barbara rose, rn, mph program director

James M. Anderson Center for Health Systems Excellence

Ohio Perinatal Quality Collaborative (OPQC) National Academy for State Health PolicyOctober 4, 2011

Barbara Rose, RN, MPH

Program Director


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Objectives

• What is OPQC?

• Partners, Results Next projects

• Transformation and Return on Investment

• What are Other States Doing?

• OPQC Publications


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What is OPQC?• Mission through collaborative use of improvement

science methods, reduce preterm births and improve outcomes of preterm newborns in Ohio as quickly as possible.

• Initial projects’ AIMS –

– Neo Reduce late onset (>72 hours) blood stream/CSF infections in infants 22-29 weeks gestational age by 50%

– OB Reduce scheduled births at 361 to 386 weeks without a medical indication 20 maternity hospitals (47% of Ohio births)

• Teams – 44: 24 level 3 NICU’s, 20 OB delivery hospitals


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Ohio Partners

• Ohio Department of Health (Vital Statistics & Children Family Health Services)

• ODJFS Ohio Medicaid/CMS• AAP, ACOG, March of Dimes - Ohio• NICHQ• Academic medical centers in Ohio• Participating health care provider teams at 24

Ohio hospitals


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Reduce inappropriate scheduled births at 36.1 to 38.6 weeks20 maternity hospitals (47% of Ohio births)


All Ohio births: 39-41 wk births pink 36-38 wk births blue

Source: custom analyses of ODH vital statistics birth certificate data

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VON data Late onset bloodstream infection in Ohio infants, 22-29 weeks gestation


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Health Care Transformation and Return on Investment• OPQC’s budget comprises three primary components: program

administration, quality improvement consultation and centralized data management. OPQC annual budget is approximately $500,000 per year divided 40% program administration, 30% quality improvement consultation and 30% centralized data management.

• Both of the OPQC projects resulted in statistically significant improvements in outcomes and reductions in costs.

• With approximately $20 million in overall cost savings demonstrated by OPQC, a large, positive return-on-investment has been achieved.

• As OPQC expands to the other 53% of Ohio births, an additional $10 million in saving could be achieved (total $30 million annual savings).


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Investment Case for Statewide Perinatal ImprovementOB - Since initiating this OPQC project, more than 14,000 births have moved from occurring prior to the due date to full term (39 to 41 wks). Approximately 400 NICU admissions and undetermined number of infant deaths have been avoided.

Compared to the baseline period before this project, this work, by 20 large Ohio maternity hospitals and their staffs represents a major, positive transformation of obstetrical care in Ohio and approximately $10 million in annual Ohio health care cost savings.


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Investment Case for Statewide Perinatal ImprovementNEO - A study of three large Ohio hospitals cost accounting systems showed that preventing infections in a typical NICU with 200 annual, preterm admissions would result in 5 fewer infection-related deaths, 131 fewer bed days and $459,000 in cost savings.

For Ohio overall this translates to approximately $10 million in annual health care cost savings.


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OPQC Next steps (Oct 2011-June 2012)• OB projects

– Antenatal Corticosteroids in OPQC hospitals– Spread of 39week scheduled delivery project

statewide (if funding awarded)

• Neo projects– Continued focus on reducing infections

• to improve reliability of catheter care• Add Human Milk project

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Other States re public partnerships & perinatal improvement?• TN GOCCC Gov’nr Office Child Care Dev’t

Oversight but not data Dept of Health & Tenncare (Medicaid)

• MA Dept. of Health- data sharing for QI and VS use, • NC Dept. of Health• IL Working on partnering w DOH and Medicaid-

sep. offices, restrictions on using VS data • LA Dept. of Health support VON data, PT physician

coordinator• FL


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What have we accomplished?• Focus on population health

– 50% of births; 80% of infants 22-29 weeks

– All Level 3 nurseries in the state

– Target improved care and improved access to care

• Focus on continuum of care– Prenatal (obstetrics) and neonatal care and decisions for mother/infant dyad

• Collaboration between health care and public health– Vital Statistics and Medicaid

– Using birth certificate data to measure practice

– Publically reported quality measures (Ohio House Bill 197)

• National attention– March of Dimes, Vermont Oxford Network State Leaders Group, Am. Academy

Pediatrics neonatal quality measures group,

• Improved care– Thousands women per year move from 36-38 weeks to 39-41 wks

– Better care of very premature infants with central IV catheters


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OPQC publications• Bailit JL; Ohio Perinatal Quality Collaborative. Rates of labor induction without medical indication

are overestimated when derived from birth certificate data. Am J Obstet Gynecol. 2010 Sep;203(3):269.e1-3. PubMed PMID: 20816150.

• Donovan EF, Besl J, Paulson J, Rose B, Iams J; Ohio Perinatal Quality Collaborative. Infant death among Ohio resident infants born at 32 to 41 weeks of gestation. Am J Obstet Gynecol. 2010 Jul;203(1):58.e1-5. Epub 2010 Apr 24. PubMed PMID: 20417495.

• Donovan EF, Lannon C, Bailit J, Rose B, Iams JD, Byczkowski T; Ohio Perinatal Quality Collaborative Writing Committee. A statewide initiative to reduce inappropriate scheduled births at 36(0/7)-38(6/7) weeks' gestation. Am J Obstet Gynecol. 2010 Mar;202(3):243.e1-8. Erratum in: Am J Obstet Gynecol. 2010Jun;202(6):603. PubMed PMID: 20207241.

• Donovan EF; Ohio Perinatal Quality Collaborative Writing Committee. Collaborative improvement of population perinatal health in Ohio: study design, methods and provider site participation. (Available on OPQC Website and SharePoint).

• Fleischman AR, Iams J. Prematurity: Art and Science. Clinics in Perinatology. In press.• Iams JD, Donovan EF. Spontaneous Late-Preterm Births: What Can Be Done to Improve

Outcomes? Seminars in Perinatology. In press.• Bailit JL, Iams J, Krew M, McKenna D, Marcotte M, Donovan E; Ohio Perinatal Quality

Collaborative. Changes in reason for delivery during the Ohio Perinatal Quality Collaborative project to lower rates of non medically indicated deliveries <39 weeks. Submitted.


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www.OPQC.net

barbara rose, rn, mph program director

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