Goal:
Through collaborative use of improvement science methods, Reduce preterm births and improve outcomes
of preterm newborns in Ohio as quickly as possible.
What is the Mission of OPQC? Reducing prematurity-related adverse
outcomes for babies in Ohio
OPQC Is A Voluntary Organization of Ohio
Stakeholders Who Care About Fetal & Infant Health
OPQC History & Membership 2007: Ohio’s Infant Mortality Rates Are Terrible !
2008 - 2011
• 20 Charter Member Maternity Hospitals
• 24 Charter Member Neonatal Intensive Care Units
2012 - 2013
• Expanded Membership to Include 85 More Ohio Maternity Hospitals Almost All in Ohio
•
OPQC Is A Voluntary Organization of Ohio
Stakeholders Who Care About Fetal & Infant Health
$ from CMS
The OPQC Charter Teams {24 Neo + 20 OB}
• Cincinnati Children’s Hospital Medical Center (NEO) • Good Samaritan Hospital (NEO & OB)
• Aultman Hospital (NEO & OB)
• Akron Children’s Hospital (NEO & OB)
• Akron General Medical Center (OB)
• Cleveland Clinic (NEO)
• Dayton Children’s Medical Center (NEO)
• Fairview Hospital (NEO & OB) • Hillcrest Hospital (NEO & OB)
• Mercy Anderson Hospital (OB)
• MetroHealth Medical Center (NEO &OB)
• Miami Valley Hospital (OB)
• Mount Carmel East (NEO & OB)
• Nationwide Children’s Hospital (NEO) • Doctor’s Hospital (Nationwide NEO) • Grant Hospital (Nationwide NEO)
• Promedica Toledo Children’s Hospital (NEO) • Promedica Toledo Hospital (OB)
• Riverside Methodist Hospital (OB+ Nationwide
NEO)
• St. Vincent Mercy Medical Center (NEO & OB)
• Summa Health System (NEO & OB)
• Ohio State University Medical Center (NEO & OB) • University Hospital – Cincinnati (NEO & OB)
• University Hospital – Cleveland – Rainbow Babies (NEO)
• University Hospital – MacDonald Women’s Hospital (OB)
• Mount Carmel West (NEO & OB) • Mount Carmel St. Ann’s (NEO & OB)
Cleveland
Akron
Youngstown •St. Elizabeth Health Center(NEO)
Canton Dayton
Cincinnati
Toledo
Columbus
~ HALF OF OHIO BIRTHS OCCUR IN THESE 20
OB CENTERS
Henry County
Wood
County Bluffton
Mercy Tiffin
Mary
Rutan
Atrium
McCulloug
h- Hyde
Fort
Hamilton
Holzer
Medic
al
Berger Health
Licking
Memorial Doctor’s
Coshocton
East Liverpool
Firelands
Trinity
Fisher-Titus
Samaritan
Wooster
Union
Lakewood
Lake
West
U.H. Geauga
Galion
Toledo
Mercy
St.
Vincent
Miami
Valley
Hospital
Mercy Anderson
UH Cincinnati
Good Samaritan TriHealth
Aultman
St. Elizabeth
Health Center
Akron General
Akron Children’s MFM Summa Health System
Mt. Carmel East
Mt. Carmel West
Mt. Carmel St. Ann’s
Riverside Methodist
OSU
Fairview
UH Case
MacDonal
d
Hillcrest Metro Health
The Christ Hospital
Bay Park
St. Rita’s
Lima
Blanchar
d Valley
Southview
Good
Samaritan
Premier
Kettering
Bethes
da
North Southern
Ohio
Fairfield
Lancaster
Genesis
Bethesda
Mercy Canton
Lake East
Ashtabula
OPQC Maternity Hospitals 2013
X Charter sites XPilot sites Wave 1 sites XWave 2 sites Wave 3 sites
Community Hospital & Wellness Center
Van Wert
County Hospital
Mercer County Community
Wilson Memorial
Highland District
Madison
County
Marietta Memorial
O’Bleness Memorial
SE Ohio Reg. mrd.Ctr
Northside
Medical
Trumbull
Memorial
Pomerene
MedCentral Mansfield
Marion General
Southwest General
St.
