Ohio Perinatal Quality Collaborative Ohio Public Health Association – Ohio Vital Statistics Conference November 6, 2014

Objectives Participants will be able to describe the structure and purpose of the Ohio Perinatal Quality Collaborative (OPQC). Participants will be able to describe the work OPQC and ODH/Office of Vital Statistics has done to improve birth data documentation in the Integrated Perinatal Health Information System (IPHIS), Ohio’s birth registry. Participants will be able to describe the Top Variables and New 2014 Variables found in the Ohio Birth Registry/IPHIS.

Goal: Through collaborative use of improvement science methods, Reduce preterm births and improve outcomes of preterm newborns in Ohio as quickly as possible. OPQC Is A Voluntary Organization of Ohio Stakeholders Who Care About Fetal & Infant Health

The OPQC Charter Teams {24 Neo + 20 OB} Cincinnati Children’s Hospital Medical Center (NEO) Good Samaritan Hospital (NEO & OB) Aultman Hospital (NEO & OB) Akron Children’s Hospital (NEO & OB) Akron General Medical Center (OB) Cleveland Clinic (NEO) Dayton Children’s Medical Center (NEO) Fairview Hospital (NEO & OB) Hillcrest Hospital (NEO & OB) Mercy Anderson Hospital (OB) MetroHealth Medical Center (NEO &OB) Miami Valley Hospital (OB) Mount Carmel East (NEO & OB) Nationwide Children’s Hospital (NEO) Doctor’s Hospital (Nationwide NEO) Grant Hospital (Nationwide NEO) Promedica Toledo Children’s Hospital (NEO) Promedica Toledo Hospital (OB) Riverside Methodist Hospital (OB+ Nationwide NEO) St. Vincent Mercy Medical Center (NEO & OB) Summa Health System (NEO & OB) Ohio State University Medical Center (NEO & OB) University Hospital – Cincinnati (NEO & OB) University Hospital – Cleveland – Rainbow Babies (NEO) University Hospital – MacDonald Women’s Hospital (OB) Mount Carmel West (NEO & OB) Mount Carmel St. Ann’s (NEO & OB) Cleveland Akron Youngstown St. Elizabeth Health Center (NEO) Canton Dayton Cincinnati Toledo Columbus ~ HALF OF OHIO BIRTHS OCCUR IN THESE 20 OB CENTERS

Obstetrics Neonatal 39-Week Scheduled Deliveries without medical indication Steroids for women at risk for preterm birth (24 0/ /7 ) Done  Transition to BC Surveillance Spread to all maternity hospitals in Ohio 2014: Progesterone to Reduce Preterm Birth Risk Blood Stream Infections: High reliability of line maintenance bundle Use of human milk in infants weeks GA 2014: Neonatal Abstinence Syndrome 2014: Neonatal Abstinence Syndrome OCHA NAS in 6 CH’s

Henry County Wood County Bluffton Mercy Tiffin Mary Rutan Atrium McCulloug h- Hyde Fort Hamilton Holzer Medic al Berger Health Licking Memorial Doctor’s Coshocton East Liverpool Firelands Trinity Fisher-Titus Samaritan Wooster Union Lakewood Lake West U.H. Geauga Galion Toledo Mercy St. Vincent Miami Valley Hospital Mercy Anderson UH Cincinnati Good Samaritan TriHealth Aultman St. Elizabeth Health Center Akron General Akron Children’s MFM Summa Health System Mt. Carmel East Mt. Carmel West Mt. Carmel St. Ann’s Riverside Methodist OSU Fairview UH Case MacDonal d Hillcrest Metro Health The Christ Hospital Bay Park St. Rita’s Lima Blanchar d Valley Southview Good Samaritan Premier Kettering Bethes da North Southern Ohio Fairfield Lancaster Genesis Bethesda Mercy Canton Lake East Ashtabula OPQC Maternity Hospitals 2013 X Charter sites XPilot sites Wave 1 sites XWave 2 sites Wave 3 sites Community Hospital & Wellness Center Van Wert County Hospital Mercer County Community Wilson Memorial Highland District Madison County Marietta Memorial O’Bleness Memorial SE Ohio Reg. mrd.Ctr Northside Medical Trumbull Memorial Pomerene MedCentral Mansfield Marion General Southwest General St. John MedCt r Memorial Health Care Mercy Lorain Bellevue St. Lukes; Mercy St. Charles Adena HealthSystem Dublin Methodist Grady Memorial Robinson Memorial Ravenna Lima Memorial Wyandot Memorial Defiance Regional Medical Center Memorial Hospital Memorial Union County Community Memorial Knox Sp Aultman Orville East Ohio RegMC St.Joseph Clinton Memorial, Wilmington Mercy Fairfield Wayne Medina General Summa Barberton EMH RMCParma Community General Fulton County Health Center Springfield Shelby

