Art and Science of Medicine Meets Quality improvement
|
|
- Leo Dalton
- 8 years ago
- Views:
Transcription
1 Art and Science of Medicine Meets Quality improvement Elliott Main, MD Medical Director, CMQCC Clinical Professor, Depts of OB/GYN UCSF, and Stanford University
2 CPQCC and CMQCC California Perinatal Quality Care Collaborative (CPQCC) Multi-stakeholder organization established in 1996 (providers, state agencies, public groups like MOD) Established Perinatal Data Center in 1996, works with VON Data submission for VON Plus data system with 131 out of 136 NICUs with >17,000 annual admissions; Over 10 quality toolkits and related collaboratives Model of working with state agencies to provide data of value California Maternal Quality Care Collaborative (CMQCC) Expertise in maternal data analysis, MMR (2006) Developer of QI toolkits: Early Elective Delivery, OB Hemorrhage, Preeclampsia, CVD in Pregnancy, and First Cesarean Prevention Host of collaborative learning sessions Established Maternal Data Center in 2011
3 CMQCC Key Partner/Stakeholders State Agencies: MCAH, Dept Public Health OSHPD Healthcare Information Division Office of Vital Records (OVR) Regional Perinatal Programs of California (RPPC) DHCS, Medi-Cal Public Groups California Hospital Accountability and Reporting Taskforce (CHART) California HealthCare Foundation Kaiser Family Foundation March of Dimes (MOD) Professional groups American College of Obstetrics and Gynecology (ACOG) Association of Women s Health, Obstetric and Neonatal Nurses (AWHONN) American College of Nurse Midwives (ACNM), American Academy of Family Physicians (AAFP) Key Medical and Nursing Leaders Universities and Hospital Systems Kaisers, Sutter, Sharp, Dignity, Scripps, Providence, Public hospitals,
4 CMQCC Key Partner/Stakeholders (con t) Medical Associations: California Hospital Association Regional Hospital Associations California Medical Association Payers Aetna Anthem Blue Cross Blue Shield Cigna Health Net Purchasers CALPERS (State and local government employees and retirees) Medi-Cal (for managed care plans) Pacific Business Group on Health/ Silicon Valley Employers Forum Cover California (ACA entity)
5 CMQCC: Major Areas of Activity Maternal Mortality and Morbidity Reduction Large- Scale Implementation Maternal Data Center Maternity Quality Measures 5
6 12- Step Program for Quality Improvement 1) Memory v. Data 2) Defenses 3) Burning Platform 4) External Measures 5) Variation 6) Autonomy 7) Translation 8) Pressures 9) Small Risks 10) Culture 11) Normalization 12) Just Do It : Transforming Maternity Care
7 1. Memory-Driven vs. Data-Driven QI : Transforming Maternity Care
8 Limitations of Memory-guided Practice Hard to remember beyond the last 10 cases and the last terrible outcome No denominators, no sense of rates Driven by anecdote and local custom Advantages of Data-driven Practice Full knowledge of rates and outcomes, of yourself, your unit and the state Not overly influenced by isolated cases Driven by evidencebased medicine and basic standards : Transforming Maternity Care
9 Elimination of Non-medically Indicated (Elective) Deliveries Prior to 39 Weeks Funding Federal Title V block grant from the California Department of Public Health; Maternal, Child and Adolescent Health Division California Maternal Quality Care Collaborative March of Dimes
10 Percent Affected Adverse Neonatal Outcomes According to Completed Week of Gestation at Delivery: Absolute Risk 16% 14% 12% 37+ Weeks 38+ Weeks 39+ Weeks 10% 8% 6% 4% 2% 0% Any adverse Adverse outcome or death respiratory outcome(overall) RDS TTN Admission to NICU Newborn Sepsis (suspected or proven) Tita AT, et al, NEJM 2009;360:111
11 Odds Ratios Adverse Neonatal Outcomes According to Completed Week of Gestation at Delivery: Odds Ratios Weeks 38+ Weeks 39+ Weeks Any adverse Adverse outcome or death respiratory outcome(overall) RDS TTN Admission to NICU Newborn Sepsis (suspected or proven) Treated Hospitalization > hypoglycemia 5 days Tita AT, et al, NEJM 2009;360:111
12 Mean EED Rate in California (%) Na onal and California Reduc on of Early Elec ve Deliveries (EED) >75% Reduction (Baseline, MOD) 2011 (Baseline, LFG) 2014 (Leap Frog Group) 2013 (Joint Commission) 2013 (CMS) 2014 Nationally, CMS estimates an 80% reduction in EED
13 EED Success: Collective Impact Prof Orgs (Natl and Local) Public Policy Public advocates Performance measures Data-driven QI EED Public Reporting Evidence 70-80% Reduction Nationally! Payment Incentives
14 2. Recognize the Defenses : Transforming Maternity Care
15 Self-Defense Manual for Medical Professionals 1970, 1980, 1990, 2000, : Transforming Maternity Care
16 Table of Contents: The best defense is a good offense. Chapter One: Attack the Data Chapter Two: Attack the Messenger Chapter Three: Attack the Premise When all else fails, there is always. Chapter Four: My Patients are Higher Risk : Transforming Maternity Care
17 Appendix: Counter Strategies Data: Clean carefully before presentation- Be very certain about case attribution Example: every obstetrician who covers midwives or FP s will have higher CS rates Premise: Good to have backing of national organization(s) Risk Adjustment: simple strategies best- Risk stratification v. logistic regression Process measures do not need risk adjustment! : Transforming Maternity Care
18 CMQCC Maternal Data Center PDD Discharge Diagnosis File (ICD9/10 Codes) Monthly uploads: mother and infant PDD (participating hospitals) Automated Linkage of all 3 files Birth Certificate (Clinical Data) Monthly uploads: electronic files for all CA births Chart Review (select metrics/qi projects) Maternal Data Center Limited manual data entry for these measures Interactive Analytics Guide QI Practice Links over 1,000,000 mother/baby records each year!
