Instructions to cook up the Baker’s Dozen
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Instructions to cook up the Baker’s Dozen Made Fresh Daily Kelly Friar, Chief, Office of Health and Vital Statistics and Accreditation Coordinator Ohio Department of Health
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Instructions to cook up the Baker’s Dozen. Made Fresh Daily Kelly Friar, Chief, Office of Health and Vital Statistics and Accreditation Coordinator Ohio Department of Health. Significance for Public Health. Public Health Accreditation Board PHAB Community Health Assessment - PowerPoint PPT Presentation
Transcript of Instructions to cook up the Baker’s Dozen
Instructions to cook up the Baker’s Dozen
Made Fresh DailyKelly Friar, Chief, Office of Health and Vital
Statistics and Accreditation CoordinatorOhio Department of Health
Significance for Public HealthPublic Health Accreditation Board
PHAB
•Community Health Assessment•Community Health Improvement Plan•Dept. Strategic Plan
•Quality Improvement Plan•Workforce Development Plan•Performance Management System
Category A – Programs with a budget of greater than $250,000
First PlaceOhio Department of HealthOhio Perinatal Quality Collaborative (OPQC)
The Ohio Perinatal Collaboration to Improve Birth Data and Prematurity Outcomes is a creative approach to using public health surveillance data (birth certificates) as a supplement to data collected from medical records to serve as the metrics that can inform and accelerate perinatal quality improvement initiatives. The Ohio Perinatal Quality Collaborative (OPQC), Ohio’s public/private partnership focused on improving health outcomes using quality improvement science, has documented early successes in reducing late preterm scheduled deliveries without medical indication in 20 delivery hospitals in Ohio. Spreading what works will be essential in reducing prematurity and having a measurable impact on population health. This effort is state administered by investing and partnering in OPQC where the improvement happens. Over many decades Ohio has relied heavily on birth certificates as source of data to measure population-level changes over time, but only recently has turned to them to measure improvements in health care and outcomes.
2012 Vision AwardsAchieving Excellence in Public Health Through Innovation
The Baker’s DozenTop Key Variables in IPHIS
Variable IPHIS Tab
1. Total number of Prenatal visits Prenatal
2. Pregnancy Risk Factors: pre-pregnancy and gestational diabetes Pregnancy
3. Pregnancy Risk Factors: pre-pregnancy and gestational hypertension Pregnancy
4. History of prior preterm birth Pregnancy
5. Induction of Labor Labor & Delivery
6. Augmentation of Labor Labor & Delivery
7. Antenatal corticosteroids (ANCS) Labor & Delivery
8. Antibiotics received by the mother during delivery Labor & Delivery
9. Birth weight Newborn
10. Obstetrical estimate of gestational age Newborn
11. Abnormal conditions of the newborn: Assisted ventilation after delivery and NICU admission
Newborn
12. Congenital abnormalities of the Newborn Newborn
13. Breast feeding at discharge Newborn
Why Are We Doing This?Why Are We Doing This?
• OPQC’s Mission: Improve Infant Health• Through collaborative use of improvement
science methods, reduce preterm births and improve outcomes of preterm newborns in Ohio as soon as possible
• What Causes Perinatal & Infant Mortality?What Causes Perinatal & Infant Mortality?• Preterm Birth Preterm Birth • Birth Defects• SUID et al
Our Shared Vision
• Decrease prematurity and infant mortality in Ohio
• OPQC, ODH-Vital Statistics and OHA• Using the PLAN-DO-STUDY-ACT cycle of
continuous quality improvement to facilitate improved data collection to accurately measure progress toward goal of reducing non-medically indicated deliveries prior to 39 weeks gestation
Bill Callaghan, MD MPHCenters for Disease Control and Prevention
December 1, 2011
“The focus of healthcare for women and infants over the
next century depends on the quality of the
data collected by those who fill out the
birth certificates.”
Obstetric Quality 2007
“ There are currently no uniformly accepted measures of obstetrical quality. Many traditional measures of obstetrical quality are flawed and newer measures are still undergoing necessary validation.”
