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Quality ImprovementPilot Indicator Project
William M. Sappenfield, MD, MPHLindsay S. Womack, MPHHumberto López Castillo, MD, MEd, MSc
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ContentsThe FPQC—Partnering to improve health care quality for mothers and babiesOur stakeholdersStatewide QI IndicatorsAnatomy of a QI Indicator Report
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VisionAll of Florida’s mothers and infants will have the best health outcomes possible
through receiving high quality evidence-based perinatal care.
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MissionAdvance 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.
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WHAT HAS THE FPQC RECENTLY DONE?
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Reduction of Non-medically Indicated Deliveries
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Reduction of Catheter-associated Blood InfectionsDetailed 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
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WHAT IS THE FPQC CURRENTLY WORKING ON?
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What is the FQQC currently working on?
Obstetric Hemorrhage Initiative (OHI)The Golden Hour Part I: Delivery Room ManagementEarly Elective Deliveries (EED)Antenatal SteroidsQuality Indicator Project
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Obstetric Hemorrhage Initiative (OHI)
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Percent of Deliveries in all Hospitals Which Blood Loss Was Quantified for Vaginal
Deliveries
Baseli
ne
Decem
ber
Janua
ry
Febru
ary
March
April
MayJu
neJu
ly 0%
5%
10%
15%
20%
25%
30%
35%
40%
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The Golden Hour Part I: Delivery Room Management
NICU Admission TemperatureGoal: 80% with NICU admission temperature of 36.5°-37.5°C
Baseli
ne
Octobe
r 201
3
Novem
ber
Decem
ber
Janua
ry 20
14
Febru
ary
March
April
MayJu
ne July
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
60% 62% 60%67%
55%
71% 70% 73% 71% 70%64%
Month of Birth
Perc
ent
of I
nfan
ts W
ithi
n Te
mpe
ratu
re
Ran
ge
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FPQC QI Pilot Indicator Project
PurposeTo pilot potential hospital perinatal health care QI measuresTo pilot potential hospital data quality measures
Funding provided by
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Our QI Indicator Stakeholders
HospitalsBroward HealthFlorida Hospital OrlandoSouth MiamiSt. Joseph'sTampa GeneralUF Health JacksonvilleWinnie Palmer
State OrganizationsACOG District XIIAHCAAWHONNFlorida BlueFlorida Dept. of HealthFlorida Hospital Assoc.HumanaMarch of Dimes
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Antenatal Steroid Use for Infants 24-33 Weeks 19 of Florida’s VON Hospitals, 2012
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
10
20
30
40
50
60
70
80
90
100
Hospitals
Hosp
ital %
of A
nten
atal
Ste
roid
Use
Median = 77
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Statewide QI Indicator Examples
New statewide quality indicator database (NY)Enhance birth certificate database (OH)Early linkage of data (CA)
Birth certificateHospital dischargeSubmitted hospital data
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CMQCC Data Linkage Algorithm
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QI Pilot Indicator Project’s Goals
To demonstrate the feasibility of such a system in FloridaTo discern whether there is adequate support for such a system among essential stakeholdersTo provide concrete examples of Florida hospital data to demonstrate the QI potential
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Development Process at a Glance
1• Convene with the Stakeholders• Present the Project
2• Propose QI indicator templates• Draft first QI indicators
3• Test indicator templates• Incorporate Stakeholder’s feedback
4• Reconvene with Stakeholders• Make future decisions
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Initial Proposed QI Indicators
Developed so farNon-medically indicated deliveries (NMID)Nulliparous, term, singleton, vertex (NTSV) cesareansAntenatal corticosteroid (ANCS) useData quality elements report
Next in lineRate of failed inductionsVery low birth weight (VLBW) infants born at appropriate level of careHealthy term newborn
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Anatomy of a QI Indicator
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Background in Q&A FormatWhat 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?
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Initial FeedbackData 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 timeProvider groups would like to see provider-level data
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Proposed Quarterly Data Flow for FL
AHCA receives and processes data
AHCA sends data to FL DOH for linkage
quarterly
FL DOH automates linked data for
quarterly production
FL DOH shares linked data for
FPQC to generate reports
FPQC provides quarterly reports to
hospitals who signed up
Hospitals use reports to focus and monitor QI
efforts
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Lessons LearnedAdvantages
Authority of the StateExtant data collection system (Vital Records)Automatic release of dataSome level of consistent funding
Disadvantages Bureaucracy limits QIVariable quality of birth registry informationDelays between data collection and reporting
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Proposed FL Hospital Agreement
No charge for hospital participationQuarterly QI indicator data will be sent free of chargeHowever, participant hospitals must:
Assign a permanent contact for this projectComply with training requirementsCollaborate with follow-up surveysParticipate in data quality improvement efforts
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Additional ActivitiesFPQC would develop strategies to train hospital staff in using QI reportsFPQC, FL DOH, and AHCA would collaborate:
Developing data QI effortsDeveloping data automation and reporting algorithms
Hospitals are encouraged to submit data on all deliveries on a quarterly basisStakeholders would recommend future indicators
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Potential Future ActivitiesRecommend AHCA move towards earlier complete hospital discharge reportingRecommend DOH consider automating established hospital QI reports as with other projectsFPQC could pilot QI process and reports for OB providers and health plansHospital discharge and QI data needs to eventually be extracted from EHR systems
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Questions?
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Thank you!
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