PQCNC III

The journey continues….

Agenda

• Update• Review of 2006 Collaborative Report• Review of the Blueprint• Expectations of Families• PQCNC Executive Board• Initiative proposals• Initiative selection• Wrap Up

Update

• Organizational Efforts– Blueprint– Family recruitment– Site Visits– PQCNC Vermont Oxford Enrollment– Presentations

• Funding

• Project Development

Site Visits

• Meet local clinical and quality improvement leaders

• Tour facilities• Meet hospital executive leadership• Identify concerns of local perinatal leaders• Present an overview of PQCNC

– Mission, vision and structural organization– State the case for PQCNC’s value to all

stakeholders

Site Visits

• Participants at Meetings to date– Nurses– OBs– Neos– NNPs– Family Support Specialists and Staff– Quality Directors– Directors of Women’s and Infant Services– VP’s– CFOs– CEOs

Site Visits

• Ideas for improvement

• Success stories

• Unsolicited presentations of local data– The good, the bad and the ugly

• Pride and enthusiasm

• A desire to share and improve

• Goal to visit all PQCNC hospital centers by years end

Site Visits

• Discussion of MOA– VON membership required to be member

• Overwhelming desire for all data to be transparent amongst centers– Clear understanding data not to be used in marketing

etc

• Concerns re public reporting– Data issues and risk adjustment

• MOA being reviewed by UNC legal• Will distribute over next two weeks

VON Enrollment

• 2005 report with 10 centers

• 2006 report includes 11 centers

• By end 2007 will be 14 centers in VON and included in the PQCNC report

• 83% of tertiary centers in the 2006 report

• At least 92% of tertiary centers will be in the 2007 report

VON Enrollment

• An increasing number of community NICUs are interested in VON

• In the 2005 report 1 community NICU

• In the 2007 report there will be at least three…14 to go….

• Absolute commitment from PQCNC to generate core education module and support for data collectors

PQCNC Comparisons Online: Nightingale

• www.vtoxford.org• https://nightingale.vtoxford.org/login.aspx?

ReturnUrl=%2freports.aspx

• MartyMc123456

Funding

• Investments for the Future Grant– Dean SOM UNC Chapel Hill– Three years, ends 2010– Funding $655,000 over three years– Support personnel, infrastructure,

communication, consultation, travel– Defined timeline for organization, initiation of

projects, spread of work from neonatal to perinatal care

IFF Timeline

Funding

• Committed supporters in the State Legislature (Senators Purcell and Dalton)

• Recurring funds through the Education Committee for 2 years

Future Funding Sources

• Private Organizations• Payers and Purchasers

– Private payers/insurers– Private purchasers– State and Federal Agencies

• Others

We are solvent for the next 2 ½ years.

Let’s prove our value!

Outreach Education in Perinatal Care

Dr. Joe Holliday

Head Women’s Health Branch

Division of Public Health NC

Update…Presentations

• NC MFM Think Tank (April 2007)– First organizational meeting for state MFMs

• ABP Subspecialties Meeting (July 2007)– CF Foundation, NACHRI, NNCVSG, CPQCC,

PQCNC – Pediatric subspecialists and MOC Part 4

• Tennessee Initiative for Perinatal Quality Care (TIPQC) (Nov 2007)– CPQCC, OPQC, PQCNC

PQCNC…Looking Ahead

• Outreach as Quality Outreach and Education • Organizing of Maternal Care Providers

– Meetings later this month, larger meeting early 2008– Identify or develop a complete perinatal data set

• Pilot development of patient generated electronic data set linked to medical record

• VON expanding maternal indicators• Use current administrative data set: Mission Hospital and

NPIC– Maternal provider representation on Executive Board

• Interstate Collaboration– Data sharing between Ohio, California, Tennessee – Development of joint projects

Why Perinatal Collaboratives? Current Environment

• Transparency– Increasing public reporting of selected clinical

outcomes• Voluntary reporting by hospitals (CMS)

– Hospital Compare (http://www.hospitalcompare.hhs.gov)

• Mandated in nine states currently• Maryland is requiring reporting of perinatal

outcomes

– Majority of reporting relates to adult diseases• Cardiac Failure, Heart Attack, Pneumonia, Surgical

Top Hospit

als93%

 

 

                                                                                                              