19 3. Build the Burning Platform : Transforming Maternity Care
20
21 Kotter s Eight Steps of Change
22 Rate per 100,000 Live Births Number of Maternal Deaths Maternal Mortality Rate California Residents and United States: ICD-9 ICD California Rate 8.9 United States Rate HP2010 Objective HP 2010 Objective 4.3 Deaths per 100,000 Live Births SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, Maternal mortality for California (deaths 42 days postpartum) calculated using ICD-9 cause of death classification (codes , , ) for and ICD-10 cause of death classification (codes A34, O00-O95,O98-O99) for United States data and HP2010 Objective were calculated using the same methods. The break in the trend line represents the change from ICD-9 to ICD-10. Produced by California Department of Public Health, Maternal, Child and Adolescent Health Program, June : Transforming Maternity Care
23 THE CALIFORNIA PREGNANCY-ASSOCIATED MORTALITY REVIEW Report from Maternal Death Reviews This project was supported by federal Title V block grant funds received from the California Department of Public Health; Center for Family Health; Maternal, Child and Adolescent Health Division
24 Causes of Maternal Mortality and Morbidity Cause Mort. ICU Serious Morbid VTE and AFE 10% 5% 2% Infection 15% 10% 5% Hemorrhage 15% 30% 45% Preeclampsia / CVA 20% 30% 30% Cardiac Disease 20% 15% 10% : Transforming Maternity Care
25 CMQCC Hemorrhage Task Force: 5 meetings in Developed a Tool Kit for OB services: Set of Best Practices (short summaries of key aspects of OB hemorrhage) Checklist for managing OB hemorrhage Flow-Chart and Table Chart Summaries of approach Implementation tools such as sample policies, procedures, charting examples, implementation hints All resources on-line at: CMQCC has sponsored an IHI-like Learning Collaboratives to help sites implement : Transforming Maternity Care
26 CMQCC California OB Hemorrhage Project 26 Hemorrhage Taskforce ( ) QI Toolkit/Best Practices CHW QI Project (2009) 1 st CMQCC Statewide Collaborative ( ) 30 hospitals (110,000 annual births) Large/small, urban/rural New CMQCC Collaboratives (2011) Statewide: 20+ hospitals (still open) LA County: 11 hospitals Systems: Kaiser North and South; Sutter Enhanced Website resources
27 Obstetrics & Gynecology April 2015 Pregnancy-related mortality should not be considered a single clinical entity. The five leading causes exhibit different characteristics, degrees of preventability, and contributing factors, with the greatest improvement opportunities identified for hemorrhage and preeclampsia.
28 Provider Contributing Factors in Maternal Deaths (California) From detailed chart reviews of maternal deaths (CA-Pregnancy Associated Mortality Review Committee; CDPH-MCAH) Main EK, McClain CL, Morton CH, Holtby S, Lawton ES. Pregnancy-related mortality in California: Causes, characteristics and improvement opportunities. Obstet Gynecol 2015
29 California Approach to Reduce Maternal Mortality and SMM Hemorrhage Taskforce (2009) Hemorrhage QI Toolkit (2010) Multi-hospital QI Collaborative(s) ( ) Test the tools and implementation strategies State-wide Implementation ( ) Preeclampsia Taskforce (2012) Preeclampsia QI Toolkit (2013) Multi-hospital QI Collaborative ( ) Cardiovascular Detailed Case Analysis (2013) Cardiovascular QI Toolkit (2015)
30 Maternal Deaths per 100,000 Live Births Maternal Mortality Rate, California and United States; California Rate United States Rate HP 2020 Objective 11.4 Deaths per 100,000 Live Births Year SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, Maternal mortality for California (deaths 42 days postpartum) was calculated using ICD-10 cause of death classification (codes A34, O00-O95,O98-O99). United States data and HP2020 Objective use the same codes. U.S. maternal mortality data is published by the National Center for Health Statistics (NCHS) through 2007 only. U.S. maternal mortality rates from 2008 through-2013 were calculated using CDC Wonder Online Database, accessed at March 11, Produced by California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, March, 2015.
