The Georgia Perinatal Quality
Collaborative:
Applying QI Strategies to Improve Perinatal
Outcomes
Georgia Hospital Association
October 22, 2014
WILL DIE TODAY
Maternal Health
Infant Health
Perinatal Health in Georgia
In 2012, Georgia ranked 49th
nationally for maternal mortality –
with 35.5 deaths per 100,000 births.
From 1993 – 2006, Black, Hispanic and
Asian women accounted for 41% of all
births nationwide , and for 62% of
pregnancy-related deaths.
Preconception health such as
diabetes, hypertension, cardiac
issues and obesity increase risk of
maternal death and LBW babies.
In 2010, 19.9% of women smoked
within the 3 months prior to
pregnancy, and 8.3% of moms
smoked in the final 3 months of
pregnancy in 2010.
In 2010, only 55.2% of Georgia mothers
started breastfeeding after delivery.*
Georgia ranked 37th nationally for
infant mortality – with 6.8 deaths per
1000 live births in 2012.
Black, non-Hispanic infants were
2.5 times more likely to die
than White, non-Hispanic infants.
The rate of SIDS in Georgia
remained stagnant
between 2007-2011.
Birth defects are the
2nd most common cause
of infant death in GA,
but the no. 1 most
common cause in the US.
Tobacco exposure during
pregnancy and secondhand
smoke after delivery is a risk factor
for preterm birth, sleep-related death and
poor lung development
11
Infant Mortality in the Southeastern United
States, 2006-2011
Infant Deaths per 1,000 Births
10
9
8
7
6
Florida
Georgia
Mississippi
North Carolina
South Carolina
Tennessee
5
4
2006
2007
2008
Year
2009
2010
2011
Infant Mortality Clusters within
Georgia, 2002-2006
Maternal Risk Factors for Infant
Mortality by Cluster
Less likely to have more than a high school
degree
Less likely to be White non-Hispanic
Less likely to have had adequate prenatal care
Less likely to be married
More likely to have had a previous adverse
pregnancy outcome
More likely to have had a c-section
More likely to be a smoker
More likely to be 19 years old or younger
More likely to have a chronic health condition
A
B
C
D
E
F
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Looking at trends from across the state
Approx. 1 in 5
births spaced
< 2 years apart
in 2012
>17% of infant
deaths in 2011
were due to
prematurity or
LBW
11 % of births
were preterm
in 2012
9.4 % of births
were LBW in
2012
Georgia Perinatal Quality Collaborative
Vision
Mission
All perinatal stakeholders in Georgia coming
together to improve health and birth outcomes
for all Georgia mothers and babies
To establish and maintain a robust statewide
perinatal data and quality improvement system
that engages stakeholders in evidence-based
practices to improve health outcomes for mothers
and babies throughout Georgia.
The GAPQC Journey
Oct. 2012
2011- 2012
Summer 2011
Vision
began to
germinate
for creation
Stakeholder
engagement
began,
review of
other state
PQCs
Formal
creation
of
GAPQC
May 2013
Steering
committee
formed,
Mission &
Vision
created,
projects
selected
July 2013
Pilot Launch.
Summer 2014
Review lessons
learned,
identify new
projects, begin
recruiting for
Phase II of
PQC.
The GAPQC Steering Committee
Co-Chairs: Catherine Bonk, MD, MPH, (OB/Gyn) and David Levine, MD, (Neo)
DPH Support: Seema Csukas, MD, PhD, MCH Director, Theresa Chapple-McGruder, PhD,
Director of MCH Epidemiology, Maria Fernandez, Infant Mortality Director
Physicians
- Mike Armand, MD, Dekalb (NEO)
- David Carlton, MD, Emory & Grady
(NEO)
- Armando Castillo, MD, NE GA Health
System (NEO)
- Jane Ellis, MD, Grady (OB/GYN)
- Jameela Harper, MD, NE GA Health
System (OB/GYN)
- Demetrice Hill, MD, Columbus Regional
(OB/GYN)
- Lucky Jain, MD, Emory & Grady (NEO)
- Ravi Patel, MD, Emory & Grady (NEO)
- Mitch Rodriguez, MD, Medical Ctr of
Central GA, (NEO)
- Champa Woodham, MD, Medical Ctr
of Central GA, (OB/GYN)
-
Community Partners and
Professional Organizations
Pat Cota, Exec. Dir, Georgia OBGyn
Society
Fozia Eskew, Early Intervention
Coordinator, GA AAP
Lynne Hall, QI Consultant, GHA
Sarah Owens, Immediate Past President,
American College of Nurse Midwives (GA)
Sheila Ryan, State Director, March of
Dimes
Kim Sumpter, Community Outreach, The
United Way of Greater Atlanta
Rick Ward, Exec. Dir., GA AAP
Sarah Dyer, Director, Maternal Services,
NE Georgia Health System
Maternal Health
Chronic Disease is a High Risk Factor
for Maternal and Infant Outcomes
Chronic conditions during pregnancy, GA birth certificate, 2008-2010
1.6
1.4
1.4
Percent of live births
1.4
1.3
1.2
1.0
0.8
0.8
0.7
0.7
Chronic Diabetes
0.6
Chronic
Hypertension
0.4
0.2
0.0
2008
2009
2010
Source: GA data repository, 2008-2010 final birth file
Obesity in Georgia
• >50% of women are
overweight or obese;
1/3 are obese*
• 48% of reproductiveaged women are
overweight or obese;
26% are obese†
• > 40% of pregnant
women are overweight
or obese*
Only 12% of women indicated a desire to
have a child in the next year,* but more than
20% are having a baby in <2 years
26
% of total live births
25
24
All of Georgia
Rural
Non-Rural
23
22
21
20
2008
2009
2010
2011
2012
States with highest rate of repeat teen
pregnancy
While 6:10 women want to space their pregnancies,
6:10 women also are not using the most effective birth
control to achieve their goals
*
Maternal Health: Opportunities
Early Elective Deliveries
Post-partum Hemorrhage
(AWHONN)
ANCS
Hypertension/Preeclampsia
Breastfeeding
AL
FL
MA
NC
NY
TN
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What about supporting high risk women (teens,
preexisting chronic conditions) to better plan and
space their pregnancies?
