Reducing Early Elective Deliveries:
Perinatal Quality Improvement
Collaboratives
Zsakeba Henderson, MD
Maternal and Infant Health Branch
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health
Promotion
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Reproductive Health
• Networks of perinatal care providers and public
health professionals working to improve
pregnancy outcomes for women and newborns.
• CDC Division of Reproductive Health currently
supports
• California Perinatal and Maternal Quality Care
Collaboratives (CPQCC, CMQCC)
• New York State Perinatal Quality Collaborative
(NYSPQC)
• Ohio Perinatal Quality Collaborative (OPQC)
Perinatal Quality Collaboratives
•
Members of the Collaborative identify processes of care
that require improvement and use the best available
methods to effect change and improve outcomes as
quickly as possible
•
Quality improvement methods are based on principles
developed and used in other areas of quality
improvement
•
Baseline and ongoing collection of data is imperative
• Involves rapid collection and return of data to member
facilities to meet objectives to improve care
Perinatal Quality Collaboratives
•
Goals of collaboratives include
• Achieving a new level of safer, more effective care
• Minimizing risks to patients
•
Successful efforts include
• Reduction of late preterm and early term deliveries
• Improvements in use of antenatal steroids for premature
infants
• Reduction in neonatal central line – associated
bloodstream infections
States with PQCs and
CDC/DRH funding
States with PQCs
States with PQCs in
development
Multi-state PQC
Reduction of Early Elective Deliveries
<39 Weeks
•
•
The goal is to reduce scheduled births <39 weeks
gestation that lack a medical indication
Approaches include
• “Champion” leaders at member institutions
• Educational efforts (webinars, conference calls, learning
sessions)
• Improving documentation of gestational age dating criteria
• Improving documentation of indications for delivery
• Feedback through review of site-specific and aggregate data
• Troubleshooting of systemic and local issues
•
Data sources include medical records, patient
discharge data, vital records
Reduction of Early Elective Deliveries
<39 Weeks
•
Improvement efforts have been successful:
• A rapid-cycle process improvement program substantially
decreased elective scheduled early-term deliveries to less than
5% in a group of diverse hospitals across multiple states.*
• In New York State, PQC efforts resulted in a 68% decrease in
scheduled deliveries without medical indication between 36 -38
weeks gestation and 20% decrease in admissions to neonatal
intensive care units (NICUs) (September 2010 and January
2013, NYSPQC)
• In Ohio, nearly 23,000 babies that would have been delivered at
36-38 weeks were delayed to 39 weeks, representing an
increase of 8 percent in full-term deliveries (2008-2012, OPQC).
*Oshiro B, et al. Obstet Gynecol. 2013 May;121(5):1025-1031.
Data for Quality Improvement
•
Improving quality requires
• Accurate information
• Complete information
• Timely feedback
•
Data is also used for performance measurement
•
•
•
•
Joint Commission
Centers for Medicare and Medicaid Services
Physician Consortium for Performance Improvement
Hospital Compare websites
Strategies to improve birth certificate
data quality
•
•
•
•
•
•
Provider education (medical record documentation)
Birth clerk training
Standardization of obstetric definitions
Identification of key data items (frequently missing or
inconsistent, e.g. Ohio’s Baker’s dozen)
Validation of birth certificate data
Providing feedback on data quality to all staff involved in
data documentation and collection
Improving birth certificate data quality:
Ohio Perinatal Quality Collaborative
•
•
•
•
•
Recruitment by ODH and OPQC Ob
Call with each site to describe project
Site visit by ODH and OPQC QC with site’s clinical and
birth data staff
Learning Session with all teams, clinical and data staff
Monthly group webinars
• Review of data and sharing of successful strategies
•
Individual coaching calls as needed
Improving birth certificate data quality:
Ohio Perinatal Quality Collaborative
Birth Certificate Exercise
•
What are the barriers of accurate birth certificate data
collection?
•
What do you see as opportunities for improvement?
Improving birth certificate data quality:
Ohio Perinatal Quality Collaborative
Number of times category was identified
16
14
14
13
12
10
9
8
6
4
3
2
0
Medical record data not
current
Lack of attention to
accuracy when entering
data into IPHIS
Medical record data not
easily accessible
Lack of knowledge re:
data collection
requirements and
definitions
Reasons for inaccurate birth certificate data collection
Ohio Perinatal Quality Collaborative Opportunities for Accurate Birth Certificate
Completion
•
Ability to go back and correct data in IPHIS
•
Improve training of birth certificate clerks
•
Find ways to extract IPHIS data from EMR
•
One dedicated person to collect data
Improving birth certificate data quality:
Ohio Perinatal Quality Collaborative
•
Monthly review of medical records to check birth
certificate data accuracy
•
Analysis of hospitals’ birth data variable processes
•
Development of training module for staff entering data
into IPHIS
•
Use of participant feedback to refine training modules
and begin to disseminate modules throughout Ohio.
Improving birth certificate data quality:
California Maternal Quality Care Collaborative
•
Survey of birth clerks to identify priority areas for quality
improvement
•
Multi-stakeholder taskforce for data quality improvement
•
Framework of strategies for improving perinatal data
quality developed
Improving birth certificate data quality:
California Maternal Quality Care Collaborative
•
Standardize obstetric data definitions
•
Educate clinical and coding personnel
•
Promote redesign and system changes
•
Apply principles of Clinical Quality Improvement to Data
Quality Improvement (DQI)
•
Create value for Perinatal DQI for hospitals
California Maternal Quality Care Collaborative
•
Birth clerk training pilot in Santa Clara County hospitals
•
Expansion of intensive birth clerk data trainings and
analytic support
•
Addition of data quality improvement metrics to the
California Maternal Data Center (CMDC).
https://demo.datacenter.cmqcc.org/hospitals/1
•
Match data quality to perinatal metrics calculations
Improving birth certificate data quality:
CMQCC/California Maternal Data Center
•
CMDC is the source of rapid-cycle data for maternal
quality improvement projects
• Validation and use of perinatal quality and data quality measures
• Interacitve web-based tool for rapid collection and feedback
•
Data quality metrics added to the CMDC include:
• Missing/Inconsistent Birthweight (Among <2500 gram
newborns)
• Missing/Inconsistent Gestational Age (Among < 37 week
newborns)
• Percent Unknown in Birth Certificate Data
• Missing/Inconsistent Diabetes Diagnosis
• Missing/Inconsistent HTN Diagnosis
• Missing/Inconsistent PROM
• Missing/Inconsistent Induction
Perinatal Quality Care Collaboratives:
Improving perinatal care and data quality
•
Use of QI science to reduce early elective deliveries has
been shown to work
•
Statewide efforts to collect and report outcomes in a
timely fashion is possible
•
Efforts will require continued attention to improving data
quality
zhenderson@cdc.gov
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion
Division of Reproductive Health