31 National Partnership for Maternal Safety: 3 Maternal Safety Bundles in 3 Years What every birthing facility in the US should have Obstetric Hemorrhage Preeclampsia/ Hypertension Prevention of VTE in Pregnancy Note: The bundles represent outlines of highly recommended protocols and materials important to safe care BUT the specific contents and protocols should be individualized to meet local capabilities. Example materials are available from perinatal collabortives and other organizations. 31
32 5 Key Complimentary Strategies: 1) QI projects for labor management practices 2) Payment reform to eliminate negative or perverse incentives 3) Education for the value of normal birth (culture) 4) Transparency with Public Reporting 5) Continued public engagement Main EK et al. Obstet Gynecol Nov 2012;120(5):
33 5. Variation Reflects Opportunity : Transforming Maternity Care
34 % 70% Large Variation of Total CS Rate Among 251 California Hospitals: % 50% 40% Range: % Median: 32.5% Mean: 32.8% 30% 20% 10% Will this degree of variation remain after risk adjustment? 0% Hospitals
35 % 70% Even Larger Variation of NTSV CS Rate Among 251 California Hospitals: % 50% 40% 30% Range: % Median: 27.0% Mean: 27.7% National Target =23.9% 20% 10% 0% 36% of CA hospitals meet national target Large Variation = Improvement Opportunity Hospitals
36 CHCF Infographic Released November 2014 CHCF reports over 11,000 page views in first week and very positive feedback calqualitycare.org
37 New National Guidelines for Defining Labor Abnormalities and Management Options
38 % 70% Even Larger Variation of NTSV CS Rate Among 251 California Hospitals: % 50% 40% 30% Range: % Median: 27.0% Mean: 27.7% National Target =23.9% 3 Pilot Hospitals for Interventions 20% 10% 0% 36% of CA hospitals meet national target Large Variation = Improvement Opportunity Hospitals
39 This is the same Orange County as depicted in the popular television show. This is the hospital where most of these mothers deliver Not the easiest population to start with
40 3 Major Drivers of the Primary CS Rate
41 3 Major Drivers of the NTSV CS Rate
42 Provider-Level Cesarean Rates G5xxxx G6xxxx G7xxxx G8xxxx A8xxxx A6xxxx A5xxxx A4xxxx A8xxxx A9xxxx
43 Data-Driven QI: NTSV CS Pilot Hospital: Orange County 35% 33% 32.9% 33.6% 31.2% 31.8% NTSV CS Rate 30% 28% 25% 23% 20% 18% 15% National Target for NTSV CS = 23.9% Jan-14 Feb-14 Mar-14 Apr-14 Apr14 May
44 Data-Driven QI: NTSV CS Pilot Hospital: Orange County 35% 33% 32.9% 33.6% 31.2% 31.8% NTSV CS Rate 30% 28% 25% 23% 20% QI Project Started: Jan % 18% 15% National Target for NTSV CS = 23.9% Jan-14 Feb-14 Mar-14 Apr-14 Apr14 May
45 CMQCC Data-Driven QI: NTSV CS Pilot Hospital: Orange County 35% 33% 32.9% 33.6% 31.2% 31.8% NTSV CS Rate 30% 28.3% 28% 25% 23% QI Project Started: Jan % 20% 18% 15% National Target for NTSV CS = 23.9% Jan-14 Feb-14 Mar-14 Apr-14 Apr14 May
46 Data-Driven QI: NTSV CS Pilot Hospital: Orange County 35% 33% 32.9% 33.6% 31.2% 31.8% NTSV CS Rate 30% 28.3% 28% 25% 23% QI Project Started: Jan % 25.0% 20% 18% 15% National Target for NTSV CS = 23.9% Jan-14 Feb-14 Mar-14 Apr-14 Apr14 May
47 Data-Driven QI: NTSV CS Pilot Hospital: Orange County 35% 33% 32.9% 33.6% 31.2% 31.8% NTSV CS Rate 30% 28.3% 28% 25% 23% QI Project Started: Jan % 25.0% 23.4% 20% 18% 15% National Target for NTSV CS = 23.9% Jan-14 Feb-14 Mar-14 Apr-14 Apr14 May
48 No Change in Baby Outcomes: Rate of Unexpected Newborn Complications Hoag Hospital Intervention Period Dec - Feb 2015
49 % 70% 60% Low-Risk First-Birth (Nuliparous Term Singleton Vertex) CS Rate (endorsed by NQF, TJC PC-02, CMS, HP2020) Among 249 California Hospitals: (Source: CMQCC--California Maternal Data Center combining primary data from OSHPD and Vital Records) 50% Hoag Hospital 40% 30% Range: % Median: 27.0% Mean: 27.7% National Target =23.9% 20% 10% 36% of CA hospitals meet national target For the last 3 mos, the rate was 22.5% 0% July 24,
50 Collaborative Action: Collective Impact Clinical Leaders Datadriven QI Public Reporting Public Policy Quality measures NTSV CS Public advocates Strong Evidence Payment Incentives Multiple Pressure Points are much more effective than one or two alone
51 Thank you, from all of us at CMQCC! Elliott Main, MD David Lagrew, MD Kathryn Melsop, MS Christine Morton PhD Anisha Abreo, MPH Andrew Carpenter Jeffrey Gould, MD MPH Barbara Murphy, RN MSN Julie Vasher, DPN, CNS Nancy Peterson, RN MS Valerie Cape Allana Moore
Improving Perinatal Care in California: Reaching 500,000 Annual Births
Improving Perinatal Care in California: Reaching 500,000 Annual Births HQI Annual Conference: November 2015 Funding from: California HealthCare Foundation Centers for Disease Control California Dept. Public
More informationThe WSHA Maternal Data Center (WSHA-MDC) Elliott Main, MD CMQCC Medical Director Anne Castles, MPH, MA MDC Project Manager
The WSHA Maternal Data Center (WSHA-MDC) Elliott Main, MD CMQCC Medical Director Anne Castles, MPH, MA MDC Project Manager National Perinatal Reporting Activities Who? Center for Medicare Services (CMS)
More informationThe California Maternal Data Center (CMDC): Resources for your Perinatal Safety Program
The California Maternal Data Center (CMDC): Resources for your Perinatal Safety Program Southern California Patient Safety First Collaborative Anne Castles Project Manager, CMDC acastles@cmqcc.org CMQCC
More informationImplementing Maternity Bundled Payment To Reduce Low-risk First-birth Cesarean Births: A Multi-Stakeholder Initiative
Implementing Maternity Bundled Payment To Reduce Low-risk First-birth Cesarean Births: A Multi-Stakeholder Initiative Elliott Main MD, CMQCC Brynn Rubinstein, PBGH Agenda 1. Pilot Overview (Brynn) 2. Quality
More informationThe California Maternal Data Center (CMDC)
The California Maternal Data Center (CMDC) Anne Castles, MPH, MA Kathryn Melsop, MS CMDC Project Managers Elliott Main, MD CMQCC Medical Director Using Data to Drive Excellence in Maternity Care CMQCC
More informationTHE OREGON MATERNAL DATA CENTER (OMDC) Detailed FAQ for Hospitals
THE OREGON MATERNAL DATA CENTER (OMDC) A statewide initiative of Q Corp, the March of Dimes and the Oregon Perinatal Collaborative Detailed FAQ for Hospitals What is the Oregon Maternal Data Center? The
More informationThe California Maternal Data Center (CMDC) Anne Castles, MPH, MA CMDC Project Manager Elliott Main, MD CMQCC Medical Director
The California Maternal Data Center (CMDC) Anne Castles, MPH, MA CMDC Project Manager Elliott Main, MD CMQCC Medical Director Using Data to Drive Excellence in Maternity Care CMQCC and CPQCC Mission: Improving
More informationBarbara Murphy, RN, MSN Director, CPQCC Director, Perinatal Programs Division of Neonatal and Developmental Medicine Stanford University
Barbara Murphy, RN, MSN Director, CPQCC Director, Perinatal Programs Division of Neonatal and Developmental Medicine Stanford University A group of CA leaders in healthcare, Committed to improving care
More informationElimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age
Errata #2 8/31/11 A California Toolkit to Transform Maternity Care Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age This collaborative project was developed
More informationInnovation Profile: A collaborative effort to reduce early inductions.
