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The Health Roundtable

The Health Roundtable. Maternity Benchmarking Group Overview 27 March 2008. Health Roundtable. UHC. IHI. An Innovation Clearinghouse. Share problems Share solutions Develop skills Compare results Provide CEO network. 40 Organisational Members – 76 Hospital facilities.

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The Health Roundtable

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  1. The Health Roundtable Maternity Benchmarking Group Overview 27 March 2008

  2. Health Roundtable UHC IHI An Innovation Clearinghouse • Share problems • Share solutions • Develop skills • Compare results • Provide CEO network

  3. 40 Organisational Members – 76 Hospital facilities

  4. Health Roundtable Program for 2008 Core Optional

  5. Today’s Agenda

  6. Friday’s Agenda

  7. 1.Knowledge 1.Knowledge 3. Decision 3. Decision 2. Persuasion 4. Implementation 5. Confirmation Fostering Innovation The Health Roundtable Process From Everett Rogers

  8. Focus on Benchmarking for Innovation… • Voluntary comparisons • Search for differences • Data Methods • Clinical Practices • No “right or wrong” • Opportunity focus • Gradual fine-tuning

  9. …Not Benchmarking for Accountability • Mandated • Uniform • Tightly defined • Score – “win/lose” • Denial “by losers” • Gaming the system • “Inspectors” needed

  10. Four Key Lessons

  11. Basic Questions • Are our results different? • Why are we different? • Who can we learn from? • How do they do it? • How can we make it happen here?

  12. Background on Maternity Benchmarking • Suggested for several years • Critical mass achieved in 2007 – first meeting in June • Initial indicators based on earlier WHA surveys – but using casemix data • Further discussions with WHA during 2007 to promote collaboration • Need direction from you on how to proceed in future

  13. Maternity Data Available • Maternity Benchmarking Group 2008 report (Maternity KPI report) Note: Each hospital also has its own report, with their comparator group based on volume of deliveries (500-1000, 1000-1500, >1500) 2. Maternity Measures Glossary 3. Maternity Survey Report

  14. Maternity Benchmarking Group KPI Report • Contains 67 measures covering: • Based on Casemix Data • All measures are defined in the Maternity Measures Glossary • Combination of ICD-10 and DRG Inclusions, Exclusions

  15. Maternity Survey Report • Contains 54 measures covering: • Structure and Volume • Models of Care • Staffing Indicators and Snapshots • Analysis of the results from the pre-meeting survey • Self-reported

  16. Some Background

  17. Jaguar and Antares4 have the highest number of deliveries – 3200 per year Maternity Benchmarking Group 2008 Report, B1.01

  18. Maximum Birthing Suites Reported in Survey – Highest at Jaguar Maternity Survey Report, S1.01

  19. Maximum Special Care Baby Unit Beds – Highest at Hera2 and Panther Maternity Survey Report, S1.03

  20. Demographics

  21. Indigenous deliveries (ATSI or Maori) are a key feature of Poseidon, Electra, and Lynx Maternity Benchmarking Group 2008 Report, B2.11

  22. Poseidon, Electra and Lynx also have higher rates of patients who are not discharged to their home following delivery Maternity Benchmarking Group 2008 Report, B3.05

  23. Length of Stay

  24. ALOS for Vaginal deliveries varies from 2.8 days at Altair to 1.5 days at Electra (which transfers many to another site) Maternity Benchmarking Group 2008 Report, B4.01

  25. The Caesarean Delivery RSI (casemix-adjusted LOS) varies from 123% at Poseidon to 74% at Hera2 Maternity Benchmarking Group 2008 Report, B4.12

  26. Care modality

  27. Hera2 and Lynx have postnatal visit models that do not typically require a medical staff member Maternity Survey Report 2008 Report, S2.02

  28. Sirius2 and Lynx report 90% of deliveries without medical intervention, while Panther reports less than 10%. Maternity Survey Report 2008 Report, S2.03

  29. Average number of antenatal clinic visits (when used) ranged from 12 at Cougar3 to 4.5 at Demeter Maternity Survey Report 2008 Report, S2.08

