Improving Birth Outcomes

1. Improving Birth Outcomes

2. DISCLOSURE • I have no financial interests or other relationship with manufacturers of commercial products, suppliers of commercial services, or commercial supporters. My presentation will not include any discussion of the unlabeled use of a product or a product under investigational use.

3. The Role of the Leader “Servants of what is.” And, “Shapers of what might be.”

4. Leading is not Tidy • Decisions are made and then reversed • Misunderstandings are frequent • Inconsistency is inevitable • Inside every solution are the needs of new problems • Most of the time most things are out of hand Nonaka and Takeuchi, The Wise Leader

5. Health and Mortality

6. Will Changes in Models Force Changes in Structure and Systems? Process Structure Outcomes Improvement Science Hoffer-Gittlell, Heller School Brandeis University

7. Where are you in the Model Life Cycle? Viability Patient Inflection Point Adaptive Leadership Technical Leadership Adapted from The Second Curve, Ian Morrison 1996 Models

8. The Patient’s Health RecordCloud Infrastructure Fitness Center Home Telemetry Financial Services Grocery Store Pharmacy Home Health Care Primary Care Long Term Care Specialist Hospitals

9. What is:

10. And what can be:

13. Opportunities • Each week 174 babies premature • VLBW babies in South Carolina= $107 million per year. • Over a thousand VLBW births per year • 235 VLBW cases are multiple birth deliveries • Small number but over 50% of hospital charges

14. Louisiana Birth Outcomes Initiative

15. Louisiana Philosophy We strive to improve health and health care by: • Using the “Lifecourse” theory • Motivating and building will for change with hope and optimism • Consensus, consensus, consensus

16. Louisiana Rankings Source: Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2008. National vital statistics reports; vol 59 no 1. Hyattsville, MD: National Center for Health Statistics. 2010.

17. FIMR Family planning Increase use of smoking cessation treatment Intensive care coordination/case management Screening and treatment for behavioral health New indicators for hospital quality monitoring Increase use of 17P Chronic disease management Risk assessment and care plan for women with adverse outcome Reduce preterm & repeat C-section Interventions to Improve Birth Outcomes Infant Prenatal Birth Postpartum & Interconception Home Visitation (Healthy Start, NFP) Early and Adequate Prenatal Care

18. Top Down • Tony Keck • Louisiana Department of Health and Hospitals • Louisiana Perinatal Commission • Authorized in 2006, 16 member commission appointed by Governor Jindal • Blue Ribbon Panel

19. Bottom Up Birth Outcomes State Wide Action Teams • Five action teams which represent community partners, consumers, advocates, public health professionals, clinicians, hospital administrators, and insurers • Care Coordination • Health Disparities • Patient Safety and Quality • Behavioral Health • Data and Measurement

20. Ideas

21. Birth Outcomes Priorities • Increase Data Capacity and Performance Measurement • Institute statewide comprehensive Behavioral Health screening and brief intervention for pregnant women in Medicaid • Pilot and expand access to Interconception Care Coordination • Increase Patient Safety and Quality of Care

23. Patient Safety and Quality of Care To create a culture of continuous quality improvement and safety in Louisiana’s birthing hospitals.

24. Gestational Age That Women Consider it Safe to Deliver

25. Rise in Induction of Labor in US 1990-2006

26. Complication Rates, Scheduled Repeat Cesareans by Weeks of Gestation

28. 115 in a 55 Forbidden behavior except under extreme circumstances 95 in a 55 Safety regs & good practices Certification/ accreditation standards 75 in a 55 Collective memory of experiences Individual Autonomy 55 in a 55 Individual Pressures the ‘illegal-illegal’ space (for almost all of us!) Perceived Vulnerability Usual space of action Illegal-normal space VERY UNSAFE SPACE Guidelines as defined by professional standardsLegal space Forbidden by all Belief in Systems- guidelines <1% 5% 50% 80% 100% percent of staff PERFORMANCE

29. Progress! 39 week initiative begins

30. Data and Measurement • Create transparency, accountability and quality improvement infrastructure for perinatal quality improvement measurement and reporting.

31. Perinatal Quality Scores • Pre-term births • VLBW by level NICU • Nulliparous term singleton vertex C-sections (NTSV) • Elective deliveries < 39 weeks gestation

32. Behavioral Health Ensure that all women in Medicaid receive a behavioral health screen, brief intervention referral and treatment for substance use, depression and violence

35. Care Coordination To provide care coordination for every woman in Louisiana Medicaid who has had an adverse pregnancy outcome

38. Community Development Economic Development Best Babies Zone Educational Development Health Development

39. Where are you in the Model Life Cycle? Viability Patient Inflection Point Adaptive Leadership Technical Leadership Adapted from The Second Curve, Ian Morrison 1996 Models

40. SC Vision Team Tony, BZ Perinatal Improvement Community SC Hospital Partners Champions

41. Department of Health and Hospitals • Louisiana Birth Outcomes Initiative • DHH Bienville Building • 628 N. 4th Street • Baton Rouge, Louisiana • (225) 342.9500 • Website: www.dhh.la.gov • The Birth Outcomes Initiative • Rebekah Gee, MD, MPH, MS, FACOG • Director of Birth Outcomes • Michelle M Alletto, MPA • Deputy Director • Bruce Greenstein, Secretary • Kathy Kliebert, Deputy Secretary • Jerry Phillips, Undersecretary This document was published in-house by the DHH Office of Birth Outcomes