Innovation Profile: A collaborative effort to reduce early inductions. Snapshot Summary The Sutter Medical Center Sacramento implemented a data driven and collaborative intervention to addressed elective
More informationCardiovascular Disease and Maternal Mortality what do we know and what are the key questions?
Cardiovascular Disease and Maternal Mortality what do we know and what are the key questions? AFSHAN HAMEED, MD, FACOG, FACC Associate Clinical Professor Maternal Fetal Medicine and Cardiology University
More informationMassachusetts Maternal Hemorrhage Clinical Improvement Initiative
Massachusetts Maternal Hemorrhage Clinical Improvement Initiative Maternal Hemorrhage Initiative 2010 Lehman Center OB Safety Panel Report made five (5) recommendations to improve maternal newborn care
More informationPregnancy-Related Deaths Due to Cardiomyopathy - Florida, 1999-2010
Pregnancy-Related Deaths Due to Cardiomyopathy - Florida, 1999-2010 THE FLORIDA PREGNANCY-ASSOCIATED MORTALITY REVIEW (FL-PAMR), 1999-2010 Funded through Title V MCH Block Grant FL-PAMR HISTORY In 1996,
More informationPUBLIC-PRIVATE PARTNERSHIPS
PUBLIC-PRIVATE PARTNERSHIPS Ohio Medicaid s Experience in Improving Children s Quality of Care & Reducing Costs through Collaboration and Improvement Science Mary Applegate, MD, FAAP. FACP Ohio Medicaid
More informationSection 3. Innovative Models
Section 3. Innovative Models 3. Innovative Models This section outlines the processes, methods and outcomes from five different hospitals and systems as they have worked to improve maternal and infant
More informationAccess to Appropriate Services for High Risk. in New York State. New York State Department of Health
Access to Appropriate Services for High Risk Neonates in New York State Di i i f F il H l h Division of Family Health New York State Department of Health Perinatal Regionalization in New York State Perinatal
More informationCesarean delivery rates in California and the United
Current Commentary Creating a Public Agenda for Maternity Safety and Quality in Cesarean Delivery Elliott K. Main, MD, Christine H. Morton, PhD, Kathryn Melsop, MS, David Hopkins, PhD, Giovanna Giuliani,
More informationMeasure Information Form
**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE** Measure Set: Perinatal Care(PC) Set Measure ID: PC-05 Measure Information Form Performance Measure Name: Exclusive Breast Milk Feeding Description:
More informationMaternity Care Primary C-Section Rate Specifications 2014 (07/01/2013 to 06/30/2014 Dates of Service)
Summary of Changes Denominator Changes: Two additions were made to the denominator criteria. The denominator was changed to include patients who had: a vertex position delivery AND a term pregnancy of
More informationOregon Birth Outcomes, by Planned Birth Place and Attendant Pursuant to: HB 2380 (2011)
Oregon Birth Outcomes, by Birth Place and Attendant Pursuant to: HB 2380 (2011) In 2011, the Oregon Legislature passed House Bill 2380, which required the Oregon Public Health Division to add two questions
More informationPOLICIES AND PROCEDURES
Purpose: To establish guidelines for the clinical practice of Nurse Midwives. Policy: The Central California Alliance for Health (the Alliance) requires all Nurse Midwives to meet the Alliance s guidelines
More informationACOG SMI Implementation Visit to South Nassau Communities Hospital
ACOG SMI Implementation Visit to South Nassau Communities Hospital Janet Shelters, RN, BS, CEN Nurse Manager, Labor and Delivery Alyson Ornstein, RN, BSN, CBC Nurse Manager, NICU/Maternity Hospital Description
More informationWendy Martinez, MPH, CPH County of San Diego, Maternal, Child & Adolescent Health
Wendy Martinez, MPH, CPH County of San Diego, Maternal, Child & Adolescent Health Describe local trends in birth Identify 3 perinatal health problems Identify 3 leading causes of infant death Age Class
More informationClinical Policy Title: Home uterine activity monitoring
Clinical Policy Title: Home uterine activity monitoring Clinical Policy Number: 12.01.01 Effective Date: August 19, 2015 Initial Review Date: July 17, 2013 Most Recent Review Date: July 15, 2015 Next Review
More informationCalifornia Children s Services Program Analysis Final Report
California Children s Services Program Analysis Final Report Paul H. Wise, MD, MPH Vandana Sundaram, MPH Lisa Chamberlain, MD, MPH Ewen Wang, MD Olga Saynina, MS Jia Chan, MS Kristen Chan, MASc Beate Danielsen,
More informationWho Is Involved in Your Care?