John
MedCt
r
Memorial
Health
Care Mercy Lorain
Bellevue
• St. Lukes;
Mercy St. Charles
Adena
HealthSystem
Dublin
Methodist
Grady
Memorial
Robinson Memorial
Ravenna
Lima Memorial
Wyandot Memorial
Defiance Regional Medical Center
Memorial Hospital
Memorial Union
County
Community Memorial
Knox
Sp
Aultman Orville
East Ohio RegMC
St.Joseph
Clinton Memorial,
Wilmington
Mercy Fairfield
Wayne
Medina
General
Summa Barberton
EMH RMC Parma Community General
Fulton County Health Center
Springfield
Shelby
Promedica
Toledo Mercy St.
Vincent
Miami Valley Hospital
Mercy Anderson
Aultman
Mt. Carmel East
OSU
UH Rainbow Babies &
Children’s
Bethesda
North
OPQC Neo NAS Participants 2014 Wave 1 Sites
Nationwide Dublin
Methodist
Akron Children’s Summa
Akron
Children’s
St. Elizabeth
Cincinnati
Children’s
Hillcrest
Fairvie
w
Cleveland Clinic
Dayton
Children’s Nationwide Riverside
Nationwide Grant
Nationwide Mt. Carmel St. Ann’s
UH Cincinnati Good Samaritan
MetroHealth
Mt. Carmel West Nationwide
Doctor’s
Akron Children’s
Nationwide
How Does OPQC Get Results? The IHI Model for Improvement
• SELECT a Common Project
• PLAN a “Change Package” and share with OPQC Teams:
• Recommended best practices
• Ideas/interventions for improvement
• Outcomes to measure/track
• DEFINE how we will know if a change = improvement
• DO the Change, STUDY the results, and then ACT
• Teams join monthly webinars to share lessons learned, discuss results, and identify new ideas to “test”, & examine aggregate data/outcomes • Teams meet face-to-face at at least twice per year
OPQC Is A Voluntary Organization of Ohio
Stakeholders Who Care About Fetal & Infant Health
Ohio Perinatal Quality Collaborative
Criteria for Choosing Projects
39 Weeks
Antenatal Steroids
Blood Stream Infection
Breast Milk = Medicine • MgSO4 Neuro Rx
• LBW Hypothermia
• Late Preterm 34-36
Opioid Dependence
Progesterone
Prematurity related
Variation in practice
Existing benchmark
Measurable outcome
Population impact
Prior success
Participant enthusiasm
Public enthusiasm March of Dimes
Ohio ACOG & AAP
CDC
Ohio Quality
Obstetrics
Steroids for women at risk for
preterm birth
(240/7 - 33 6/7)
Done Transition to BC Surveillance
39-Week Scheduled Deliveries without medical
indication
Increase Birth Data Accuracy &
Online modules
Spread to all maternity
hospitals in Ohio
Progesterone to Reduce Preterm
Birth Risk
Neonatal
Blood Stream Infections:
High reliability of line
maintenance bundle
Use of human milk in infants 22-29
weeks GA OCHA NAS in 6 CH’s
Neonatal
Abstinence
A Series of Interventions = a BUNDLE
• Central Line Insertion Bundle
•
• Earlier Start of Feedings
•
• Use Donor Milk if Mom’s Milk Not Available.
• Mother’s Milk Is Medicine !
OPQC Is A Voluntary Organization of Ohio
Stakeholders Who Care About Fetal & Infant Health
24 Ohio NICUs Proportion of Infants 22-29 Weeks Gestation Discharged with at least 1 Nosocomial Infection
OPQC Is A Voluntary Organization of Ohio
Stakeholders Who Care About Fetal & Infant Health
Together We Saved Enough Babies to Fill TWO School Buses!
The OPQC Neo BSI Project •Prevented 600 Infections •Saved 75 Babies’ Lives
Observe X 2 Months ……………
Project data 9-1-08 11-30-09
%
20 hospitals = 47% of Ohio births 18,384 births between 360 386
4780 (26%) scheduled 13,604 (74%) unscheduled
AJOG 2010
Effects of the Initial OPQC 39 Week Scheduled Birth Project
September 2008 July 2013
• 36,200 births moved from 37-38 to 39-41 wks • Conservative estimate = 3% fewer “near
term” NICU admissions: N = 1086
• 1086 x $17,500 per NICU Admission
$ 19 million savings in 5 years
OPQC Is A Voluntary Organization of Ohio
Stakeholders Who Care About Fetal & Infant Health
Different from Charters
• Used Birth Registry data instead of hand collected
• Site Visits by BEACON QI Coordinators
• Monthly Calls
• Periodic Learning Mtgs
• Collaboration w/ ODH + ODH Office of Vital Statistics + CDC
Dissemination of The 39 Week Delivery Project
Done in Waves
• Piloted in 15 Sites 2012
• 3 Subsequent Waves
with Staggered Start
Dates
•Jan 2013 Apr 2014
• Ohio Birth Registrars are
excited to participate
Results of Phase 1 39 Week Dissemination Project
• Hospital Birth Certificate Staff Excited !!
