rate of failed inductions Very low birth weight (VLBW) infants born at appropriate level of care Healthy term newborn • Non-medically indicated deliveries (NMID) • Nulliparous, term, singleton, vertex (NTSV) cesareans • Antenatal corticosteroid (ANCS) use • Data quality elements report

20. Anatomy of a QI Indicator

21. Background in Q&A Format What is the indicator? Why is it important to measure the indicator? How is the indicator measured? How can we improve quality based on the indicator?

22. Initial Feedback • Data flow is very good • The report’s electronic version is desirable • http://health.usf.edu/publichealth/chiles/fpqc/indicators • Box-and-whisker plots are not intuitive at first sight, but are readily learned over time • Provider groups would like to see provider-level data

23. Proposed Quarterly Data Flow for FL

24. Lessons Learned Advantages Disadvantages Bureaucracy limits QI Variable quality of birth registry information Delays between data collection and reporting • Authority of the State • Extant data collection system (Vital Records) • Automatic release of data • Some level of consistent funding

26. Proposed FL Hospital Agreement • No charge for hospital participation • Quarterly QI indicator data will be sent free of charge • However, participant hospitals must: • Assign a permanent contact for this project • Comply with training requirements • Collaborate with follow-up surveys • Participate in data quality improvement efforts

27. Additional Activities • FPQC would develop strategies to train hospital staff in using QI reports • FPQC, FL DOH, and AHCA would collaborate: • Developing data QI efforts • Developing data automation and reporting algorithms • Hospitals are encouraged to submit data on all deliveries on a quarterly basis • Stakeholders would recommend future indicators

28. Potential Future Activities Recommend AHCA move towards earlier complete hospital discharge reporting Recommend DOH consider automating established hospital QI reports as with other projects FPQC could pilot QI process and reports for OB providers and health plans Hospital discharge and QI data needs to eventually be extracted from EHR systems

29. Questions?

30. Thank you!