Patient Education Page 3 Pregnancy and Giving Birth Who Is Involved in Your Care? Our goal is to surround you and your family with a safe environment for the birth of your baby. We look forward to providing
More informationCertified Nurse-Midwife and Women s Health Care Nurse Practitioner
Certified Nurse-Midwife and Women s Health Care Nurse Practitioner Practice Agreements at Chicago Revised March 2007 TABLE OF CONTENTS SIGNATURES OF AGREEMENT 3 ORGANIZATION RELATIONSHIPS AND MEMBERSHIP
More informationPerinatal Care (PC) Core Measures: Updates for Fall 2015 Webinar Question and Answer Session
Updates for Fall 2015 and Answer Session Should we continue submitting the PC-5a data until October? ACOG definition of full term is 39-41 weeks. What is the rationale for including 37 & 38 weeks in the
More informationRegina Grazel, MSN RN BC APN-C
Regina Grazel, MSN RN BC APN-C Primary Work Function/Position: CNS, NJ Department of Health CCHD Screening Program Education: UNIVERSITY OF PENNSYLVANIA, Philadelphia, Pennsylvania. MSN in Perinatal Nursing.
More informationInnovative use of Neonatal Nurse Practitioners in Rural Hawaii
Innovative use of Neonatal Nurse Practitioners in Rural Hawaii Petri Pate Pieron, MSN, MPH, APRN Rx, CPNP, NNP Presentation was supported by NIH 1 R25 RR019321 Clinical Research Education and Career Development
More informationTestimony of the American College of Nurse-Midwives. at a Hearing of the House Committee on Energy and Commerce Subcommittee on Health.
Testimony of the American College of Nurse-Midwives at a Hearing of the House Committee on Energy and Commerce Subcommittee on Health on the Improving Access to Maternity Care Act (H.R.1209) Wednesday,
More informationPregnancy Medical Home Update: October 2012
Pregnancy Medical Home Update: October 2012 Pregnancy Medical Home Program Population approach to improving quality of care and birth outcomes for pregnant Medicaid patients while reducing costs launched
More informationHome Health Agencies. Ante & Postpartum Members
FIRST PRIORITY HEALTH /FIRST PRIORITY LIFE INSURANCE COMPANY BLUE CROSS OF NORTHEASTERN PENNSYLVANIA CREDENTIALING CRITERIA FOR OBSTETRIC NURSES IN HOME CARE ADMINISTRATIVE PRACTICE GUIDELINE PROVIDER
More informationNewborn outcomes after cesarean section for fetal distress in BC
Newborn outcomes after cesarean section for fetal distress in BC Patricia Janssen, PhD, UBC School of Population and Public Health Scientist, Child and Family Research Institute Kevin Jenniskens, MSc,
More informationMANA Home Birth Data 2004-2009: Consumer Considerations
MANA Home Birth Data 2004-2009: Consumer Considerations By: Lauren Korfine, PhD U.S. maternity care costs continue to rise without evidence of improving outcomes for women or babies. The cesarean section
More informationSubmission by the Australian College of Midwives (Inc.) in relation to The Australian Safety and Quality Goals for Health Care
Submission by the Australian College of Midwives (Inc.) in relation to The Australian Safety and Quality Goals for Health Care The Consultation Paper titled Australian Safety and Quality Goals for Health
More informationCLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014
CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014 e 55 0495 2 Emergency Department (ED)- 1 Emergency Department Throughput Median time from
More informationFederal Efforts to Improve Maternal and Infant Health Data Capacity and Health Outcomes
Federal Efforts to Improve Maternal and Infant Health Data Capacity and Health Outcomes US Centers for Disease Control and Prevention (CDC) Centers for Medicare & Medicaid Services (CMS) Health Resources
More informationCalifornia Diabetes and Pregnancy Program (CDAPP) Sweet Success
California Diabetes and Pregnancy Program (CDAPP) Sweet Success CDAPP Sweet Success Resource and Training Center INFORMATIONAL WEBINAR Thank you for attending today s webinar. We will begin shortly. The
More informationMidwifery in New York
Midwifery in New York Barbara Hughes, CNM, MS, MBA, FACNM Wilson Hughes Consulting, LLC The culture of midwifery: It s all about listening to women, caring for women, empowering women, and doing the right
More informationDelayed Cord Clamping
ICEA Position Paper Delayed Cord Clamping Position The International Childbirth Education Association recognizes that the first minutes after birth are crucial to both mother and newborn. Optimal care
More informationRacial and Ethnic Disparities in Maternal Mortality in the United States
Racial and Ethnic Disparities in Maternal Mortality in the United States KYRIAKOS S. MARKIDES, PHD UNIVERSITY OF TEXAS MEDICAL BRANCH GALVESTON, TEXAS PRESENTED AT THE HOWARD TAYLOR INTERNATIONAL SYMPOSIUM
More informationManaging Risk in Perinatal Care
Managing Risk in Perinatal Care Stan Davis MD, FACOG Laerdal SUN Conference Philadelphia 2014 Objectives 1) Discuss the medical/legal environment in the perinatal area 2) Identify issues specific to perinatal
More informationInsurance Reimbursement for Post-Pregnancy Long-Acting Reversible Contraception (LARC) Background Benefits of LARC
Insurance Reimbursement for Post-Pregnancy Long-Acting Reversible Contraception (LARC) Shandhini Raidoo MD, Bliss Kaneshiro MD, MPH, Mary Tschann MPH, Reni Soon MD, MPH, Emmakate Friedlander MD, Jennifer
More informationPackages of antenatal care for low-risk pregnancy
Packages of antenatal care for low-risk pregnancy Evolution of knowledge and lessons learnt A. Metin Gülmezoglu G on behalf of Professor Pisake Lumbiganon Outline The background to the WHO antenatal care
