instructions to cook up the baker’s dozen
DESCRIPTION
Instructions to cook up the Baker’s Dozen. Made Fresh Daily Kelly Friar, Chief, Office of Health and Vital Statistics and Accreditation Coordinator Ohio Department of Health. Significance for Public Health. Public Health Accreditation Board PHAB Community Health Assessment - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/1.jpg)
Instructions to cook up the Baker’s Dozen
Made Fresh DailyKelly Friar, Chief, Office of Health and Vital
Statistics and Accreditation CoordinatorOhio Department of Health
![Page 2: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/2.jpg)
Significance for Public HealthPublic Health Accreditation Board
PHAB
•Community Health Assessment•Community Health Improvement Plan•Dept. Strategic Plan
•Quality Improvement Plan•Workforce Development Plan•Performance Management System
![Page 3: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/3.jpg)
Category A – Programs with a budget of greater than $250,000
First PlaceOhio Department of HealthOhio Perinatal Quality Collaborative (OPQC)
The Ohio Perinatal Collaboration to Improve Birth Data and Prematurity Outcomes is a creative approach to using public health surveillance data (birth certificates) as a supplement to data collected from medical records to serve as the metrics that can inform and accelerate perinatal quality improvement initiatives. The Ohio Perinatal Quality Collaborative (OPQC), Ohio’s public/private partnership focused on improving health outcomes using quality improvement science, has documented early successes in reducing late preterm scheduled deliveries without medical indication in 20 delivery hospitals in Ohio. Spreading what works will be essential in reducing prematurity and having a measurable impact on population health. This effort is state administered by investing and partnering in OPQC where the improvement happens. Over many decades Ohio has relied heavily on birth certificates as source of data to measure population-level changes over time, but only recently has turned to them to measure improvements in health care and outcomes.
2012 Vision AwardsAchieving Excellence in Public Health Through Innovation
![Page 4: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/4.jpg)
The Baker’s DozenTop Key Variables in IPHIS
Variable IPHIS Tab
1. Total number of Prenatal visits Prenatal
2. Pregnancy Risk Factors: pre-pregnancy and gestational diabetes Pregnancy
3. Pregnancy Risk Factors: pre-pregnancy and gestational hypertension Pregnancy
4. History of prior preterm birth Pregnancy
5. Induction of Labor Labor & Delivery
6. Augmentation of Labor Labor & Delivery
7. Antenatal corticosteroids (ANCS) Labor & Delivery
8. Antibiotics received by the mother during delivery Labor & Delivery
9. Birth weight Newborn
10. Obstetrical estimate of gestational age Newborn
11. Abnormal conditions of the newborn: Assisted ventilation after delivery and NICU admission
Newborn
12. Congenital abnormalities of the Newborn Newborn
13. Breast feeding at discharge Newborn
![Page 5: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/5.jpg)
Why Are We Doing This?Why Are We Doing This?
• OPQC’s Mission: Improve Infant Health• Through collaborative use of improvement
science methods, reduce preterm births and improve outcomes of preterm newborns in Ohio as soon as possible
• What Causes Perinatal & Infant Mortality?What Causes Perinatal & Infant Mortality?• Preterm Birth Preterm Birth • Birth Defects• SUID et al
![Page 6: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/6.jpg)
Our Shared Vision
• Decrease prematurity and infant mortality in Ohio
• OPQC, ODH-Vital Statistics and OHA• Using the PLAN-DO-STUDY-ACT cycle of
continuous quality improvement to facilitate improved data collection to accurately measure progress toward goal of reducing non-medically indicated deliveries prior to 39 weeks gestation
![Page 7: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/7.jpg)
Bill Callaghan, MD MPHCenters for Disease Control and Prevention
December 1, 2011
“The focus of healthcare for women and infants over the
next century depends on the quality of the
data collected by those who fill out the
birth certificates.”
![Page 8: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/8.jpg)
Obstetric Quality 2007
“ There are currently no uniformly accepted measures of obstetrical quality. Many traditional measures of obstetrical quality are flawed and newer measures are still undergoing necessary validation.”
- Jennifer L. Bailit, MD, MPHOBG Survey 2007
![Page 9: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/9.jpg)
OB Quality Monitoring • National Quality Foundation• Joint Commission • Ohio Hospital Compare • Leap Frog• CMS• Ohio Perinatal Quality Collaborative• PCPI• PQRS
![Page 10: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/10.jpg)
JOINT COMMISION: Perinatal Care Measures
• PC-01 Elective Delivery • PC-02 Cesarean Section (NTSV)• PC-03 Antenatal Steroids • PC-04 Health Care-Associated
Bloodstream Infections in Newborns• PC-05 Exclusive Breast Milk Feeding https://manual.jointcommission.org/releases/TJC2013A/PerinatalCare.html
![Page 11: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/11.jpg)
PC -01
• Numerator: Patients with elective deliveries
• Denominator: Patients delivering newborns with >= 37 and < 39 weeks of gestation completed
• Inductions and cesarean delivery included
![Page 12: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/12.jpg)
JOINT COMMISION: New for July 1, 2013
“It is acceptable to use data derived from vital records reports received from state or local departments of public health if they are available and are directly derived from the medical record with a process in place to confirm their accuracy. If this is the case, these may be used in lieu of the acceptable data sources listed below.”
