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

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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%

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n=

20

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n=

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4

6/1

/20

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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