More informationHow To Improve Maternity Care In California
Using Data to Improve Maternity Care in California: Research Collaborations and Future Opportunities Symposium Summary Authors Helen W. Wu, PhD Policy and Research Analyst, Institute for Population Health
More informationCorporate Reimbursement Policy
Corporate Reimbursement Policy Guidelines for Global Maternity Reimbursement File Name: Origination: Last Review: Next Review: guidelines_for_global_maternity_reimbursement 10/2003 7/2016 7/2017 Description
More informationIncorporating Life Course, Social Determinants, and Health Equity into California s MCAH Programs
Incorporating Life Course, Social Determinants, and Health Equity into California s MCAH Programs Shabbir Ahmad, DVM, MS, PhD Maternal, Child and Adolescent Health Program Center for Family Health California
More informationBEST- Practice Management Guidelines B: BEST Decision E: Evidence-Based S: Simple & Safe T: Team Focused
OB Excellence: Postpartum Hemorrhage [PPH]-DATA ANALYSIS Perinatal University Speaker/Master Instructor: Carol A. Curran RNC, MS, OGNP CEO & Founder: Clinical Specialists Consulting & Perinatal University
More informationIdaho Perinatal Project Newsletter
Idaho Perinatal Project Newsletter In This Issue Meet the Advisory Board April 2014 Maternal Obesity May Predict Likelihood of Infant Death Antidepressant Use During Pregnancy Doctor's Warn Against Underwater
More informationVITAL STATISTICS ADVISORY COMMITTEE (VSAC) VITAL RECORDS PROTECTION ADVISORY COMMITTEE (VRPAC) JOINT COMMITTEE MEETING
VITAL STATISTICS ADVISORY COMMITTEE () VITAL RECORDS PROTECTION ADVISORY COMMITTEE (VRPAC) JOINT COMMITTEE MEETING PUBLIC HEALTH POLICY AND RESEARCH BRANCH (PHPRB) HEALTH INFORMATION AND RESEARCH SECTION
More informationA8b. Resuscitation of a Term Infant with Meconium Staining. Session Summary. Session Objectives. References
A8b Resuscitation of a Term Infant with Meconium Staining Karen Wright, PhD, NNP-BC Assistant Professor and Coordinator, Neonatal Nurse Practitioner Program Dept. of Women, Children, and Family Nursing,
More informationProgram Name: Post-Master s Certificate - Nursing and Healthcare Leadership
Program Name: Post-Master s Certificate - Gerontology CIP Code: 30.1101 CIP Description: Gerontology Program Length in Credits: 16-28 Program Description: A program that focuses on the human aging process
More informationWhy San JoSe needs a Medical center for WoMen & children APR I L 2 014
Why San JoSe needs a Medical center for WoMen & children APR I L 2 014 SUMMary San Jose is the largest city in the United States without a stand-alone children s hospital. Santa Clara Valley Medical Center
More informationOn behalf of the Association of Maternal and Child Health Programs (AMCHP), I am
Christopher Kus, M.D., M.P.H. Association of Maternal and Child Health Programs, Public Witness Testimony House Labor, Health and Human Services and Education Appropriations Subcommittee March 13, 2013
More informationSARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY
PS1006 SARASOTA MMORIAL HOSPITAL NURSING DPARTMNT POLICY TITL MOTHR/BABY UNIT Job Title of Reviewer FFCTIV DAT RVISD DAT POLICY TYP Director, Women s and Children s Services 7/87 9/15 DPARTMNTAL INTRDPARTMNTAL
More informationNaviCare WatchChild Solution. Perinatal Monitoring and Data Management. A Closer Look
NaviCare WatchChild Solution Perinatal Monitoring and Data Management A Closer Look Helping you take A Closer Look The Hill-Rom NaviCare WatchChild Solution is an integrated and comprehensive Perinatal
More informationA Guide for Enrolling Patients and Clients in Text4baby. Harnessing the Power of Mobile for Maternal & Child Health in the U.S.
A Guide for Enrolling Patients and Clients in Text4baby Harnessing the Power of Mobile for Maternal & Child Health in the U.S. Text4baby Supports Patients Text4baby is the largest mobile health initiative
More informationQuality of Birth Certificate Data. Daniela Nitcheva, PhD Division of Biostatistics PHSIS
Quality of Birth Certificate Data Daniela Nitcheva, PhD Division of Biostatistics PHSIS Data Quality SC State Law requires that you file the birth certificate within 5 days of a child s birth. Data needs
More informationMEMORANDUM. Dr. Michael Lu, Associate Administrator Maternal and Child Health Bureau, Health Resources and Services Administration
MEMORANDUM TO: Dr. Michael Lu, Associate Administrator Maternal and Child Health Bureau, Health Resources and Services Administration FROM: AMCHP Board of Directors DATE: February 14, 2014 RE: Final Recommendations
More informationRural Health Advisory Committee s Rural Obstetric Services Work Group
Rural Health Advisory Committee s Rural Obstetric Services Work Group March 15 th webinar topic: Rural Obstetric Patient and Community Issues Audio: 888-742-5095, conference code 6054760826 Rural Obstetric
More informationNo. 125 April 2001. Enhanced Surveillance of Maternal Mortality in North Carolina
CHIS Studies North Carolina Public Health A Special Report Series by the 1908 Mail Service Center, Raleigh, N.C. 27699-1908 www.schs.state.nc.us/schs/ No. 125 April 2001 Enhanced Surveillance of Maternal
More informationValue-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012
Value-Based Purchasing Program Overview Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012 Presentation Overview Background and Introduction Inpatient Quality Reporting Program Value-Based
