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Jan 30, 2012. OB Subgroup Recommendations for the Bree Collaborative. Subgroup Members. Theresa Helle , Manager Health Care Quality and Efficiency Initiatives, the Boeing Company Ellen Kauffman, MD, OB-COAP Medical Director Roger Rowles , MD, Yakima Memorial OB-GYN

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Jan 30 2012

Jan 30, 2012

OB Subgroup Recommendations for the Bree Collaborative


Subgroup members
Subgroup Members

  • Theresa Helle, Manager Health Care Quality and Efficiency Initiatives, the Boeing Company

  • Ellen Kauffman, MD, OB-COAP Medical Director

  • Roger Rowles, MD, Yakima Memorial OB-GYN

  • Dale Reisner, MD, Swedish Hospital perinatologist

  • Carl Olden, MD, Family Practice in Yakima and President, WA Academy of Family Physicians

  • Mary Kay O’Neill, MD, PNW Medical Director, CIGNA


What s happening now
What’s happening now?

  • Perinatal Advisory Collaborative (Dr. Rowles to report)

  • OB-COAP (Obstetrics Clinical Outcomes Assessment Program) (Dr. Kauffman to report)

  • Leapfrog Call to Action

  • Shared medical decision making

  • State “report cards”


Leapfrog call to action
Leapfrog Call to Action

  • Current report applies to hospitals that voluntarily supply data to Leapfrog (19 WA hospitals)

  • IHI/Leapfrog national webinars for providers

  • Catalyst for Payment Reform has model health plan contract language to help purchasers signal expectations to health plans about how they should improve payment practices for maternity care

  • Aetna, CIGNA, UnitedHealthcare and Wellpoint continuing a public awareness campaign to expectant women


Shared medical d ecision making
Shared Medical Decision Making

  • “Expecting More” partnership between Childbirth Connection (maternity care advocacy group) and Foundation for Shared Medical Decision Making, to develop patient decision aids for maternity care

  • Interest in piloting in WA

  • RCW 7.70.060 , passed in 2007. Unclear if this work would meet state’s definition


State report card program
State report card program

  • Reports based on birth certificate data

  • Includes c-section, VBAC, low birthweight, and induction rates

  • Will be reported by facility and available on secure website

  • Plan is to encourage facilities to drill down to provider level, then use forthcoming OHSU toolkit to make improvements


Recommended goal reduce first time c sections
Recommended Goal:“Reduce first-time c-sections.”

  • Since inductions increase the likelihood of a c-section, interventions that reduce inductions at any gestational age still address this goal

  • Interventions to increase VBAC do not fall under this goal, but are worthy and will still be pursued by other groups

  • Somewhat narrow goal is necessary given our time frame

  • The goal is “reduction”, recognizing that some are indeed medically necessary


Recommended strategies
Recommended Strategies

  • Many studies have shown narrowly focused, single interventions unlikely to produce lasting results

  • Necessary to pursue several strategies at once


1 support improved data collection and analysis
1. Support improved data collection and analysis

  • Encourage all hospitals that perform deliveries to participate in OB-COAP (or a homegrown robust reporting system, if a hospital has one)

  • Data would be available to dig down into causes of variation across the state

  • OB-COAP does not require ongoing oversight by the Bree, but does provide a means of ongoing quality improvement


2 take advantage of existing toolkits
2. Take advantage of existing toolkits

  • This includes the CA Maternal Quality Care Collaborative, the March of Dimes, Childbirth Connection, and the forthcoming toolkit from OHSU

  • Toolkits can be made available to any hospital- all are free of charge

  • Can be useful guides to behavior change, once variation has been identified


3 public education campaign patient decision aid promotion
3.Public Education Campaign & Patient Decision Aid Promotion

  • Explore partnership with March of Dimes, based on their successful initiatives elsewhere

  • Explore statewide pilot of patient decision aids being developed by “Expecting More” program


4 explore potential financial incentives for behavior change
4. Explore potential financial incentives for behavior change

  • Many models exist

  • Start with survey of WA plans to see what is currently being tried

  • Possibility of modeling on Minnesota (bundled payment for full episode of maternity care for low-risk women, plus denial of payment for unecessary births before 39 weeks)


Thank you
Thank you! change

  • For more information, contact:

    Caren Goldenberg, MPH

    Bree Collaborative Project Manager

    cgoldenberg@qualityhealth.org