  30. Average post-delivery home visits (when used) ranged from 7 at Demeter (QLD) to 1 at Jaguar Maternity Survey Report 2008 Report, S2.11

  31. Average full time / part time midwives on duty (averaged over four times) varied from over 8 at Panther and Jaguar to 1.5 at Altair Maternity Survey Report 2008 Report, S4.01

  32. Worked hours for consultant / SMO obstetrician per delivery ranges up to 5.2 at Altair. Jaguar’s data appears to be in error. Maternity Survey Report 2008 Report, S3.08

  33. Labour and Delivery

  34. Vaginal delivery rate varies from 63% at Cougar3 to 85% at Sirius2 and Lynx Maternity Benchmarking Group 2008 Report, B3.03

  35. Rate of Oxytocin use in induction of labour varies from 22% at Poseidon and Jaguar to 6% at Antares2 and Fox2 Maternity Benchmarking Group 2008 Report, B6.06a

  36. Rate of Prostaglandin use in induction of labour varies from 41% at Fox2 to 3% at Antares4 Maternity Benchmarking Group 2008 Report, B6.06b

  37. Recorded Rate of Artificial Rupture of Membranes in Induction of Labour varies from 27% at Fox3 to 3% at Sirius4 Maternity Benchmarking Group 2008 Report, B6.06c

  38. Recorded Rate of Ectopic Pregnancies with Fetotoxic Management (Methotrexate) varies from 45% at Jaguar to 0% at several facilities. Note: Denominator is count of ectopic pregnancies. Maternity Benchmarking Group 2008 Report, B3.12 b

  39. Complications

  40. The rate of deliveries recorded with long labour is highest at 16% at Antares4 Maternity Benchmarking Group 2008 Report, B4.13

  41. VBAC rate at Lynx at 40% is much higher than the other facilities. The rate is less than 5% at Altair and Sirius2 Maternity Benchmarking Group 2008 Report, B5.02

  42. Rate of low birth weight babies is highest at Hera2 at 43% and second highest at Gemma at 22% Maternity Benchmarking Group 2008 Report, B9.01

  43. Other Indicators of Interest? Survey Document Casemix-Base Report

  44. Key Issues to address • Definitional issues for existing indicators? • Data quality issues? • Clinical practice issues? • Different indicators? • Leadership for the Benchmarking Group • Chair & Deputy • Interest Group Leaders • Overall Steering Group

  45. Key Outcomes • For the Health Service • Staff • L.O.S. / Cost • Risk, Complications of Care • For the mother • Operational Practices • Drug & Alcohol • Delivery • Complications of Care • For the baby • Breast Feeding • Charts • Maternal Behaviour • Outcomes

  46. Health Service – Staff • Staff satisfaction – retention / recruitment • Succession planning • Good skill mix across the board – support and advice • Accreditation with external auditors • Optimal staffing levels • Service & Staff • Work practices – retaining staff • Workforce issues – retention, satisfaction, skill mix, OB / midwifery / patient ratios • Practice development for staff competency • Access – antenatal care, interpreters • Safety – staffing • Workforce substitution

  47. Health Service - LOS / Cost • Antenatal patient flow • “Appropriate” transition of care into community (time & access) • Cost per episode • LOS  Cost • DOSA admissions for caesarean section • Appropriate access to specific model care (???? / ATSI / refugee) • Accuracy of coding, data integrity

  48. Health Service – Risk / Complications of Care • Identification of risk factors in a timely manner leading to appropriate on-going care • Reduce readmissions (? Relation to LOS) • Minimise adverse events – appropriate support when the event occurs • Readmission rates for caesarean section

  49. Mothers – Operational Practices • Delivery meets their expectation’ • Confident parent GRAFF skills • Well informed mother approaching birth. Clear defined management plan. • Length of stay • Referral to first appointment • Gestation at booking visit. Earlier attendance  better outcome • Care is client focused • Happy mother with high natural birth rate, uninjured, with low caesarean rate

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