More informationCertified Nurse Midwives in Delivery: What benefits they bring! Presented by: Deborah Johnson, CNM Jodee Gutierrez CNM
Certified Nurse Midwives in Delivery: What benefits they bring! Presented by: Deborah Johnson, CNM Jodee Gutierrez CNM History of Midwifery Midwife means with woman French Sage femme Spanish La Partera
More informationSection 4. Managing Change
Section 4. Managing Change 4. Managing Change Introduction Every system is perfectly designed to get the results it gets. Paul Batalden, MD This section offers a conceptual model for managing change, establishing
More informationWAPC Infant and Family Committee Minutes May 10, 2013, 10:00 a.m. 2:30 p.m. WAPC Office, Madison, WI
WAPC Infant and Family Committee Minutes May 10, 2013, 10:00 a.m. 2:30 p.m. WAPC Office, Madison, WI Participants: Mary Jo Snorek, Chair, Sarah Antczak, RN; Children s Hospital of Wisconsin, Milwaukee
More informationCDC National Survey of Maternity Practices in Infant Nutrition and Care (mpinc)
OMB #0920-0743 EXP. DATE: 10/31/2010 CDC National Survey of Maternity Practices in Infant Nutrition and Care (mpinc) Hospital Survey Conducted for Centers for Disease Control and Prevention National Center
More informationNew York State Ten Steps to a Breastfeeding Friendly Practice Implementation Guide June 2014
Ten Steps to a Breastfeeding Friendly Practice 1. Develop and maintain a written breastfeeding friendly office policy. 2. Train all staff to promote, support and protect breastfeeding and breastfeeding
More informationNational Outcome Measures and National Performance Measures Kansas Maternal and Child Health Services Block Grant 2016 Application/2014 Annual Report
NOM # 1 2 3 National Outcome Measures and National Performance Measures Kansas Maternal and Child Services Block Grant National Outcome Measures Percent of pregnant women who receive prenatal care beginning
More informationCertified Professional Midwives Caring for Mothers and Babies in Virginia
Certified Professional Midwives Caring for Mothers and Babies in Virginia Commonwealth Midwives Alliance Certified Professional Midwives in VA Licensed by the BOM since January 2006 5 member Midwifery
More informationClaudia Benton, MSN, RN-BC, PHN Erin Slack, MPH February 12, 2014
Claudia Benton, MSN, RN-BC, PHN Erin Slack, MPH February 12, 2014 Present local data highlights, including bright spots, areas for improvement and data of interest Provide a summary list of areas for improvement
More informationDevelop strategies to increase provider participation.
Critical Component: Access to Health Insurance and Medical Homes Goal 1: Comprehensive Medical Home for Mother and Child * A. Increase the percentage of mothers and children 0-5 who have access to a medical
More informationIntroduction. Health is a precious commodity for all people of Utah. It provides a richer context for life experiences and is a driver for a
Strategic Plan 2012 Introduction Health is a precious commodity for all people of Utah. It provides a richer context for life experiences and is a driver for a number of key community and economic issues.
More informationACNM Department of Advocacy and Government Affairs Grassroots Advocacy Resources State Fact Sheet: Alabama
ACNM Department of Advocacy and Government Affairs Grassroots Advocacy Resources State Fact Sheet: Alabama The American College of Nurse- Midwives (ACNM) is the national organization representing the interests
More informationObstetrical Hemorrhage and Obstetric Laceration Workgroup
Obstetrical Hemorrhage and Obstetric Laceration Workgroup Purpose To develop standard clinical definitions on select diagnoses & categories to be used consistently across all hospitals in Maryland Definitions
More informationmidwifery/ alternative births Mother-Baby Resource Guide
midwifery/ alternative births Mother-Baby Resource Guide INTRODUCTION St. Luke s Hospital & Health Network, its physicians, nurses and ancillary staff in the Department of Obstetrics and Gynecology liberally
More informationDelivery System Reform Incentive Pool Plan (DSRIP) One Hospital s Experience
Delivery System Reform Incentive Pool Plan (DSRIP) One Hospital s Experience Carolyn Brown, Director Quality and Safety Vickie Wilson, Manager - DSRIP ABOUT US Santa Clara Valley Hospital and Health System
More informationMARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE FAMILY HEALTH ADMINISTRATION CENTER FOR MATERNAL AND CHILD HEALTH. Maternal Mortality Review Program
MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE FAMILY HEALTH ADMINISTRATION CENTER FOR MATERNAL AND CHILD HEALTH Maternal Mortality Review Program 2010 ANNUAL REPORT Martin O Malley Governor Anthony
More information2016 Board Nominations Slate. Board of Directors
2016 Board Nominations Slate Board of Directors David McLean, MD, MPH, FACOG, C-EFM MD, University of West Indies, Jamaica MPH, Columbia University, New York Attending Physician Department of Ob/Gyn LeHigh
More informationCatherine Dodd, RN, PhD Director, Health Service System
Catherine Dodd, RN, PhD Director, Joint Labor Management Wellness Committee Presentation January 2013 Total Medical Premium Costs 2011-12 Kaiser $282.6M Blue Shield $275.6M City Plan $65.5M Kaiser and
More informationAdvanced Registered Nurse Practitioners. Dr. Liane Connelly Fort Hays State University
Advanced Registered Nurse Practitioners Dr. Liane Connelly Fort Hays State University What is an ARNP? In Kansas ARNPs are Registered Nurses with a Bachelor of Science in Nursing Degree They have completed
