7/29/2019 PQCNC Patient Family Partnerships - History and Charge
1/21
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!
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
2/21
Mission
Conduct time limited statewide perinatalquality improvement projects
Best evidence, reduce variation
Partnership with patients and families
Resource optimization
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
3/21
Stakeholders
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
4/21
Non-Denominational
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
5/21
On the Road
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
6/21
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)
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
7/21
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
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
8/21
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
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
9/21
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
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
10/21
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
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
11/21
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
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
12/21
EHM NCCC: Infant ExclusiveMothers Milk Feeding
Phase I Phase II
46% increase in
Maternal Milk Use
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
13/21
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
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
14/21
NCABSI CABSI/1000 Line Days
50% Reduction
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
15/21
Think Big
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
16/21
Data
W ki h
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
17/21
Were making changes, are we
changing culture?
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
18/21
Culture?
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
19/21
Were making changes, arewe changing culture?
Tales from theJersey Turnpike
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
20/21
Families and Patients
7/29/2019 PQCNC Patient Family Partnerships - History and Charge
21/21
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)