Quality Improvement
Pilot Indicator Project
William M. Sappenfield, MD, MPH
Lindsay S. Womack, MPH
Humberto López Castillo, MD, MEd, MSc
Contents
The FPQC—Partnering to improve health care
quality for mothers and babies
Our stakeholders
Statewide QI Indicators
Anatomy of a QI Indicator Report
Vision
All 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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Mission
Advance 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 Infections
Detailed 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
Management
Early Elective Deliveries (EED)
Antenatal Steroids
Quality Indicator Project
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Obstetric Hemorrhage Initiative (OHI)
Percent of Deliveries in all Hospitals Which Blood Loss Was
Quantified for Vaginal Deliveries
40%
35%
30%
25%
20%
15%
10%
5%
0%
Baseline December January February
March
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April
May
June
July
The Golden Hour Part I: Delivery Room Management
NICU Admission Temperature
Goal: 80% with NICU admission temperature of 36.5°-37.5°C
Percent of Infants Within Temperature Range
100%
90%
80%
70%
60%
50%
60%
62%
71%
67%
60%
70%
73%
71%
70%
64%
55%
40%
30%
20%
10%
0%
Month of Birth
FPQC QI Pilot Indicator Project
Purpose
To pilot potential hospital perinatal health care QI
measures
To pilot potential hospital data quality measures
Funding provided by
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Our QI Indicator Stakeholders
Hospitals
Broward Health
Florida Hospital Orlando
South Miami
St. Joseph's
Tampa General
UF Health Jacksonville
Winnie Palmer
State Organizations
ACOG District XII
AHCA
AWHONN
Florida Blue
Florida Dept. of Health
Florida Hospital Assoc.
Humana
March of Dimes
Antenatal Steroid Use for Infants 24-33 Weeks
19 of Florida’s VON Hospitals, 2012
Hospital % of Antenatal Steroid Use
100
Median = 77
90
80
70
60
50
40
30
20
10
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19
Hospitals
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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 certificate
Hospital discharge
Submitted hospital data
CMQCC Data Linkage Algorithm
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QI Pilot Indicator Project’s Goals
To demonstrate the feasibility of such a system
in Florida
To discern whether there is adequate support
for such a system among essential
stakeholders
To provide concrete examples of Florida
hospital data to demonstrate the QI potential
Development Process at a Glance
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3
4
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Initial Proposed QI Indicators
Developed so far
Non-medically indicated
deliveries (NMID)
Nulliparous, term, singleton,
vertex (NTSV) cesareans
Antenatal corticosteroid
(ANCS) use
Data quality elements
report
Next in line
Rate of failed inductions
Very low birth weight
(VLBW) infants born at
appropriate level of care
Healthy 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?
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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 time
Provider groups would like to see providerlevel data
Proposed Quarterly Data Flow for FL
AHCA receives and
processes data
Hospitals use reports to
focus and monitor QI
efforts
AHCA sends data to FL
DOH for linkage quarterly
FPQC provides quarterly
reports to hospitals who
signed up
FL DOH automates
linked data for quarterly
production
FL DOH shares linked
data for FPQC to generate
reports
Lessons Learned
Advantages
Authority of the State
Extant data collection
system (Vital Records)
Automatic release of data
Some level of consistent
funding
Disadvantages
Bureaucracy limits QI
Variable quality of birth
registry information
Delays between data
collection and reporting
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Proposed FL Hospital Agreement
No charge for hospital participation
Quarterly QI indicator data will be sent free
of charge
However, participant hospitals must:
Assign a permanent contact for this project
Comply with training requirements
Collaborate with follow-up surveys
Participate in data quality improvement efforts
Additional Activities
FPQC would develop strategies to train hospital
staff in using QI reports
FPQC, FL DOH, and AHCA would collaborate:
Developing data QI efforts
Developing data automation and reporting algorithms
Hospitals are encouraged to submit data on all
deliveries on a quarterly basis
Stakeholders would recommend future indicators
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Potential Future Activities
Recommend AHCA move towards earlier
complete hospital discharge reporting
Recommend DOH consider automating
established hospital QI reports as with other
projects
FPQC could pilot QI process and reports for
OB providers and health plans
Hospital discharge and QI data needs to
eventually be extracted from EHR systems
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Questions?
Thank you!
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