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2019 FPQC Update

“Raising the Bar Together”. 2019 FPQC Update. William M. Sappenfield, MD, MPH, CPH FPQC Director. Vision. Voluntary Population-Based Data-Driven Evidence-Based Value Added. Values.

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2019 FPQC Update

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  1. “Raising the Bar Together” 2019 FPQC Update William M. Sappenfield, MD, MPH, CPH FPQC Director

  2. Vision • Voluntary • Population-Based • Data-Driven • Evidence-Based • Value Added Values “Allof Florida’s mothers and infants will have the besthealth outcomespossible through receivinghigh quality evidence-basedperinatalcare.” 2

  3. FPQC Initiatives Perinatal QI Indicators Data Birth Certificate Workshops Birth Certificate Initiative Infant Health NAS—Neonatal Abstinence PROVIDE 2.0 PROVIDE Maternal Health MORE Access LARC • 2019 • 2020 • 2018

  4. Current PQI Perinatal QI Indicator Sets • Non-medically indicated deliveries—PC-01 • Nulliparous, term, single, vertex cesareans—PC-02 • Antenatal corticosteroid use—PC-03 • Failed inductions of labor • Severe Maternal Morbidity—CDC • Unexpected Newborn Complications—CMQCC • Severe Hypertension/Preeclampsia—ACOG AIM • Obstetric Hemorrhage—ACOG AIM

  5. Current PQI Perinatal QI Indicator Sets • Non-medically indicated deliveries—PC-01 • Nulliparous, term, single, vertex cesareans—PC-02 • Antenatal corticosteroid use—PC-03 • Failed inductions of labor • Severe Maternal Morbidity—CDC • Unexpected Newborn Complications—CMQCC • Severe Hypertension/Preeclampsia—ACOG AIM • Obstetric Hemorrhage—ACOG AIM

  6. Current PQI Perinatal QI Indicator Sets • Non-medically indicated deliveries—PC-01 • Nulliparous, term, single, vertex cesareans—PC-02 • Antenatal corticosteroid use—PC-03 • Failed inductions of labor • Severe Maternal Morbidity—CDC • Unexpected Newborn Complications—CMQCC • Severe Hypertension/Preeclampsia—ACOG AIM • Obstetric Hemorrhage—ACOG AIM

  7. Where would you want to deliver?

  8. Rolling Enrollment • No charge for hospital participation • No data submission to the FPQC • Biannual QI indicator reports free of charge • Participating hospitals must: • Assign a permanent contact person • Comply with online training requirements • Participate with 2 short surveys per year • Promote a data quality improvement effort

  9. Coming Soon… Regional Training Birth Certificate Clerks & Supervisors

  10. Immediate Postpartum Long-Acting Reversible Contraceptives (LARC) Access LARC

  11. Florida Access LARC Initiative Team Sites 10 Florida Hospital/Residency Program Teams 2 North Carolina Teams

  12. Percent of hospitals that have established and tested billing codes for LARC devices

  13. 221 • 361 Number and type of LARC devices placed • IUDs • Implants

  14. Reducing Low Risk Cesareans (NTSV) Promoting Primary Vaginal Deliveries (PROVIDE)

  15. 2018 NTSV Cesarean Rates, 115 FL Hospitals Range: 13.37—59.8% Median: 28.7% Mean: 29.9% Joint Commission Reporting >30.0% National Target =23.9% Source: FL Vital Records, 2018

  16. 44 PROVIDEHospitals in the first phase

  17. NON-PROVIDE Baseline PROVIDE Baseline Enrollment

  18. PROVIDE 2.0Extended, Expanded & Enhanced

  19. Multiple Pressure Points DOH AHCA Recognition Health Insurance Incentives JC Reporting NTSV rate >30% Health Care Purchasers Concerns ACOG/SMFM Guidelines Provider Specific Reports Medicaid Plans . by 12% QI Initiatives Maternal Preference

  20. PROVIDE 2.0 Enhancement Stimulating Focus on change management—Nursing leadership Develop new maternal education campaign Transform webinars to smaller coaching calls Launch online hospital reports including new options Recruit new hospitals—offer advance regional training Provide quarterly delivery attendant NTSV rates Advice from leading national experts

  21. NTSV Cesarean Rates by Delivery Attendant

  22. Just Launched! Neonatal Abstinence Syndrome—NAS

  23. OPIOID EPIDEMIC Statistics 80% of global opioid supply USA is 4.6% of the world’s population 99% of global hydrocodone supply 78 Americans die every day from opioid overdoses 66% of all illegal drug use Birnbaum HG, et al. Societal costs of prescription opioid use, dependence, and misuse in the United States. Pain Med 2011; 12:657-67; 2. CDC Vital signs: overdoses of prescription opioid pain relievers and other drugs among women-United States, 1999-2010. MMWR Morb Mortal Wkly Rep 2013; 62: 537-42; 3. Lee J, Hulman S, Musci M, Stang E. Neonatal abstinence syndrome: Influence of a combined inpatient/outpatient methadone treatment regimen on the average length of stay of a Medicaid NICU population. Popul Health Manag 2015; 18: 392-7; 4. https://www.surgeongeneral.gov/priorities/opioids/