AVERAGE FOR ALL REPORTING HOSPITALS IN THE UNITED STATES

AVERAGE FOR ALL REPORTING HOSPITALS IN THE STATE OF NORTH CAROLINA

CAROLINAS MED CTR-UNIVERSITY

FIRSTHEALTH MOORE REGIONAL HOSPITAL

NORTH CAROLINA BAPTIST HOSPITAL

UNIVERSITY OF NORTH CAROLINA HOSPITAL

 

                                                                                                              

   

  80% 

  80% 

  90% 

  86% 

  75% 

  56% 

Proper Antibiotics Within 4 Hours of Arrival at Hospital

www.hospitalcompare.hhs.gov

Prince George's Hospital Center

122 5.1

Shady Grove Adventist Hospital 191 4.2

Sinai Hospital 181 6.1

Southern Maryland Hospital Center 58 4.6

St. Agnes Hospital 106 4.4

St. Joseph Medical Center 117 6.2

St. Mary's Hospital 32 2.5

Neonatal Indicators

• Maryland Health Care CommissionLOSVol

PQCNC…Looking Ahead

• Perinatal Care Transformation– Call for indicators by National Quality Forum

• Numerous groups giving input re tested indicators• Indicators likely to be based on administrative data

sets• Current favorites are birth trauma/3 and 4th degree

lacerations

– Successful collaboratives will have the opportunity to be part of these discussions

2006 PQCNC Report

2006 PQCNC Collaborative Report

• Disc or hard copy• Compares PQCNC centers anonymously• 40 key indicators• 11 Centers• 2006 Report

– 1672 VLBW infants– 76% of VLBWs in NC

• Data from 2 tertiary centers not included this report

PQCNC Blueprint

PQCNC Blueprint

• Intended to make the case for PQCNC• Designed to provide some structure• Allow the Executive Board to develop rules

of order• Form an Executive Board which will guide

future PQCNC direction• Blueprint currently being reviewed by

reader volunteers• Final document for distribution by Dec 1

PQCNC Blueprint

• Why do we need a perinatal Collaborative?

• The mission and objectives of PQCNC• Keys to our success

– Data – Collaboration – Action– Analysis– Education

PQCNC Blueprint

• Describe the PQCNC organizational structure

• State PQCNC responsibilities

• Identify stakeholders and responsibilities

• Make the value case for PQCNC– Value to families– Value to payers and purchasers– Value to providers

PQCNC Structural Organization

Data Comm

Project Committee

Projects &Education

ParticipatingCenters

PQITs

Communications(incl. website)

QualityImprovementConsultants

Data Management

VON

Executive Committee

Advisory Board

Administrative Core

ADVISORY RESPONSIBILITIES OPERATIONAL RESPONSIBILITIES

Education Committee

Other data sets

Families and PQCNC

PQCNC Executive Board

Executive Board

• Key driver for PQCNC activities and function• A position which requires some heavy lifting

– Optimize travel– Limit time away from home

• Initial meeting in January– Communication beforehand– Establish working relationships– No proxies

• Many other leaders at local and state level will be needed to advance the PQCNC mission

Executive Board

• Initial board selection– Manageable size– Demonstrated commitment– Balance regions, geography, hospital type,

personnel by medical and provider specialty

• Board service period, rules of operation and order and priorities are the Board’s decisions

Executive Board

• Brenda Boberg• Mike Cotten• Jim Cummings• Kate Menard• Mildred Carraway• John Wimmer• Mike O’Shea• Ross Vaughan• Dave Fischer• Jincie Nichols• Joe Holliday• Barb Buechler

• Ginny Raviotta• Merry-K Moos• Nick Lynn• Keith Gallaher• Patti Forest• Sheri Carrol• Rob Silver • Jay Kothaida• Tom Ivester• Heidi Brown• Sam Cykert• Rob Silver

Project Proposals

Project Selection

Next Steps

• Initial steps towards project development– Champions develop action plan in conjunction with Executive

Board – Administrative Core offers assistance (IT, consultative services,

education, data collection etc)– Execution has already begun, target implementation February

2008– Horizon for completion…Dec 2008

• Board discussions re organization and priorities over the next two months

• Subcommittees need to be established by the Board• Board meeting end January

Next Steps

• Strengthen alignment with maternal providers – Present, ? Present at next state OB/MFM

meeting– Guidance of maternal care Board Members– Begin discussion of potential perinatal

projects

Next Steps

• Complete site visits • Increase VON enrollement• As projects evolve so will communication

methods (interactive website) – PQCNC members updated on project

progress– Update on ongoing PQCNC activities

• Board will determine schedule, agenda, and location for next meeting

Thank You!