New York State Perinatal Quality Collaborative (NYSPQC): Promoting - - PowerPoint PPT Presentation

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New York State Perinatal Quality Collaborative (NYSPQC): Promoting - - PowerPoint PPT Presentation

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New York State Perinatal Quality Collaborative (NYSPQC): Promoting Infant Safe Sleep to Reduce Infant Mortality December 20, 2016 December 20, 2016 2 Presenters Kristen Lawless, MS Program Director, NYSPQC New York State Department

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December 20, 2016

New York State Perinatal Quality Collaborative (NYSPQC): Promoting Infant Safe Sleep to Reduce Infant Mortality

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December 20, 2016 2

Presenters

  • Kristen Lawless, MS

– Program Director, NYSPQC New York State Department of Health

  • Deborah Campbell, MD, FAAP

– Chief, Division of Neonatology Children’s Hospital at Montefiore – Clinical Advisor, NYSPQC

  • Pat Heinrich, RN, MSN

– Executive Project Director, NICHQ – Clinical and Quality Improvement Advisor, NYSPQC

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Presentation Objectives

  • Provide an overview of the NYSPQC,

including its mission, structure, and focus areas

  • Describe the NYSPQC Hospital-based Safe

Sleep Project

  • Review progress of the NYSPQC Hospital-

based Safe Sleep Project

  • Discuss initiative successes and challenges
  • Answer questions from meeting attendees
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December 20, 2016 4

New York State Perinatal Quality Collaborative (NYSPQC)

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December 20, 2016 5

NYSPQC Mission & Strategy

To provide the best and safest care for women and infants by preventing and minimizing harm through the translation of evidence-based practice guidelines to clinical practice. This is achieved through collaboration amongst participants and the utilization of quality improvement science.

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NYSPQC Resources

  • The NYSPQC is an initiative of the New York State Department of

Health (NYSDOH), which provides unique and important resources:

– Infrastructure and leadership – Connections to other state agencies for programmatic and data needs

  • Medicaid
  • Vital Records
  • Hospital Acquired Infections

– Statewide health information network

  • Web-based
  • Available for centralized data collection

– Statewide partnerships – Established relationships with hospitals and community-based organizations

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NYSPQC Structure

  • Adapts the Institute for Healthcare Improvement (IHI)

model for Idealized Perinatal Care and Breakthrough Series Methodology as a framework to guide improvement

  • This strategy has been executed with the

assistance of a long standing partnership with NICHQ

  • Utilizes NYS’ well-established system of perinatal

regionalization

  • Collaborates with NYS birthing hospitals

and various other organizations

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December 20, 2016 8

Collaborating for Success

8

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December 20, 2016 9

NYSPQC Past Focus Areas

  • Reducing scheduled deliveries without a

medical indication before 39 weeks gestation

  • Improving identification/management of

maternal hemorrhage/hypertension

  • Reducing central line associated blood

stream infections in NICUs

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NYSPQC Current Focus Areas

  • Optimizing enteral nutrition practices in

NICUs to improve infant growth

  • Improving access to and utilization of

antenatal corticosteroid treatment

  • Improving safe sleep practices to

reduce infant mortality

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December 20, 2016 11

NYSPQC Safe Sleep Project

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Infant Sleep Related Mortality

  • The ~90 infants who will die in New York State this

year due to sleeping in an unsafe environment are enough to fill five kindergarten classes

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NYSPQC Safe Sleep Project

  • Focuses on improving safe sleep practices to

reduce infant mortality

  • Implements the national IM-CoIIN infant safe

sleep activities

  • NYS hospitals participating in the NYSPQC

Safe Sleep Project are the state’s stakeholders in the national CoIIN Safe Sleep Network

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NYSPQC Safe Sleep Project

  • Improvements in safe sleep practices are being

achieved by:

– Ensuring all infant caregivers (i.e., new moms or guardians) have documentation of safe sleep education documented in the medical record; – Establishing consistent modeling of a safe sleep environment for all infants without a medical contraindication during the birth hospitalization; and – Discussing caregiver (i.e., new moms or guardians) understanding of infant safe sleep education prior to discharge from the birth hospitalization.

