Maternal Data Center (MDC) Anne Castles, MPH, MA MDC Project - - PowerPoint PPT Presentation

▶
maternal data center
SMART_READER_LITE
LIVE PREVIEW

Maternal Data Center (MDC) Anne Castles, MPH, MA MDC Project - - PowerPoint PPT Presentation

May 27, 2023 175 likes •499 views

The California Maternal Data Center (MDC) Anne Castles, MPH, MA MDC Project Manager Kathryn Melsop, MS CMQCC Administrative Director Elliott Main, MD CMQCC Medical Director What is the MDC? A one- stop shop to support hospitals obstetric

slide-1
SLIDE 1

The California Maternal Data Center (MDC)

Anne Castles, MPH, MA MDC Project Manager Kathryn Melsop, MS CMQCC Administrative Director Elliott Main, MD CMQCC Medical Director

slide-2
SLIDE 2

: Transforming Maternity Care

What is the MDC?

A one-stop shop to support hospitals’ obstetric quality improvement initiatives and service line management

  • Overall hospital performance measures
  • Drill-down to the patient level and case review worksheets

to identify quality improvement opportunities—for both clinical quality and data quality

  • Provider-level statistics—to assess variation within a

hospital

  • Benchmarking statistics--to compare your hospital to

regional, state, and like-hospital peers

  • Facilitating reporting to Leapfrog, PSF and Cal-HEN
slide-3
SLIDE 3

The MDC: Now Serving Hospitals in 3 States

Launched August 2014 25 Hospitals Launched in April 2015 14 Hospitals Launched in 2012 148 Hospitals 72% of CA Deliveries Joined in 2015: Kaiser Permanente Dignity Health Sutter Health

  • St. Joseph Health
slide-4
SLIDE 4

: Transforming Maternity Care

PDD—Patient Discharge Data (ICD9 codes) Birth Certificate Data

Data Sources

CMQCC Data Center

REPORTS

Benchmarks against other hospitals Sub-measure reports

Calculates all the Measures Immediately LIMITED & OPTIONAL Supplemental Data

  • ED<39 Weeks
  • Antenatal Steroids
  • Bilirubin Screen
  • DVT Prophylaxis

State Vital Records Data to CMQCC Monthly within 45 Days Active Track: Hospital PDD to CMQCC Monthly/Quarterly within 45 days View Only Track: State PDD to CMQCC 8-14 months

slide-5
SLIDE 5

: Transforming Maternity Care

MDC Features View Only Active Hospital-Level Metrics   Statewide benchmarks for all of the above metrics   Ability to calculate additional measures  Patient-Level Drill-Down and Data Editing  Provider-level metrics  Timeliness of Data 8-14 months 45 days Data Source OSHPD PDD & BC Hospital PDD & BC Cost Free Free

Two Tracks: Active and View Only

slide-6
SLIDE 6

: Transforming Maternity Care

6

slide-7
SLIDE 7

32 Hospital Clinical Quality Measures Today’s Highlight: NTSV C-Section

slide-8
SLIDE 8

Cesarean Births Have Risen by Over 50% in the Last 15 years

US 2013= 32.7% CA 2013= 33.1%

slide-9
SLIDE 9

9

slide-10
SLIDE 10

0% 10% 20% 30% 40% 50% 60% 70% 80%

1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 81 86 91 96 101 106 111 116 121 126 131 136 141 146 151 156 161 166 171 176 181 186 191 196 201 206 211 216 221 226 231 236 241 246 251

Large Variation of Total Cesarean Rate Among 251 California Hospitals: 2013

Range: 15.0—71.4% Median: 32.5% Mean: 32.8% Hospitals

“But, our patients are higher risk than other hospitals!”

10

slide-11
SLIDE 11

Nulliparous, Term, Singleton, Vertex (NTSV) Cesarean Section Rate

 Risk Stratified (“standard population”)  Widely Adopted Nationally

 ACOG: Task Force on Cesarean Section rates

(2000)

 DHHS: Healthy Person 2010 and 2020  NQF endorsed, Joint Commission Perinatal Core

Measure (PC-02), Leapfrog Group, CMS

 Further risk adjustment adds little  >15 years experience

11

slide-12
SLIDE 12

12

0% 10% 20% 30% 40% 50% 60% 70% 80%

1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103 109 115 121 127 133 139 145 151 157 163 169 175 181 187 193 199 205 211 217 223 229 235 241 247

NTSV CS Rate Among CA Hospitals: 2014

(Nulliparous Term Singleton Vertex) (Source: Linked OSHPD-Birth Certificate Data) Range: 12%—70% Median: 25.3% Mean: 26.2%

40% of CA hospitals meet national target Large Variation = Improvement Opportunity

National Target =23.9%

slide-13
SLIDE 13

13

NTSV CS Rate Among Pac/Lac Region: 2014

(Nulliparous Term Singleton Vertex) (Source: Linked OSHPD-Birth Certificate Data) Range: 12%—70% Median: 25.3% Mean: 26.2%

National Target =23.9%

0% 10% 20% 30% 40% 50% 60%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Range: 17%—56% Mean: 28.6%

National Target =23.9%

slide-14
SLIDE 14

Why should we care about CS rates?