  24. FLORIDA 10-fold increase in NAS rates (2002-2012) 80% NAS infants covered by Medicaid

  25. 33 NAS Initiative Hospitals 26

  26. V2. 6/12/18 Aim Primary Drivers Interventions Educate staff and providers on trauma-informed care, psychology of addiction, and communication methods By 6/2020, FPQC participating hospitals will have a 20% decrease in average length of stay1,2 (from a baseline of 16.7 days to 13.4 days) for infants ≥37 weeks GA diagnosed with NAS regardless of inpatient hospital location. Caregiver engagement Educate the primary parent for each NAS infant Assess parent perception of communication prior to hospital discharge using standardized FPQC survey Assess duration of rooming-in Nonpharmacologic treatment Determine rates of any breastfeeding or MOM intake on day of life 3 and day of discharge to home Comply with a standardized NAS guideline including use of recommended initial drug and dose, and medication weaning Pharmacologic treatment Achieve ≥ 90% inter-rater reliability on NAS scoring tool Safe discharge Comply with all elements of FPQC’s safe discharge care plan for NAS infants 1 Baseline length of stay pending – derived from an average of each hospital’s baseline LOS 2Length of stay starts with date of birth and ends with discharge to home.

  27. Caregiver Engagement Survey The NICU/Nursing staff: Helped understand & care for withdrawal Included caregiver in baby’s care Explained importance of spending time Encouraged to spend time Felt respected and supported Involved in discharged decision making *MB = my baby

  28. Maternal Opioid Use Initiative Maternal Opioid Recovery EffortMORE

  29. Non-Pregnancy Related Death Ratios by Cause of Death, Florida, 2008-2017

  30. Global aim:Improve identification, clinical care and coordinated treatment / support for pregnant women with any exposure to opioids and their infants By 3/2021, >50% pregnant women with OUD will receive screening, prevention, and treatment services. Screening Perform universal SUD screening for all pregnant women S1 & P1 Perform secondary screening1 for all pregnant women with any opioid use P 2-4 Complete service assessment checklist during delivery admission P 5 Prevention P 6 Documentation of family planning/contraceptive counseling P 7&8 Increase breastfeeding initiation and rooming in rates Use SBIRT screening to obtain appropriate referrals for mothers with any opioid use S1; P9, 10 Treatment P11 Referral/scheduled follow up to MAT/BH services for all pregnant women with any opioid use Develop a map of local resources for community resources (e.g., behavioral health, and addiction/treatment services) S3 Comprehensive discharge planning Compliance with discharge checklist2 P11 S2 Compliance with the hospital’s pain management prescribing practices Policies & Procedures Provider education bundle P12; S4 O1 P13; S5 Patient education bundle 1Secondary screening: 1) infectious diseases: HIV, HepB, HepC, GC, CT, trichomonas, syphilis. Tb and HepA if risk factors are present; 2) mental health including PPD 2 Discharge checklist: 1) Postpartum depression  screening, 2) Scheduled OB postpartum visit, 3) Scheduled Behavioral Health and/or MAT visit or referral, 4) Narcan Counseling, 5) Social work consult, 6) Pediatric consult 7) Contraception counseling & plan 8) Healthy Start/Home visiting program referral, and 9) patient education bundle

  31. FPQC Initiative Resources • Project-wide in-person collaboration meetings • Educational sessions, videos, and resources • Monthly and Quarterly QI Data Reports • Technical Assistance • from FPQC staff, state Clinical Advisors, and National Experts • Custom, Personalized • webcam, phone, or on-site Consultations & Grand Rounds Education • Monthly e-mail Bulletins • Monthly Collaboration Calls with hospitals state-wide • Online Tool Box • Algorithms, Sample protocols, Maternal education tools, Slide sets, etc.

  32. MORE Initiative Project Timeline Ongoing Technical Assistance, Data Collection, Educational Sessions

  33. FPQC Testimonials “Participating in the FPQC helped our hospital collect data, examine the data and make changes in a unified manner to improve maternal and neonatal care” - MD “As part of a collaborative, we have been given many resources so as not to re-create the wheel” - MD “Being involved with FPQC initiatives has strengthened our department in our patient care and teamwork.” -RN

  34. FPQC Partners & Funders

  35. Get Involved! Facebook.com/TheFPQC/ @TheFPQC Join our mailing list at FPQC.org E-mail: FPQC@health.usf.edu

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