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NYSPQC Safe Sleep Project

  • Project began in September 2015
  • 76 out of 125 (60.8%) NYS birthing

hospitals participating in the initiative:

– 17 Regional Perinatal Centers (RPCs) – 25 Level III birthing hospitals – 13 Level II birthing hospitals – 21 Level I birthing hospitals

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Progress to Date

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Documentation of Safe Sleep Education Form

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Measure 1: Percent of medical records with documentation of safe sleep education

90.3 92.6 90.8 91.8 93.1 92.8 94.0 94.4 96.6 94.8 96.1 96.1 96.8 97.3 50 55 60 65 70 75 80 85 90 95 100 Percent %

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Crib Check Tool

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Measure 2: Percent of infants, sleeping or awake- and-unattended in crib, in a safe sleep environment

50 55 60 65 70 75 80 85 90 95 100 Percent % Safe Sleep Envir* Supine Safe Clothing Head Flat No Objects *A safe sleep environment is defined as infants who were positioned supine, in safe clothing, with head of crib flat and no objects in the crib

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Measure 2: Percent of infants, sleeping or awake- and-unattended in crib, in a safe sleep environment, by unit type

10 20 30 40 50 60 70 80 90 100

Percent %

Well baby Room‐in NICU

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Caregiver Survey

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Measure 4: Percent of primary caregivers indicating they understand safe sleep practices*

50 55 60 65 70 75 80 85 90 95 100 Percent % Understand safe sleep* Alone Back Crib No Objects *Understanding safe sleep practices is defined as reporting that infants should sleep alone, on their back, in a crib, with the crib free of objects

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Measure 4: Percent of primary caregivers indicating they understand safe sleep practices, by caregiver race/ethnicity

50 55 60 65 70 75 80 85 90 95 100

Percent %

Hispanic Asian Black White Other

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Measure 4: Percent of primary caregivers indicating they understand safe sleep practices, by caregiver insurance type

10 20 30 40 50 60 70 80 90 100

Percent %

Medicaid Private Other

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Measure 4: Percent of primary caregivers indicating they understand safe sleep practices, by caregiver education level

50 55 60 65 70 75 80 85 90 95 100

Percent %

Less Than High School High School More Than High School

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Summary

  • Improvement has been seen in all project

measures

  • Between September 2015 and September 2016:

– The percent of medical records with documentation

  • f education increased 8%;

– The percent of infants in a safe sleep environment has increased by 33%; and – The percent of caregivers who understand safe sleep practices increased by 15%.

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Still Room for Improvement

  • Hispanic and Black caregivers understand

safe sleep practices less frequently than White caregivers

  • Caregivers insured by Medicaid or other

insurance understood safe sleep less frequently compared to those with private insurance

  • Caregivers with lower levels of education

understood safe sleep less frequently than those with more than a high school education

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Successes and Challenges

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Success: CBO Safe Sleep Project

  • Six NYS Maternal & Infant Community

Health Collaborative (MICHC)

  • rganizations engaged in CBO Project

– Survey administered to caregivers by home visiting organizations to assess the effectiveness of safe sleep education on caregivers’ practices in the home setting

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  • Collaborations among participating

hospitals and stakeholder organizations

  • Hospital policies and procedures put into

place, or updated as appropriate

  • Safe sleep education and documentation

built into birthing hospitals’ electronic medical records (EMR) systems

Success: Safe Sleep Project

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Successes: Tailored Tests of Change Working to Reduce Disparities

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Tailored Tests of Change

Developing changes – what’s different?

