Having a PQCNC!

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

PQCNC Reducing Elective Deliveries < 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

PQCNC Reducing CABSI

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

EHM NCCC: Infant Exclusive Mothers Milk Feeding

46% increase in Maternal Milk Use

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

EHM Well: Exclusive Breastfeeding

20% Increase in Exclusive Breastfeeding

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

0.5655 0.5208 0.4761

NCABSI CABSI/1000 Line Days

50% Reduction

Think Big

Data

Were making changes, are we changing culture?

Culture?

Were making changes, are we changing culture?

Tales from the Jersey Turnpike

Families and Patients

Leadership and Teamwork

If you tell people where to go, but not how to get there, youll be amazed at the results. (Gen George S Patton)