• Major Misunderstandings on Major Outcomes
• Determination of Gestational Age - Rounding Up!
• Definition of Preeclampsia
• Recognition of Antenatal Steroid Rx
• Definition of Breast Feeding at Discharge
• Aggregate Rate Declined Significantly
• Significant Improvement in 10 of 15 Sites
0
10
20
30
40
50
60
70Ja
n-0
6M
ar-
06
Ma
y-0
6Ju
l-0
6S
ep
-06
Nov-0
6Ja
n-0
7M
ar-
07
Ma
y-0
7Ju
l-0
7S
ep
-07
Nov-0
7Ja
n-0
8M
ar-
08
Ma
y-0
8Ju
l-0
8S
ep
-08
Nov-0
8Ja
n-0
9M
ar-
09
Ma
y-0
9Ju
l-0
9S
ep
-09
Nov-0
9Ja
n-1
0M
ar-
10
Ma
y-1
0Ju
l-1
0S
ep
-10
No
v-1
0Ja
n-1
1M
ar-
11
Ma
y-1
1Ju
l-1
1S
ep
-11
Nov-1
1Ja
n-1
2M
ar-
12
Ma
y-1
2Ju
l-1
2S
ep
-12
Nov-1
2Ja
n-1
3M
ar-
13
Ma
y-1
3Ju
l-1
3S
ep
-13
Nov-1
3
Pe
rce
nt
Percent distribution of Ohio births, by gestational age and month January 2006 to December 2013
<39 weeks ≥39 weeks Baseline, <39 Baseline, ≥39
Baseline averages were calculated from the initial 24 months, January 2006 to December 2007.
OPQC inception
Since OPQC inception, 39,800 expected births <39 weeks have shifted to ≥39 weeks.
GESTATIONAL AGE DISTRIBUTION OF OHIO BIRTHS
BEFORE AND AFTER 39 WEEKS 2006 2013
January 2006 June 2013 Retrospective Prospective
Ohio
Hospital
Compare
Birth Registry Documentation
Antenatal Steroids at OPQC Sites
Actual ANCS Use
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12
/1/2
011
n=
12
7
1/1
/20
12
n=
15
0
2/1
/20
12
n=
20
2
3/1
/20
12
n=
21
2
4/1
/20
12
n=
20
3
5/1
/20
12
n=
26
2
6/1
/20
12
n=
22
7
7/1
/20
12
n=
23
7
8/1
/20
12
n=
18
7
9/1
/20
12
n=
18
9
10
/1/2
012
n=
24
8
11
/1/2
012
n=
25
3
12
/1/2
012
n=
23
1
1/1
/20
13
n=
20
5
2/1
/20
13
n=
17
5
3/1
/20
13
n=
22
4
4/1
/20
13
n=
20
7
5/1
/20
13
n=
22
4
6/1
/20
13
n=
18
1
ANCS Administration - Aggregate Data
Full Course Partial Course No ANCS and Rupture 32-34 weeks No ANCS
FINAL Aggregate Report of the OPQC Project to Improve
Documentation of Antenatal Corticosteroid Use 2011 2013
OPQC HAND COLLECTED DATA on 3954 Infants 24 33+6 wks
Blue = Partial Course
Green = Full Course
Goal: 90% Rx’d w/ ANCS
OPQC’s 1st Five Years
• Infrastructure, Leadership, Data & Results
•Funding Mechanisms
•Team Building in Ohio Perinatal Care
•Largest hospitals + Ohio VON NICU’s
•All But 2 Ohio Maternity Hospitals
•Working Partnerships
•ODH, Medicaid, GRC, MedTAPP, BEACON QI
•Ohio Vital Statistics / Birth Registry !!!
•March of Dimes, OHA, ACOG, AAP