Maternal Hypertension Initiative
Hypertensive disorders of pregnancy are a leading case of maternal mortality and morbidity. Hospital teams participating in the Hypertension Initiative, which rolled out to teams in January 2016, are working to reduce severe maternal morbidity in women with severe range hypertension through increased use of appropriate medical management of severe hypertension, debriefs, and discharge education and follow-up with new onset severe maternal hypertension cases through education and evidence-based strategies for integrating patient safety practices associated with early identification and medical management of severe hypertension into existing care delivery infrastructure.
Aim: Reduce the rate of severe morbidities in women with severe preeclampsia, eclampsia, or preeclampsia superimposed on pre-existing hypertension by 20% over the course of the initiative.
Birth Certificate Accuracy Initiative
Birth certificates provide a critical source of information on birth and birth outcomes and the health of mothers and babies. Hospital teams participating in the Birth Certificate Accuracy Initiative work to obtain at least 95% consistency between the birth certificate and the medical record on key birth certificate variables through audits of their medical records and birth certificate data and collaborative learning on best practices to timprove birh certificate accuracy for hospital teams.
The Birth Certificate Accuracy Initiative was a partnership between Illinois Department of Public Health and ILPQC with support from the Illinois Hospital Association. Hospital teams assessed and monitored the degree to which information in the medical record supports information on the birth certificate to reach at least 95% consistency between the birth certificate and the medical record on key birth certificate variables through audits of their medical records and birth certificate data. Targeted education of physicians, nurses, and birth certificate clerks to promote improvement was be provided as an integral part of the initiative.
Initiative Aim and Outcome
Aim: In partnership with IDPH and IHA, obtain at least 95% accuracy on 17 key birth certificate variables.
Outcome: At baseline (Aug-Oct 2014), the overall accuracy for all 17 key variables for all 107 participating hospitals was 87%. In December 2015, the overall accuracy was 97% for 92 hospital teams reporting data, a 10% increase.
Reducing Early Elective Deliveries (EED)
Early Elective Delivery (EED) before 39 weeks gestation may result in higher rates of adverse respiratory outcomes, mechanical ventilation, sepsis and hypoglycemia for the newborns (Tita et al., 2009). A study in the American Journal of Obstetrics and Gynecology estimated the cost of such deliveries to be nearly $1 billion dollars per year. The American College of Obstetrics and Gynecology (ACOG) recommends against non-medically indicated delivery prior to 39 weeks and recommends that all hospitals put in place a hard stop policy against this practice. The Illinois Department of Public Health (IDPH) also recommends implementation of a hard stop policy for all maternity hospitals in the state.
ILPQC, in collaboration with the Illinois Hospital Association and the March of Dimes, provided a series of OB Quality Boot Camps to Illinois birthing hospitals to provide OB quality learning sessions and a forum for hospitals to ask questions regarding the ILPQC initiative and the IDPH birth certificate data. In addition, ILPQC worked with the ILPQC OB Advisory Workgroup to develop an Early Elective Delivery data form and data dictionary to provide hospitals a standard form that should match the Joint Commission Data that they were already collecting. ILPQC created a data system that allowed hospitals to submit Early Elective Delivery data and provided monthly reports to hospitals so that hospitals could assess their progress over time and compare themselves to other hospitals. All hospital data is held securely and hospital names / locations are never reported with the data.
Initiative Aim and Outcome
Aim: Reduce EED to <5% across >=95% of participating hospitals and improve ability for hospitals to compare accurate EED data across time and across other Illinois hospitals.
Outcome: Of 40 hospitals reporting 2014 Q4 PC-01 data, 87.5% have <5% EED. The baseline EED rate for 40 hospitals reporting data (Q1 2013) was 2.32%. In Q4 of 2014 for 40 hospitals reporting data it is 1.81%, a 0.51% decrease.