1. PQCNC III The journey continues….

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

3. Update Organizational Efforts –Blueprint –Family recruitment –Site Visits –PQCNC Vermont Oxford Enrollment –Presentations Funding Project Development

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. PQCNC Comparisons Online: Nightingale www.vtoxford.org https://nightingale.vtoxford.org/login.aspx? ReturnUrl=%2freports.aspxhttps://nightingale.vtoxford.org/login.aspx? ReturnUrl=%2freports.aspx MartyMc123456

11. 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

12. IFF Timeline

13. Funding Committed supporters in the State Legislature (Senators Purcell and Dalton) Recurring funds through the Education Committee for 2 years

14. 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!

15. Outreach Education in Perinatal Care Dr. Joe Holliday Head Women’s Health Branch Division of Public Health NC

16. 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

17. 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

18. 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

19. Top Hospit als 93% 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% 90% 86% 75% 56% Proper Antibiotics Within 4 Hours of Arrival at Hospital www.hospitalcompare.hhs.gov

20. Prince George's Hospital Centerrince George's Hospital Center1225.1 Shady Grove Adventist Hospital1914.2 Sinai Hospital1816.1 Southern Maryland Hospital Center584.6 St. Agnes Hospital1064.4 St. Joseph Medical Center1176.2 St. Mary's Hospital322.5 Neonatal Indicators Maryland Health Care Commission LOS Vol

21. 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 4 th degree lacerations –Successful collaboratives will have the opportunity to be part of these discussions

22. 2006 PQCNC Report

23. 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

33. PQCNC Blueprint

34. 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

35. PQCNC Blueprint Why do we need a perinatal Collaborative? The mission and objectives of PQCNC Keys to our success –Data –Collaboration –Action –Analysis –Education

36. 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

37. PQCNC Structural Organization Data Comm Project Committee Projects & Education Participating Centers PQITs Communications (incl. website) Quality Improvement Consultants Data Management VON Executive Committee Advisory Board Administrative Core ADVISORY RESPONSIBILITIESOPERATIONAL RESPONSIBILITIES Education Committee Other data sets

38. Families and PQCNC

39. PQCNC Executive Board

40. 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

41. 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

42. 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

43. Project Proposals

44. Project Selection

45. 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

46. 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

47. 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

48. Thank You!