More informationInnovations in Value-Based Insurance Design Improving Care and Bending the Cost Curve. A. Mark Fendrick, MD
Innovations in Value-Based Insurance Design Improving Care and Bending the Cost Curve A. Mark Fendrick, MD University of Michigan Center for Value-Based Insurance Design www.vbidcenter.org IOM Roundtable
More informationQuality Maternity Care: the Role of the Public Health Nurse
Quality Maternity Care: the Role of the Public Health Nurse Lori Webel-Edgar RN, MN Program Manager-Reproductive Health Simcoe Muskoka District Health Unit Barrie, Ontario session overview quality maternity
More informationUsing CDS (Clinical Decision Support) for Quality Initiatives at a Community Hospital
Using CDS (Clinical Decision Support) for Quality Initiatives at a Community Hospital Jonathan Sykes MD, CMIO Jacalyn Liebowitz RN, MBA,NEA-BCFACHE VP Care Continuum Allegiance Health - Jackson, MI DISCLAIMER:
More informationAHE 232 Introduction to Clinical Software. Week ten:
AHE 232 Introduction to Clinical Software Week ten: Note: I have set up the entire curriculum for this class with weekly lesson plans. This will allow the Instructor to determine how to incorporate the
More informationHow To Stop A Pregnant Addict From Getting A Jail Sentence For Drug Use
Case: 3:14-cv-00870-jdp Document #: 14-9 Filed: 01/07/15 Page 1 of 6 APPENDIX 8 Case: 3:14-cv-00870-jdp Document #: 14-9 Filed: 01/07/15 Page 2 of 6 AMERICAN MEDICAL ASSOCIATION Pregnant women will be
More informationImproving Perinatal Safety: Managing Risk. Simulation User Network San Diego Dec 1-2, 2010. Teri Kiehn MS, RNC
Improving Perinatal Safety: Managing Risk Simulation User Network San Diego Dec 1-2, 2010 Teri Kiehn MS, RNC Objectives Discuss the medical/legal environment in the Perinatal area Identify issues specific
More informationMODEL HEALTH PLAN CONTRACT LANGUAGE ON PAYMENT REFORM
MODEL HEALTH PLAN CONTRACT LANGUAGE ON PAYMENT REFORM IMPROVING VALUE THROUGH PAYMENT REFORM This Agreement is made and entered into this _ day of, 2012, by and between [health plan name], hereinafter
More informationFairview Health Services CERTIFIED NURSE MIDWIFE Delineation of Privileges CROSSWALK FOR REQUESTING FAIRVIEW PRIVILEGES
PAGE 1 OF 4 Fairview Health Services CERTIFIED NURSE MIDWIFE Delineation of Privileges Applicant s Name (please print): CROSSWALK FOR REQUESTING FAIRVIEW PRIVILEGES I Want to Work at the Following Fairview
More informationREWRITING PAYER/PROVIDER COLLABORATION July 24, 2015. MIKE FAY Vice President, Health Networks
REWRITING PAYER/PROVIDER COLLABORATION July 24, 2015 MIKE FAY Vice President, Health Networks AGENDA ACO Overview ACO Financial Performance ACO Quality Performance Observations 2 AGENDA ACO OVERVIEW ACO
More informationPertussis and Pregnancy
Pertussis and Pregnancy Protect Your Patients From Pertussis (Whooping Cough) 1 Pertussis Video https://www.youtube.com/watch?v=f1g5woy5qce#a ction=share 2 1 Class Objectives By the end of this class the
More informationCosts of Maternal Health Care Serv ices in Masaka District, Uganda. Executive Summary. Special Initiatives Report 16
Costs of Maternal Health Care Serv ices in Masaka District, Uganda Special Initiatives Report 16 Cambridge, MA Lexington, MA Hadley, MA Bethesda, MD Washington, DC Chicago, IL Cairo, Egypt Johannesburg,
More informationEarly Childhood Indicators Report
2015 Early Childhood Indicators Report Carol Prentice, Prentice Consulting, 2012 Updated by Alaska Department of Health & Social Services, September 2013 Updated by Prentice Consulting, July 2015 Early
More informationAppendix 6.2 Data Source Described in Detail Hospital Data Sets
Appendix 6.2 Data Source Described in Detail Hospital Data Sets Appendix 6.2 Data Source Described in Detail Hospital Data Sets Source or Site Hospital discharge data set Hospital admissions reporting
More informationHow To Reduce Healthcare Expenditures In California
1 Webinar Housekeeping Berkeley Forum Report and webinar slides are available at: http://www.chhs.ca.gov/pages/payrefinnovat.aspx Submit questions in writing using the Questions feature on the Citrix webinar
More informationAn Integrated, Holistic Approach to Care Management Blue Care Connection
An Integrated, Holistic Approach to Care Management Blue Care Connection With health care costs continuing to rise, both employers and health plans need innovative solutions to help employees manage their
More informationBORN Ontario: Clinical Reports Hospitals Part 1 May 2012
BORN Ontario: Clinical Reports Hospitals Part 1 May 2012 Hospital Reports Release dates Report types Use and interpretation Access Questions and Answers 2 Clinical Reports Release Dates Available in the
More informationHow To Bill For A Pregnancy
Maternity Billing The Maternity Period - For billing purposes, the obstetrical period begins on the date of the initial visit in which pregnancy was confirmed and extends through the end of the postpartum
More informationChapter 6 Case Ascertainment Methods
Chapter 6 Case Ascertainment Methods Table of Contents 6.1 Introduction...6-1 6.2 Terminology...6-2 6.3 General Surveillance Development...6-4 6.3.1 Plan and Document... 6-4 6.3.2 Identify Data Sources...
More informationVaccines in Pregnancy MARK H. SAWYER, MD UCSD SCHOOL OF MEDICINE RADY CHILDREN S HOSPITAL SAN DIEGO
Vaccines in Pregnancy MARK H. SAWYER, MD UCSD SCHOOL OF MEDICINE RADY CHILDREN S HOSPITAL SAN DIEGO 1 Objectives List vaccines that should be given either during pregnancy or immediately post-partum in
More information