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Maternal Health: QI Strategy
Aim
Key Drivers
Collaborative
Opportunity
Improve maternal and infant health outcomes by increasing rate
of immediate post-partum LARC insertion to help high risk women
better control chronic conditions and achieve birth planning goals
- Address policies and processes that impact women receiving
preferred birth control option at discharge
- Increase training and awareness in the inpatient and outpatient
setting for providers, clinicians and others
- Provide patient-focused and sensitive education and counseling
- Leverage changes in Medicaid reimbursement to expand LARC
access to women who may not have received LARCS previously
DCH and DPH Collaboration on QI project sponsored by CMS.
Kick off begins in November for nine-month cycle.
Infant Health
10 Leading Causes of Infant Death
Georgia, 2002-2006
Cause of Death
#
All Causes
% of
total
Rate
Rank
5743 100
8.24
--
Disorders related to short gestation and low birth weight,
not elsewhere classified
1117 19.5
1.62
1
Congenital malformations, deformations and chromosomal
abnormalities
964
16.8
1.39
2
Sudden infant death syndrome & sleep-related deaths
621
10.8
0.90
3
Newborn affected by complications of pregnancy
321
5.6
0.46
4
Respiratory distress of newborn
245
4.3
0.35
5
Accidental/unintentional injuries
181
3.2
0.26
6
Bacterial sepsis of newborn
169
2.9
0.24
7
Newborn affected by complications of placenta, cord and
membranes
164
2.9
0.24
7
Necrotizing enterocolitis of newborn
134
2.3
0.19
9
Disease of circulatory system
131
2.3
0.19
9
Georgia’s NBS program panel expansion
Congenital heart defects are the most common birth defect. By
expanding the panel to include screening, we can have an impact on:
• Infant, child and adolescent mortality rates
• Healthcare utilization and costs for children with special healthcare
needs
Three new screens added to the panel
20
Inborn Metabolic errors
2
Endocrine disorders
4
3
Other Metabolic errors
(includes SCID)
Hemoglobinopathies
1
1
Audiology screen for
hearing impairment
CCHD screen detects
12 conditions
Infant Health: QI Strategy
Aim
Key Drivers
Collaborative
Opportunity
Improve support hospitals in the implementation of CCHD as part
of newborn screening to increase awareness, identification and
treatment of children born with congenital heart defects.
- Address policies, staffing models, supply chain considerations
and procedures to support efficient implementation and reduce
rejections of NBS cards.
- Identify and implement best practices for short-term and longterm training of physicians, clinicians and other staff
- Provide patient-focused and sensitive education and counseling
to families
Both Children’s National Medical Center and the University of
Minnesota have issued toolkits to support CCHD screening
implementation. Georgia is developing a toolkit that integrates
best practices from both to support the implementation in
Georgia, across a variety of hospital settings.
Infant Health: Opportunities
AL
Neonatal Abstinence
Syndrome
CLABSIs and other HAIs
NICU Human Milk
The “Golden Hour”*
Newborn Screening/CCHD
Neonatal High Risk FollowUp Clinic*
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FL
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MA
NC
NY
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* Based on toolkit from California toolkit
TN
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Why Join GAPQC?
Working together we accomplish
more:
-
Bringing together
neonatologists and ob/gyns,
we can address the spectrum
of factors that impact
perinatal outcomes.
-
Larger numbers let us pool
resources, see more changes
and outcomes more quickly.
-
We can attract other
stakeholders and partners –
combining the clinical
interventions with
patient/family education we
can address the variety of
issues that impact outcomes.
- The better our outcomes and
the larger our reach, the
more we are able to
demonstrate our value to
payors, funding sources and
communities
GaPQC Timeline
July 1, 2014 - June 30, 2015
Planning
Design
Sept
Launch
recruitment effort
and Phase II QI
Project planning
begins
Implementation &
Reporting
Oct.
Nov.
Full day
Kickoff
Session
GA AAP Meeting
July
15
Jan.
2 Education sessions
Finalize
project
planning
Ongoing Monthly Conference Calls to Review Data and Plan
PDSA Cycles
Education Session
Next Wave
Recruited and
Project Planning
Launched
Recruitment Goal: Statewide Collaborative with All
Perinatal Stakeholders
No. of Hospitals:
5
12-18
25-40
41+
Pilot
2015
2016
2017
Kick-Off Educational Session:
January 2015
Atlanta, GA
Application Deadline:
November 25
For more information, contact
Maria.Fernandez@dph.ga.gov
or call 404-657-2852