- Jennifer L. Bailit, MD, MPHOBG Survey 2007
OB Quality Monitoring • National Quality Foundation• Joint Commission • Ohio Hospital Compare • Leap Frog• CMS• Ohio Perinatal Quality Collaborative• PCPI• PQRS
JOINT COMMISION: Perinatal Care Measures
• PC-01 Elective Delivery • PC-02 Cesarean Section (NTSV)• PC-03 Antenatal Steroids • PC-04 Health Care-Associated
Bloodstream Infections in Newborns• PC-05 Exclusive Breast Milk Feeding https://manual.jointcommission.org/releases/TJC2013A/PerinatalCare.html
PC -01
• Numerator: Patients with elective deliveries
• Denominator: Patients delivering newborns with >= 37 and < 39 weeks of gestation completed
• Inductions and cesarean delivery included
JOINT COMMISION: New for July 1, 2013
“It is acceptable to use data derived from vital records reports received from state or local departments of public health if they are available and are directly derived from the medical record with a process in place to confirm their accuracy. If this is the case, these may be used in lieu of the acceptable data sources listed below.”
https://manual.jointcommission.org/releases/TJC2013B/DataElem0265.html
Promedica Toledo Hospital Mercy St. Vincent
Medical Center
Miami Valley Hospital
Mercy AndersonUH CincinnatiGood Samaritan
Aultman Hospital
St. ElizabethHealth Center
Akron GeneralAkron Children’s MFM
Summa Health System
Mt. Carmel EastMt. Carmel West
Mt. Carmel St. Ann’s
Riverside Methodist
OSUWexner
Fairview Hospital
UH Case MacDonald Women’s
HillcrestMetro Health
<39 Week Scheduled Delivery – 20 Charter Hospitals
BC Data Varies By:BC Data Varies By:•HospitalHospital•Maternal DisMaternal Dis•CredentialsCredentials•State State
Effects of the Initial OPQC39 Week Scheduled Birth Project
September 2008 March 2013
• 30,000 births shifted to 39-41 weeks • Conservative estimate = 3% fewer
“near term” NICU admissions: N = 950• 950 x $20,000 $20,000 per NICU Admission =• $19,000,000 $19,000,000 savings in 4 ½ years
Lessons From the Initial 39 Week Project• Create A Culture of Change• Learn From All Participants• Improve Communication
• Data Collectors, Data Users, Data AnalystsData Collectors, Data Users, Data Analysts• OPQC = Data for You to Use, Not the Police
• Birth Certificate = A Q.I. InstrumentBirth Certificate = A Q.I. Instrument• More Training and More Cross TalkMore Training and More Cross Talk• Use Use Greater Accuracy Greater Accuracy Promotes Use Promotes Use• Rapid Turnaround EssentialRapid Turnaround Essential
<39 Week Scheduled Delivery and Birth Certificate Accuracy 15 Pilot Hospitals
The Christ Hospital
Bay Park Promedica
St. Rita’s Lima
Blanchard Valley
SouthviewGood SamaritanDayton
Kettering
BethesdaNorth
Southern Ohio Medical Center
Fairfield Lancaster
Genesis Bethesda
Mercy Regional Lorain
Mercy Canton
Lake East
Ashtabula County
Team Sharing and Learning
Harvard School of Education http://socrativegarden.wordpress.com/2011/08/04/1-2-3-word-cloud/
Two reasons for inaccurate gestational age entry
1. Sometimes the gestational age is “rounded up” in IPHIS.• Gestational age is NEVER TO BE ROUNDED UP; it is recorded in
completed weeks.• For example, 38 weeks, and 5 days is properly termed 38 weeks.
2. Often there is no agreement re: where in the medical record gestational age should be recorded; in addition, varying gestational ages are found in the medical record.• Consistent agreement regarding where in the medical record the
IPHIS variable for gestational age is found will greatly increase your accuracy.
Remaining 73 Ohio Maternity Hospitals
•January 2013 thru April 2014
•Divided into three separate “Waves” with staggered start dates
Differences from Charter and Pilot Sites
•Updated the report of allowed medical indications from Birth Registry/IPHIS data
•*Change in measure from 36.0 - 38.6 weeks to 37.0-38.6 weeks gestation; more in harmony with Joint Commission, Leap Frog and Ohio Hospital Care
Can You Do This In Your Hospital ? What Are The Keys to Success?
• Adopt ACOG Guidelines• Use a Scheduled Birth Form (ACOG or Site Specific)
• Document the Pregnancy Dating Method• Document the Reasons for Scheduled Birth
• OPQC Is Not The Police = Start with Soft Stop• Rapid Data Turnaround• Frequent Group & Site PDSA’s• Enthusiasm from Local Leaders
PDSA
• Plan• Look at a particular aspect of project• Review intervention options• Plan implementation of intervention• What do you predict will happen?