BC Data Varies By: Hospital Hospital Maternal Dis Maternal Dis Credentials Credentials State State

Variation between IPHIS and hand collected data Improving birth registry accuracy was added when the project was spread in 2011 IPHIS data was the only data used to document improvement in <39 weeks scheduled deliveries 15 pilot hospitals tested and studied changes to decrease early scheduled deliveries and increase birth registry documentation accuracy

Different from Charters Used Birth Registry data instead of hand collected Site Visits by BEACON QI Coordinators Monthly Calls Periodic Learning Meetings Collaboration w/ ODH + ODH Office of Vital Statistics + CDC Dissemination of The 39 Week Delivery Project Done in Waves Piloted in 15 Sites Subsequent Waves with Staggered Start Dates Jan 2013  Apr 2014 Ohio Birth Registrars are excited to participate

Ohio inductions < 39 weeks without a medical indication 10

Bill Callaghan, MD MPH Centers 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.”

39 weeks/Birth Registry Accuracy Aims In 9 months, reduce to 5% or less, the number of women in Ohio of 37.0 to 38.6 weeks gestation for whom delivery is scheduled in the absence of appropriate medical indication In 9 months, improve birth registry accuracy so that focused variables* will be transmitted accurately in 95% of records (*Pre-pregnancy and Gestational Diabetes; Pre-pregnancy and Gestational hypertension; Induction of Labor; ANCS; OB estimate of GA)

OPQC & ODH met with Hospital’s Clinical and Data Teams for half day covering: Importance of the birth certificate data Process flow map detailing Abstraction of Birth Data and Submission into IPHIS 5-8 “audits” of previously submitted Birth Certificates compared with the Patient Chart Site Visits to Hospitals

Top IPHIS Variables

Variables of the Month: Breastfeeding at Discharge Is the infant being breast-fed before discharge from the hospital? “Breast-fed” is the action of breast- feeding or pumping (expressing) milk. **Exclusive breast feeding is not required to check “yes”. Infant may be intermittently fed both breast milk and formula at discharge. It is NOT the intent or plan to breast- feed.

POLL: Breastfeeding at Discharge? RN obtains history from mom on admission to L&D. Mom states “breast” when asked if breast or bottle feeding.  Breastfeeding at discharge  Not breastfeeding at discharge Infant is in the Special Care Nursery and is on NG feeds. Mom is pumping her breasts to supply milk for her baby.  Breastfeeding at discharge  Not breastfeeding at discharge

Team Take Aways Better understanding from Clinicians regarding requirements for birth certificate data collection Numerous areas documented throughout the patient chart for several of the variables; documentation not always consistent Data personnel did not always have a clear understanding of variables; often had difficulty finding the data in the patient chart

New IPHIS Variables 2014

Education for New IPHIS Variables OPQC – OHD VS webinars November 14 th & 17 th from 12N – 1pm Additional webinars to be added in December Regional site trainings coming in 2015

Summary Birth Registry Data is important!! Hospitals want their data to accurately reflect the work they are doing. OPQC and ODH – VS working together were able to assist hospitals in improving their data accuracy; team work makes the dream work! Ohio is a frontrunner in this type of Quality Improvement work; other states are interested in learning from and working with us!

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