https://manual.jointcommission.org/releases/TJC2013B/DataElem0265.html
![Page 13: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/13.jpg)
Promedica Toledo Hospital Mercy St. Vincent
Medical Center
Miami Valley Hospital
Mercy AndersonUH CincinnatiGood Samaritan
Aultman Hospital
St. ElizabethHealth Center
Akron GeneralAkron Children’s MFM
Summa Health System
Mt. Carmel EastMt. Carmel West
Mt. Carmel St. Ann’s
Riverside Methodist
OSUWexner
Fairview Hospital
UH Case MacDonald Women’s
HillcrestMetro Health
<39 Week Scheduled Delivery – 20 Charter Hospitals
![Page 14: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/14.jpg)
BC Data Varies By:BC Data Varies By:•HospitalHospital•Maternal DisMaternal Dis•CredentialsCredentials•State State
![Page 15: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/15.jpg)
Effects of the Initial OPQC39 Week Scheduled Birth Project
September 2008 March 2013
• 30,000 births shifted to 39-41 weeks • Conservative estimate = 3% fewer
“near term” NICU admissions: N = 950• 950 x $20,000 $20,000 per NICU Admission =• $19,000,000 $19,000,000 savings in 4 ½ years
![Page 16: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/16.jpg)
Lessons From the Initial 39 Week Project• Create A Culture of Change• Learn From All Participants• Improve Communication
• Data Collectors, Data Users, Data AnalystsData Collectors, Data Users, Data Analysts• OPQC = Data for You to Use, Not the Police
• Birth Certificate = A Q.I. InstrumentBirth Certificate = A Q.I. Instrument• More Training and More Cross TalkMore Training and More Cross Talk• Use Use Greater Accuracy Greater Accuracy Promotes Use Promotes Use• Rapid Turnaround EssentialRapid Turnaround Essential
![Page 17: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/17.jpg)
<39 Week Scheduled Delivery and Birth Certificate Accuracy 15 Pilot Hospitals
The Christ Hospital
Bay Park Promedica
St. Rita’s Lima
Blanchard Valley
SouthviewGood SamaritanDayton
Kettering
BethesdaNorth
Southern Ohio Medical Center
Fairfield Lancaster
Genesis Bethesda
Mercy Regional Lorain
Mercy Canton
Lake East
Ashtabula County
![Page 18: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/18.jpg)
Team Sharing and Learning
Harvard School of Education http://socrativegarden.wordpress.com/2011/08/04/1-2-3-word-cloud/
![Page 19: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/19.jpg)
Two reasons for inaccurate gestational age entry
1. Sometimes the gestational age is “rounded up” in IPHIS.• Gestational age is NEVER TO BE ROUNDED UP; it is recorded in
completed weeks.• For example, 38 weeks, and 5 days is properly termed 38 weeks.
2. Often there is no agreement re: where in the medical record gestational age should be recorded; in addition, varying gestational ages are found in the medical record.• Consistent agreement regarding where in the medical record the
IPHIS variable for gestational age is found will greatly increase your accuracy.
![Page 20: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/20.jpg)
Remaining 73 Ohio Maternity Hospitals
•January 2013 thru April 2014
•Divided into three separate “Waves” with staggered start dates
Differences from Charter and Pilot Sites
•Updated the report of allowed medical indications from Birth Registry/IPHIS data
•*Change in measure from 36.0 - 38.6 weeks to 37.0-38.6 weeks gestation; more in harmony with Joint Commission, Leap Frog and Ohio Hospital Care
![Page 21: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/21.jpg)
![Page 22: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/22.jpg)
![Page 23: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/23.jpg)
![Page 24: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/24.jpg)
Can You Do This In Your Hospital ? What Are The Keys to Success?
• Adopt ACOG Guidelines• Use a Scheduled Birth Form (ACOG or Site Specific)
• Document the Pregnancy Dating Method• Document the Reasons for Scheduled Birth
• OPQC Is Not The Police = Start with Soft Stop• Rapid Data Turnaround• Frequent Group & Site PDSA’s• Enthusiasm from Local Leaders
![Page 25: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/25.jpg)
![Page 26: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/26.jpg)
PDSA
• Plan• Look at a particular aspect of project• Review intervention options• Plan implementation of intervention• What do you predict will happen?
• Do• Execute the intervention
![Page 27: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/27.jpg)
PDSA• Study
• How did the intervention go?• Did it go the way you expected?• What was the outcome?• Was the a measure?
