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CDC Levels of Care Assessment Tool

CDC Levels of Care Assessment Tool. Andrea Catalano, MPH West Virginia Perinatal Summit November 15, 2018. Background . Risk-Appropriate Care. * Committee on Perinatal Health. Toward Improving the Outcome of Pregnancy:

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CDC Levels of Care Assessment Tool

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  1. CDC Levels of Care Assessment Tool Andrea Catalano, MPH West Virginia Perinatal Summit November 15, 2018

  2. Background

  3. Risk-Appropriate Care * Committee on Perinatal Health. Toward Improving the Outcome of Pregnancy: Recommendations for the Regional Development of Maternal and Perinatal Health Services. White Plains, NY: March of Dimes National Foundation, 1976. • Strategy promoted in 1976 March of Dimes report* • Simple concept quickly embraced by many states • Enhanced by • Public health research • Implementation complicated by • Reimbursement policies • Hospital competition • Regional context

  4. Policy Based on Guidance * Blackmon LR, Barfield WD, Stark AR. Hospital neonatal services in the United States: variation in definitions, criteria, and regulatory status, 2008. J Perinatol. 2009 Dec;29(12):788-94 ** Levels of maternal care. Obstetric Care Consensus No. 2. American College of Obstetricians and Gynecologists. ObstetGynecol 2015;125:502–15 Challenges • Reimbursement, competition, landscape • Lack of granularity = Inconsistent policies • AAP guidelines + X/Y/Z = State policy A/B/C* • Absence of maternal level criteria comparable to neonatal (Until 2015**)

  5. A Perfect Storm

  6. What is LOCATe? • Levels of Care Assessment Tool • Produces standardized assessments • Fosters collaboration across borders • Strengthens evidence for increased specificity in criteria 3) Facilitates stakeholder conversations • Increases (common) understanding of landscape • Data driven improvements in facilities & systems …while, minimizing burden on respondents

  7. Development of LOCATe • 2013-Pilot testing • Several facilities in 5 states • 2014-Field testing • All facilities in 2 states, initially • Then, staged roll-out with additional states • 2017-Version 8 • Each state implementation provides feedback • V8 includes: • Questions on drills & protocols • More refined wording

  8. LOCATe Content

  9. LOCATe Content • Includes questions about: • Hospital equipment and staffing • Subspecialists and their availability • Self-designation of level of care • Volume of procedures • Pediatric Surgery • Ventilation for neonates • Transports and facility-level statistics

  10. The LOCATe Process

  11. The LOCATe Process

  12. The LOCATe Assessment

  13. LOCATeJurisdictions* *as of 11/2018

  14. Analysis & Dissemination

  15. Analysis Opportunities • State level report • Summary of guidelines • Aggregate information by levels • Merge levels with public health surveillance data • Hospital discharge records (Severe Maternal Morbidity and neonatal morbidity) • Vital Records (neonatal and post neonatal mortality) • Examine outcomes between and within levels of care and by specific capabilities

  16. Dissemination Opportunities • Webinar for Hospitals • High-level information & overview • Individual Hospital Reports • Describe facility’s levels and reasons for variation from expected levels • Discuss quality improvement opportunities • Patient safety bundles • Partner with other organizations to strategize activities on risk-appropriate care in state/jurisdiction

  17. Future Activities • Multi-jurisdiction analysis • LOCATe toolkit • ACOG Levels of Maternal Care Verification Program • More Technical Assistance Materials • Emergency preparedness • Quality Improvement • Opportunities for telemedicine use

  18. Thank you!Questions? Andrea Catalano acatalano@cdc.gov • The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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