Quality ImprovementPilot Indicator Project

William M. Sappenfield, MD, MPHLindsay S. Womack, MPHHumberto López Castillo, MD, MEd, MSc

Contents

The FPQC—Partnering to improve health care quality for mothers and babiesOur stakeholdersStatewide QI IndicatorsAnatomy of a QI Indicator Report

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

Obstetric Hemorrhage Initiative (OHI)

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Percent of Deliveries in all Hospitals Which Blood Loss Was Quantified for Vaginal

Deliveries

Basel

ine

Decem

ber

Janu

ary

Febru

ary

Mar

chApr

ilM

ayJu

neJu

ly

0%

5%

10%

15%

20%

25%

30%

35%

40%

The Golden Hour Part I: Delivery Room Management

NICU Admission TemperatureGoal: 80% with NICU admission temperature of 36.5°-37.5°C

Basel

ine

Oct

ober

201

3

Nov

embe

r

Decem

ber

Janu

ary

2014

Febru

ary

Mar

chApr

ilM

ayJu

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

en

t o

f In

fan

ts W

ith

in T

em

pera

ture

R

an

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

Our QI Indicator Stakeholders

Hospitals

Broward HealthFlorida Hospital OrlandoSouth MiamiSt. Joseph'sTampa GeneralUF Health JacksonvilleWinnie Palmer

State Organizations

ACOG District XIIAHCAAWHONNFlorida BlueFlorida Dept. of HealthFlorida Hospital Assoc.HumanaMarch of Dimes

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

Hos

pita

l % o

f Ant

enat

al S

tero

id U

se

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

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 far

Non-medically indicated deliveries (NMID)Nulliparous, term, singleton, vertex (NTSV) cesareansAntenatal corticosteroid (ANCS) useData quality elements report

Next in line

Rate 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 Format

What 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?

Initial Feedback

Data 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

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 Learned

Advantages

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 Activities

FPQC 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

Questions?

Thank you!

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