• Do• Execute the intervention
PDSA• Study
• How did the intervention go?• Did it go the way you expected?• What was the outcome?• Was the a measure?
• Act• Accept• Adopt • Abandon
13 Key IPHIS Variables Handout
Is there any way to get gestational age correctly
recorded in IPHIS all the time?
Essential Data Elements to Accurately Document Gestational Age
• Earliest Ultrasound that documented GA• Ideal CRL•Best < 20 weeks gestation
• documentation by provider •estimate of GA •what it is based on
Second Step-entering Data into IPHIS
Make sure everyone agrees where to find best OB estimate of GA and EDD acquisition of dataRecording of dataTransfer of dataMonitoring of process
Photo courtesy of fotolia.com
IPHIS to Patient Medical Record ChecklistDirections, Data Dictionary, and Examples
IPHIS to Patient Medical Record ChecklistHospital: ____________________ Month: ____________
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Pregnancy tab: Risk Factors
Pre-pregnancy and Gestational diabetes
Does the data documented in IPHIS match the data found in the patient records?
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Pregnancy tab: Risk Factors
Pre-pregnancy and Gestational hypertension
Does the data documented in IPHIS match the data found in the patient records?
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Labor & Delivery tab: Characteristics of Labor & Delivery
Induction of Labor Does the data documented in
IPHIS match the data found in the patient records?
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Labor & Delivery tab: Characteristics of Labor & Delivery
Antenatal cortical-steroids (ANCS)
Does the data documented in IPHIS match the data found in the patient records?
IPHIS Variable Chart 1 Y N
Chart 2Y N
Chart 3 Y N
Chart 4 Y N
Chart 5 Y N
Total Y
Total N
Total Y+N
Newborn tab: Other
Obstetrical estimate of gestation at delivery
Does the data documented in IPHIS match the data found in the patient records?
Total Y
Total N
Total Y+N
Total “yes” responses divided by total “yes” + “no” responses=
%
Step 1Analyze results and dig deeper
•Is there any difference among data suppliers, documentation, data collectors?
•What data do you want to work on ?
Fishbone Diagram: Design
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ProblemStatement
PeoplePolicies
Procedures Place
Cause
of Prim
ary
Cause
Primary Cause
Fishbone Diagrams: Tips
• Use Fishbone Diagram on an on-going basis• Identify contributing factors to each cause• Dig deeply into the causes of the causes• May do multiple diagrams to get at the root
cause• Use data to verify – what is causing the most
or worst error of error?• Don’t jump to solutions!
What We Are DoingWhat We Are Doing
• Reviewed 10 charts: information in chart, on the ODH facility worksheet and in IPHIS.
• Discovered: Missing/incorrect data in numerous IPHIS fields.
• Plan: Change the way data is collected and review data prior to entering in to IPHIS.
Scheduled Delivery Form• One Page Inclusive: Facilitates
information from admitting physician.• Variables from IPHIS that are medical
indications for elective delivery <39 weeks.
• Faxed to Maternity Dept.• Reviewed by RN prior to scheduling
mother for elective delivery.
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Step 2. Experiment with a solution: improve a specific problem with a specific solution
• Pilot
• Run
• Audit
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Step 3: Display Results Data
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A BA1D1D2A2
A BA1D1D2A2
Checksheets
CCR
Gap
Sigma=
X
UCL
LCL
Sigma=
X
Hover Function
Modules1. Why is the birth certificate important to the healthcare of women and newborn
infants? Use of the birth certificate as a QI tool is discussed in detail in this Module.
2. What are the variables in the Ohio birth certificate and what do they mean? The importance of obtaining the correct gestational age is highlighted as well as the “Bakers Dozen of the Most Important Variables,” with appropriate definitions for each.
3. Where are select birth certificate variables found in the medical record? Select variables are highlighted as well as the need for collaboration between the clinical and data abstraction teams.
4. How can I know if I have accurately entered data into IPHIS? This is the most technical of all the Modules, providing an overview of the IPHIS software and the data checks within it. A suggested quality review of hospital’s submissions is also covered.
5. How can I Improve the data entry processes at my hospital? This Module reviews the Model for Improvement, AIM statements, & PDSA’s.
Keys to Success
• Communication • Don’t assume• Consensus and key personnel buy-in• Grit and determination• Monitoring of efforts (DATA)