 Relentless Rise without Baby or Mother benefit

 6% in early 70’s, 20% in mid 80’s, 33% in 2010  CP rates, neonatal seizures unchanged since 1980  Overall, no benefit for long-term urinary continence

 Increased maternal and neonatal morbidity

 Impaired neonatal respiratory function, NICU admits  Affects maternal-infant interaction/Breast Feeding  Increased maternal PP infections, VTE, transfusions  Longer recovery, 2X PP re-admissions

 Prior CS can have major complications

 Placenta previa and accreta (invasion deep into or thru the

uterine wall) hysterectomy or worse

14

slide-15
SLIDE 15

New Statewide Initiative in 2016!

Supporting Vaginal Birth and Reducing Primary Cesarean Section

■ NEW TOOLKIT! To be distributed in February 2016 ■ QI Implementation Project: Seeking engaged hospital participants for 2016 project

□ Develop a maternity culture that values, promotes, and supports intended vaginal birth □ General labor support □ Response to labor challenges □ Lessons from Hospitals that have successfully reduced their NTSV CS Rate □ Data to drive improvement

slide-16
SLIDE 16

Hospital Performance Over Time

For each hospital quality measure:

  • View reports on monthly/quarterly/annual basis
  • Easy downloads of the graphics or numerical data
slide-17
SLIDE 17

: Transforming Maternity Care

Drill Down Information

  • Drill down to case-level information within own hospital account
  • Hover boxes show definitions for ICD-9 codes
slide-18
SLIDE 18

: Transforming Maternity Care

18

State, Regional, Nursery-Level Comparisons

Benchmark your hospital against other peer comparison groups

slide-19
SLIDE 19

: Transforming Maternity Care

19

System Comparisons

If part of a multi-hospital system, can view all hospital rates within the system

slide-20
SLIDE 20

Provider-Level Cesarean Rates

G5xxxx G6xxxx G7xxxx G8xxxx A8xxxx A6xxxx A5xxxx A4xxxx A8xxxx A9xxxx

Screen Shot from the CMQCC Maternal Data Center

Note the two busiest providers had widely different rates Sample Medical Center

slide-21
SLIDE 21

Measure Analysis: Identify Drivers of the CS Rate (Step 1)

NTSV: Nulliparous (first-birth), Term, Singleton, Vertex presentation MTSV: Multiparous (second or more-birth), Term, Singleton, Vertex presentation

Screen Shot from the CMQCC Maternal Data Center

slide-22
SLIDE 22

Measure Analysis: Identify Drivers of the CS Rate (Step 2)

What Drives Our Nulliparous Term Singleton Vertex (NTSV) CS Rate?

Screen Shot from the CMQCC Maternal Data Center

slide-23
SLIDE 23

New National Guidelines for Defining Labor Abnormalities and Management Options

slide-24
SLIDE 24

ACOG/SMFM Criteria for Dystocia: CMQCC Checklist

  • 1. Diagnosis of Dystocia/Arrest Disorder

(All 3 should be present)

  • 2. Diagnosis of Failed Induction before 6 cm dilation

(both should be present)

  • 3. Diagnosis of Failed Induction after 6 cm dilation

(see criteria 1)

 Cervix 6 cm or greater  Membranes ruptured, then  No change X 4 hours with Adequate Uterine activity (or 6hrs with oxytocin)  Bishop Score ≥ 6 cm before elective induction  Oxytocin used for a minimum of 12 hrs after membrane rupture

24

slide-25
SLIDE 25

 Other Labor Management Bundles

 Discouraging Early Labor Admissions  Labor Inductions

Case Reviews of NTSV CS—Do we follow the Labor Guidelines?

Measuring Adherence to Labor Management Guidelines

Screen Shot from the CMQCC Maternal Data Center

slide-26
SLIDE 26

Balancing Measure: Unexpected Newborn Complications

Term infants without “pre-existing conditions” that experienced unexpected complication

slide-27
SLIDE 27

Balancing Measure: Unexpected Newborn Complications

slide-28
SLIDE 28

Measure Analysis Unexpected Newborn Complications

slide-29
SLIDE 29

Impact of MDC’s Data-Driven QI: NTSV C-Section

29

32.9% 33.6% 31.2% 31.8% 28.3% 24.3% 25.0% 23.4%

15% 18% 20% 23% 25% 28% 30% 33% 35% 2011 2012 2013 Jan-14 Feb-14 Mar-14 Apr-14 May-14

Pilot Hospital: PBGH / RWJ C-Section Pilot

NTSV CS Rate

National Target for NTSV CS = 23.9% QI Project Started: Jan 16

slide-30
SLIDE 30

30

Hospital is Not Active Track

  • Contact CMQCC to request access with your name, role, e-

mail, and hospital name

  • CMQCC will invite you to access the system
  • Registration takes less than 1 minute--NO PAPERWORK

Hospital is already Active Track

  • Contact personnel at your hospital with MDC Administrator

status (usually Director of MCH)

  • Contact CMQCC to get the list

CMQCC Contact

Datacenter@cmqcc.org

How to Access the MDC

slide-31
SLIDE 31

: Transforming Maternity Care

Becoming an Active Track Participant

Coordination

  • Complete a Participation Agreement with CMQCC
  • Appoint Project Coordinator for the hospital.

Data Submissions

  • Identify IT staff to upload patient discharge data to the

CMDC on a monthly or quarterly basis: Best to delegate to department responsible for OSHPD PDD submission

Use Results for Clinical and Data QI

  • Participate in training and quality review session with

CMQCC staff.