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Martin J McCaffrey, MD, CAPT USN (Ret)Clinical Professor Pediatrics

Division of Neonatal Perinatal Medicinefor the Perinatal Quality Collaborative of North Carolina

Having a PQCNC!

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Mission

Conduct time limited statewide perinatalquality improvement projects

Best evidence, reduce variation

Partnership with patients and families

Resource optimization

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Stakeholders

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Non-Denominational

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On the Road

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PQCNC Table

Family Members

Perinatal providers (55 Hospitals)

Doctors (OB, MFM, Neos, Peds, FP)

Nurses (Peds, NICU, & OB)

Midwives

Hospital Administrators

Payers (Medicaid, BCBSNC)

State Legislators

DPH

State Hospital Association

Others (Malpractice insurers)

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PQCNC Initiatives

PQCNC CLABSI

39 Weeks

Exclusive Human Milk in the Nursery Exclusive Human Milk in the NICU

Support for Intended Vaginal Birth

Hows Your Baby Immunization Registry

NCLABSI

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39 Weeks

Included 39 centers in 2009-2010

Goal was elimination of Elective

Deliveries < 39 Weeks

Achieved 43% reduction

Moved total of 769 deliveries to > 39

Weeks

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PQCNC Reducing Elective Deliveries < 39Weeks

370 non-indicated deliveries moved to > 39 Weeks 769 total deliveries shifted to > 39 Weeks

Avoided 58 NICU admits, 253 CS Cost avoidance (NICU & OB) $2.4M

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PQCNC Reducing CABSI

Avoided 132 infections Saved 20 lives Hospital savings of $3.9M

Assumptions: 10% mortality, 10 days extended hospital stay & $30K/infection Associated morbidities: CLD, IVH, NEC, ROP

Phase I Phase II

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PQCNC Support for Intended Vaginal Birth

(Reduction of Rate of NTSV CS)

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%30.0%

35.0%

40.0%

45.0%

50.0%

Baseline

Feb

ruary

M

arch

April

May

June

July

August

Septe

mber

October

Nove

mber

Dece

mber

CesareanR

ate

All Patients

High-Risk Patients

Low-Risk Patients

Phase I Phase II

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EHM NCCC: Infant ExclusiveMothers Milk Feeding

Phase I Phase II

46% increase in

Maternal Milk Use

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EHM Nursery

Phase I Phase II

CL 0.466

0.5208UCL

0.53480.5655

LCL 0.3971

0.4761

0%

10%

20%

30%

40%

50%

60%

Oct'10

Nov'10

Dec'10

Jan'11

Feb'11

Mar'11

Apr'11

May'11

Jun'11

Jul'11

Aug'11

Sep'11

Oct'11

Mar'12

Apr'12

May'12

Jun'12

Jul'12

Aug'12

Sep'12

Oct'12

Nov'12

Dec'12

Jan'13

Feb'13

Mar'13

%SoleyMaternalM

ilk

Intervention Months

EHM Well: Exclusive Breastfeeding

20% Increase in Exclusive Breastfeeding

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NCABSI CABSI/1000 Line Days

50% Reduction

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Think Big

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Data

W ki h

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Were making changes, are we

changing culture?

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Culture?

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Were making changes, arewe changing culture?

Tales from theJersey Turnpike

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Families and Patients

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Leadership and Teamwork

If you tell people where to go, but not how to get there, youll be amazed at

the results.

(Gen George S Patton)