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Martin J McCaffrey, MD, CAPT USN (Ret) Clinical Professor Pediatrics Division of Neonatal Perinatal Medicine for the Perinatal Quality Collaborative of North Carolina
Mission
Conduct time limited statewide perinatal quality improvement projects
Best evidence, reduce variation Partnership with patients and families Resource optimization
Stakeholders
Non-Denominational
On the Road
PQCNC Table
Family Members Perinatal providers (55 Hospitals) Doctors (OB, MFM, Neos, Peds, FP) Nurses (Peds, NICU, & OB) Midwives Hospital Administrators Payers (Medicaid, BCBSNC) State Legislators DPH State Hospital Association Others (Malpractice insurers)
PQCNC Initiatives
PQCNC CLABSI 39 Weeks Exclusive Human Milk in the Nursery Exclusive Human Milk in the NICU Support for Intended Vaginal Birth Hows Your Baby Immunization Registry NCLABSI
39 Weeks
Included 39 centers in 2009-2010 Goal was elimination of Elective Deliveries < 39 Weeks Achieved 43% reduction Moved total of 769 deliveries to > 39 Weeks
370 non-indicated deliveries moved to > 39 Weeks 769 total deliveries shifted to > 39 Weeks Avoided 58 NICU admits, 253 CS Cost avoidance (NICU & OB) $2.4M
Phase I
Phase II
Avoided 132 infections Saved 20 lives Hospital savings of $3.9M Assumptions: 10% mortality, 10 days extended hospital stay & $30K/infection Associated morbidities: CLD, IVH, NEC, ROP
PQCNC Support for Intended Vaginal Birth (Reduction of Rate of NTSV CS)
50.0% 45.0% 40.0% Cesarean Rate 35.0%
30.0%
25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Baseline February March April May June July August September October November December All Patients High-Risk Patients Low-Risk Patients
Phase I
Phase II
Phase I
Phase II
% Soley Maternal Milk 10% UCL CL LCL 20% 30% 40% 50% 60% 0%
Phase I
Oct '10 Nov '10 Dec '10 Jan '11 Feb '11 Mar '11 Apr '11 May '11 Jun '11 Jul '11 Aug '11 Sep '11 Oct ' 11 0.3971 0.5348 0.466
EHM Nursery
Intervention Months
Phase II
Mar '12 Apr '12 May '12 Jun '12 Jul '12 Aug '12 Sep '12 Oct '12 Nov'12 Dec '12 Jan '13 Feb '13 Mar '13
Think Big
Data
Culture?
If you tell people where to go, but not how to get there, youll be amazed at the results. (Gen George S Patton)