1. Milestones from the Past / A Spotlight on the Future Quality Improvement Operations Management Research Randall Wetzel, MD, MBA - Chief Executive Officer, VPS - VPS Board Member - Chairman, Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles

2. The MISSION of VPS To improve critical care quality and outcomes for all children and their families through collaborative high quality data management and actionable comparative reports for clinicians and other health care leaders.

4. Participating Units In VPS: 124

5. The VPS Registry

6. VPS Enhancements VPS Comparative Database Started Risk Adjustment PIM 2 (required) PRISM 2 PRISM 3 PCPC / POPC Added Site Profiles Initiated (comparison group developed) VPS BETA Version VPS v3.5 VPS v4.1 VPS v5.0 Data Collection Profiles ( completed non-required fields) User requested improvements PRISM 3 individual scores PELOD VPS WEB Cardiac Module Quality Module Diagnosis/Procedure Enhancements Post-Index Scoring PIM/PRISM Adjusted LOS Recalibrated myReports PICSIM PIM 3 20022003 20042005 2006 2007 2008 2011 2012 2013 Minimum dataset plus non-required fields 2014

7. VPS: The Initial Vision Back in 1997, Dr. Tom Rice and Dr. Randall Wetzel…..

8. VPS: Our Roots 1997: Collaboration between NACHRI PICU FOCUS group and CHLA’s Virtual Pediatric Intensive Care Unit (VPICU) – Goal: Create data solutions to support the improvement and research interests of pediatric critical care clinicians and leaders Critical Care Clinicians, ICU Administrators, hospital leaders, and others developed the first data collection system The National Outcomes Center (CHHS, Milwaukee) joined VPS to provide quality control, scientific and reporting services

9. * since 2004 VPS Annual, Quarterly and CCS Reports Completed VPS Reports: 1,630

10. Use of VPS Data for Research Sample of Recent Research Requests PICU Volume and Outcomes Validation of the PIM2 Risk of Mortality Tool in the United States Predictive Models of Readmission to the PICU Deaths in the PICU: Timing and Associations Development of a risk-adjusted morbidity tool for the pediatric intensive care unit Developing a methodology to benchmark PICU functional outcomes Racial and Ethnic Health Care Disparities in the PICU: Acute Respiratory Failure The use of Rotary Wing Interfacility Transport Decreases Mortality for Pediatric Patients Admitted to PICUs The Epidemiology of Catheter-Associated Bloodstream Infections in a Multi-Center Ethnic differences in timing of stages of Single Ventricle Palliation and its impact on Outcome Respiratory Failure in Children with Acute Asthma Ventilator Associated Pneumonia Registry Early Enteral Nutrition in the PICU 94 Topics in the VPS Research Database

11. VPS Reporting Services myReports: On demand querying of data by users with requisite access Standardized Reports: Generate reports on demand by users Data Downloads: Users access data with ability to manipulate in Excel or Access Annual and Quarterly Comparative Program Performance Reports – User defined comparison group – Statistically analyzed and professionally presented – One-on-one consultation with each unit to interpret results/generation of recommendations for improvement Ad Hoc Data Requests Coming June 2015: VPS Analytics

12. VPS Cardiac Cardiac Surgical Specific Risk Adjustment Allows for Stronger Comparisons Pediatric Index of Cardiac Surgical Intensive Care Mortality (PICSIM score) * Stay Tuned for the Dr. Howard Jeffries Presentation, Thursday @ 10:50a

13. VPS Cardiac Supports both free standing CICUs and mixed PICUs to strengthen the ability to compare outcomes and benchmark best practices. Allows following patients across the continuum of care. Promotes guidance of future developments through collaboration to improve the overall care of cardiac patients Facilitates current and future program advancements through a dynamic alliance of cardiac advisory team physicians. Supports group research efforts to strengthen the knowledge base and improve pediatric cardiac critical care.

14. The VPS Quality Module Developed to support the needs of our customers in providing data for required and voluntary reporting Includes the three pediatric critical care core measures endorsed by the National Quality Forum – PRISM 3 standardized mortality ratio, PRISM 3 adjusted length of stay, and unplanned readmission rate within 24 hours including case level review of all unplanned readmissions – Baseline and ongoing pain assessment/reassessment (previously endorsed by NQF and required by The Joint Commission) For on demand production of automated reports to support unannounced visits and urgent requests for data

15. Questions? We have come a long way Together!