• Act• Accept• Adopt • Abandon
![Page 28: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/28.jpg)
13 Key IPHIS Variables Handout
![Page 29: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/29.jpg)
Is there any way to get gestational age correctly
recorded in IPHIS all the time?
![Page 30: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/30.jpg)
Essential Data Elements to Accurately Document Gestational Age
• Earliest Ultrasound that documented GA• Ideal CRL•Best < 20 weeks gestation
• documentation by provider •estimate of GA •what it is based on
![Page 31: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/31.jpg)
Second Step-entering Data into IPHIS
Make sure everyone agrees where to find best OB estimate of GA and EDD acquisition of dataRecording of dataTransfer of dataMonitoring of process
![Page 32: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/32.jpg)
Photo courtesy of fotolia.com
IPHIS to Patient Medical Record ChecklistDirections, Data Dictionary, and Examples
![Page 33: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/33.jpg)
IPHIS to Patient Medical Record ChecklistHospital: ____________________ Month: ____________
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Pregnancy tab: Risk Factors
Pre-pregnancy and Gestational diabetes
Does the data documented in IPHIS match the data found in the patient records?
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Pregnancy tab: Risk Factors
Pre-pregnancy and Gestational hypertension
Does the data documented in IPHIS match the data found in the patient records?
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Labor & Delivery tab: Characteristics of Labor & Delivery
Induction of Labor Does the data documented in
IPHIS match the data found in the patient records?
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Labor & Delivery tab: Characteristics of Labor & Delivery
Antenatal cortical-steroids (ANCS)
Does the data documented in IPHIS match the data found in the patient records?
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Newborn tab: Other
Obstetrical estimate of gestation at delivery
Does the data documented in IPHIS match the data found in the patient records?
Total Y
Total N
Total Y+N
Total “yes” responses divided by total “yes” + “no” responses=
%
![Page 34: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/34.jpg)
Step 1Analyze results and dig deeper
•Is there any difference among data suppliers, documentation, data collectors?
•What data do you want to work on ?
![Page 35: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/35.jpg)
Fishbone Diagram: Design
36
ProblemStatement
PeoplePolicies
Procedures Place
Cause
of Prim
ary
Cause
Primary Cause
![Page 36: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/36.jpg)
Fishbone Diagrams: Tips
• Use Fishbone Diagram on an on-going basis• Identify contributing factors to each cause• Dig deeply into the causes of the causes• May do multiple diagrams to get at the root
cause• Use data to verify – what is causing the most
or worst error of error?• Don’t jump to solutions!
![Page 37: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/37.jpg)
What We Are DoingWhat We Are Doing
• Reviewed 10 charts: information in chart, on the ODH facility worksheet and in IPHIS.
• Discovered: Missing/incorrect data in numerous IPHIS fields.
• Plan: Change the way data is collected and review data prior to entering in to IPHIS.
![Page 38: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/38.jpg)
Scheduled Delivery Form• One Page Inclusive: Facilitates
information from admitting physician.• Variables from IPHIS that are medical
indications for elective delivery <39 weeks.
• Faxed to Maternity Dept.• Reviewed by RN prior to scheduling
mother for elective delivery.
![Page 39: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/39.jpg)
40
Step 2. Experiment with a solution: improve a specific problem with a specific solution
• Pilot
• Run
• Audit
![Page 40: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/40.jpg)
41
Step 3: Display Results Data
A BA1D1D2A2
A BA1D1D2A2
A BA1D1D2A2
Checksheets
CCR
Gap
Sigma=
X
UCL
LCL
Sigma=
X
![Page 41: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/41.jpg)
Hover Function
![Page 42: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/42.jpg)
Modules1. Why is the birth certificate important to the healthcare of women and newborn
infants? Use of the birth certificate as a QI tool is discussed in detail in this Module.
2. What are the variables in the Ohio birth certificate and what do they mean? The importance of obtaining the correct gestational age is highlighted as well as the “Bakers Dozen of the Most Important Variables,” with appropriate definitions for each.
3. Where are select birth certificate variables found in the medical record? Select variables are highlighted as well as the need for collaboration between the clinical and data abstraction teams.
4. How can I know if I have accurately entered data into IPHIS? This is the most technical of all the Modules, providing an overview of the IPHIS software and the data checks within it. A suggested quality review of hospital’s submissions is also covered.
5. How can I Improve the data entry processes at my hospital? This Module reviews the Model for Improvement, AIM statements, & PDSA’s.
![Page 43: Instructions to cook up the Baker’s Dozen](https://reader035.vdocuments.site/reader035/viewer/2022062222/568167ff550346895ddd7cfd/html5/thumbnails/43.jpg)
Keys to Success
• Communication • Don’t assume• Consensus and key personnel buy-in• Grit and determination• Monitoring of efforts (DATA)