1. SACIM Assuring Safety & High Quality, Patient-centered services along the continuum of perinatal care Presented by: Virginia Pressler, MD Executive Vice President Chief Strategic Officer Nov 14, 2012 L’Enfant Plaza Hotel, Wash DC

2. Kapi‘olani Medical Center for Women & Children - Quest for Safety & Quality Outcomes Evidence Based Care (Core measures) Patient Experience Harm Avoidance/Complications Transitions of Care - readmissions End of Life – Advance Care Planning Innovations- Perinatal Harm/Ambulatory OB (2013)

3. Evidence Based Care Vermont Oxford Registry – largest national neonatal data base IHI Perinatal Collaborative The Joint Commission Perinatal Core Measures

4. Harm Avoidance Ventillator Associated Pneumonia Central Line Associated Blood Stream Infection Perinatal Adverse Outcomes Catheter Associated UTI (2013) MRSA, C.Difficile (2013)

5. TJC PCM Core Measure Elective Delivery at 37 or 38 weeks Gestational Age ↓ Lower is Better

6. TJC PCM Core Measure C. Section for Nulliparous Women with Term, Singleton, Vertex Babies ↓ Lower is Better

7. TJC PCM Core Measure Patients at Risk of Preterm Delivery (24-32 Weeks) Receiving Antenatal Steroids Prior to Delivery ↑ Higher is Better

8. TJC PCM Core Measure Health Care Associated BSI in Newborns ↓ Lower is Better

9. TJC PCM Core Measure Newborns Who Were Fed Only Breast Milk Since Birth ↑ Higher is Better

10. PCM CORE MEASURE

11. NEC reduction Colostrum tube fed in NICU Encourage exclusive breast feeding Donor banked breast milk when needed Transfusion protocol changes – smaller aliquots of blood and holding tube feedings during blood transfusions

12. AMA-PCPI ACOG/NCQA Maternity Care Measures Under Testing Establishment of gestational age Prenatal Care Screening Behavioral Health Risk Assessment BMI Assessment & Weight Gain Recommendations Care Coordination: Prenatal Record Present at time of delivery Post Partum Follow up – breast feeding, depression, family planning

13. Following Best Practices Ongoing communication Best practices alerts on EMR Appropriate screens on EMR Easy/retrievable information Data collection & benchmarking Timely reporting of outcomes