Nolan, K. et al. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd

  • Edition. New York, NY: Jossey‐Bass
  • Evidence
  • Theories, questions, hunches
  • Linked to aim
  • Involve key players
  • Tailored
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  • Language
  • Religiosity
  • Cultural norms
  • Health beliefs
  • Literacy
  • …..

Revisiting Safe Sleep Recommendations for African‐American Infants: Why Current Counseling is Insufficient. Gaydos, L.M., Blake, S.C., Gazmararian, J.A. et al. Matern Child Health J (2015) 19: 496. doi:10.1007/s10995‐014‐1530‐z file:///Users/patriciacheinrich/Downloads/Revisiting%20Safe%20Sleep%20Recommen dations%20for%20African‐American%20Infants‐ %20Why%20Current%20Counseling%20is%20Insufficient.%202014.pdf

Tailored Tests of Change

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Success: Tailored Changes

  • Consideration given to cultural beliefs,

and resources tailored as appropriate

  • NYSDOH collaborations with various state

agencies (OCFS, OASAS, WIC, etc.)

– Consistent safe sleep messaging

  • Various educational materials developed

and translated into multiple languages

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Success: Media Campaign

  • Goal is to increase awareness among parents and
  • ther caregivers about infant safe sleep, through the

development of:

 Posters  Brochures  Magnets  Clings  Crib cards  Videos

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https://www.youtube.com/watch?v=B4M9pCU4LMc&feature=youtu.be

Success: Safe Sleep Video

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https://www.youtube.com/watch?v=rCcYzWg2N20&feature=youtu.be

Success: Safe Sleep Video

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Success: Engaging Prenatal Providers

  • Commissioner letter

sent to obstetricians and nurse midwives statewide

  • Educate and reinforce

safe sleep messages prior to delivery

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Success: Engaging Providers After Birth

  • Commissioner letter

sent to:

  • Pediatricians
  • Family practitioners
  • Nurse practitioners
  • Reinforce safe sleep

message that has been provided previously in different settings

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Success: NYS Public Health Law

  • New York State Public Health Law was

amended in July 2016 to include language that requires birthing hospitals and birthing centers to distribute infant safe sleep information to all maternity patients.

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Challenges

  • Changes to EMR systems can take time
  • Grandparents - “You slept on your

stomach, and you’re fine”

  • Cultural barriers
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Challenges

  • Financial issues – can’t afford a crib,

bassinet, etc.

  • No room in apartment/trailer/home for crib
  • Evolving thoughts and research on

swaddling

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Questions & Discussion

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NYSPQC Safe Sleep Project Team

  • Marilyn Kacica, MD, MPH
  • Susan Slade
  • Chris Kus, MD, MPH
  • Kristen Lawless
  • Eileen Shields
  • Kuangnan Xiong, PhD
  • Amanda Roy
  • Solita Jones
  • Lusine Ghazaryan, MD, MPH
  • Brandi Wells
  • Kathy Harris
  • Mari Sepowski
  • Pat Heinrich, RN, MSN

(NICHQ)

  • Emma Smizik (NICHQ)
  • Emma Hopkinson (NICHQ)
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NYSPQC Clinical Expert Work Group – Neonatology

  • Deborah Campbell, MD, FAAP

– Children’s Hospital at Montefiore

  • Martha Caprio, MD

– New York University Langone Medical Center

  • Adriann Combs, BS, RN

– Winthrop University Hospital

  • Pat Heinrich, RN, MSN

– NICHQ

  • Michael Horgan, MD

– Albany Medical Center

  • Edmund LaGamma, MD

– Maria Fareri Children's Hospital at Westchester Medical Center

  • Timothy Stevens, MD, MPH

– Golisano Children’s Hospital at University of Rochester Medical Center

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Contact

New York State Perinatal Quality Collaborative Empire State Plaza Corning Tower, Room 984 Albany, NY 12237 Ph: 518 / 473-9883 F: 518 / 474-1420 NYSPQC@health.ny.gov www.nyspqc.org

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