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The Health Roundtable

The Health Roundtable

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The Health Roundtable

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  1. The Health Roundtable Maternity Benchmarking 28-29 May Melbourne– HRT0910

  2. The Health Roundtable …… An Innovation Clearinghouse Non-profit membership group 60+ Members 110+ Facilities Founded 1995 Share problems Share solutions Provides informal network Health Roundtable

  3. 60+ Organisational Members –110+ Hospital facilities

  4. Help members answer basic questions Are our results different? Why are we different? Who can we learn from? How do they do it? How can we make it happen here?

  5. Focus on Benchmarking for Innovation… Voluntary comparisons Search for differences Data Methods Clinical Practices No “right or wrong” Opportunity focus Gradual fine-tuning

  6. …Not Benchmarking for Accountability Mandated Uniform Tightly defined Score – “win/lose” Denial “by losers” Gaming the system “Inspectors” needed

  7. 1.Knowledge 1.Knowledge 3. Decision 3. Decision 2. Persuasion 4. Implementation 5. Confirmation The Health Roundtable Process Fostering Innovation From Everett Rogers

  8. Program for 2009 Core Optional

  9. AgendaDay 1

  10. Agenda Day 2

  11. Meeting Goals • Compare maternity-related KPIs • Review innovative practices in antenatal care • Develop action plans to apply innovations specific to your needs • Plan for the second maternity meeting (8-9 October, Sydney)

  12. Data Used 1. Casemix data => KPI report • Individual and all-hospital report • Service Volume • Demographics • Service Mix • Length of Stay • VBAC • Delivery Characteristics • Co-morbidities • Complications of Care • Neonatal Indicators • Antenatal Care 2. Survey • Demographics • Antenatal Services • Antenatal Staffing • Delivery Characteristics • Post-Natal care

  13. KPI and Survey data

  14. Service Volume

  15. B1.01 Number of Deliveries (6 mos) • Range from 509 (Cougar3) to 4006 at Fury • Antares4, Jaguar, Fury highest

  16. Antenatal visits (Full yr) • Jaguar, Scorpio, Fury highest in total antenatal visits • NZ model distinction, does not capture all antenatal visits Survey 2.1

  17. Antenatal visits • 9 of 12 hospitals, > 90% of pregnant women have at least one antenatal visit • 61-70% at Antares4

  18. Antenatal visits • 3 of 12 hospitals, greater than 90% of women have at least 4 antenatal visits • Largest decrease at Antares4, Fury, and Lynx >= 1 >= 4

  19. Antenatal visits per delivery • Antares4: 1.3 antenatal visits for each delivery • Jaguar: 14.2 visits per delivery

  20. Receive antenatal care elsewhere? • Antares4, Fury, Lynx lowest # in visits/delivery, perhaps due to high number getting antenatal care elsewhere • See the highest numbers at the NZ hospitals, seems to hold true. • 31-40% at Poseidon • 10% or less at Cougar3, Jaguar, Hera2

  21. Avg Antenatal visits per woman • At Fury: 4.4 antenatal visits • 13.5 antenatal visits at Jaguar (3x the rate of Fury, 2x rate of Antares 4, Poseidon) Survey 2.3

  22. Patient Demographics

  23. B2.01 Age of Mothers • Jaguar highest % of mothers >40 (~7%) • Poseidon and Fury high % of <18 mums (~7%) • Achilles and Hera2 : Young Mums program

  24. B2.02 Rate of Deliveries with Indigenous Mothers • Highest at Poseidon and NZ hospitals (Lynx and Fury) • Hera2: ATSI program

  25. Smoking • 1-10% of at Cougar3; > 50% at Antares4 • Only Cougar3 does not offer smoking cessation counselling to pregnant women. (lowest rate reported). • Dionysis: National Smoke Free Pregnancy project

  26. Drug Addiction • < 1% at Cougar3 • Sirius: 31-40%, the highest of reporting hospitals. • Neither Cougar3 nor Poseidon offers drug addiction services or counseling

  27. Alcohol Abuse • < than 1% at 4 hospitals (Apollo, Dionysis, Cougar3, and Jaguar); 4 1-10%. • Poseidon and Cougar3 also do not offer alcohol abuse services. • Hera2: Drug and Alcohol program

  28. BMI • Highest reported at Apollo and Sirius (23-25%) • 5-6% at Scorpio and Hera2 Bariatric Management Policy/Practice BLOOM program

  29. Translation • >50% of women at Scorpio require a translator • <1% at Dionysis, Cougar3, Lynx Annual audit of translator requirements

  30. Antenatal Clinics and Staffing

  31. Midwife-led Antenatal Clinic Visits • Antares4 and Sirius lowest % of midwife-led antenatal clinics(1-10%) • Lynx: Nearly all midwife-led

  32. Improvements to Antenatal Clinics

  33. Recommended Transfer to Antenatal Services • 8-10 weeks at 5 hospitals (Apollo, Cougar3, Jaguar, Scorpio, and Achilles) • At Antares 4: 20 weeks Survey 2.4

  34. Antenatal Clinics: Midwife hours • Highest reported at Hera2 (25,800); also high at Antares4 and Scorpio • 5,408 at Cougar3 4.1 Survey

  35. Midwife hours per antenatal visit • Antares4: 2.7 midwife hours per visit. • Apollo .32 hours • Antares4, Poseidon, Hera2 > 1 hr per visit Survey 4.1/2.1

  36. Midwife as Lead Professional • Scorpio: high number of midwife hours and high % with midwife as lead professional

  37. Midwife as Lead Professional: Low risk pregnancies • Much higher number of midwife-led pregnancies • Apollo: from 31-40% to 81-90% of low risk pregnancies • Sirius: <1% to 41-50% • Dionysis: 21-30% to 61-70%

  38. Midwife: Direct Access to Beds • Of the 4 hospitals that indicated midwives have direct access to beds, Apollo, Scorpio, Fury, and Lynx), 3 of those (Scorpio, Fury, and Lynx) also have the highest percentages of pregnancies led by midwives.

  39. Antenatal Clinics: Obstetric hours • Scorpio and Achilles both have a high number of Obsetric jr hrs; ~1FTE at each • Nearly 4000 hours Obstetric consultant hrs at Antares4 Survey 4.1

  40. Midwife hours per obstetric hour • >4 midwife hours for every obstetric hour at Cougar3 and Hera2 • ~2.5 to 1 at 4 hospitals (Antares4, Poseidon, Scorpio, Lynx) • All hospitals > 1; Achilles closest with 1.02

  41. Appointment reminders • Most typically by a letter • Jaguar: letter is only with the 1st appointment. • Antares4 and Scorpio both also use telephone reminders as well as letters. • Hera2 and Fury have both recently introduced SMS • Dionysis is planning to implement

  42. Shared Care • All hospitals use a Shared Care model for at least some women • 15% at Apollo, Poseidon, and Cougar3 • 80% at Scorpio (>50% at Fury, Lynx) • Implemented full GP/midwife shared care 2.8 HRT0910 Maternity Survey

  43. Antenatal indicators

  44. B10.01 Rate of Pre-existing hypertension complicating pregnancy • Antares4 highest at 1.1% • Low at Sirius2 and Lynx; 0 at Cougar3

  45. B10.02 Rate of pre-eclampsia • Highest at Antares4 at 4.8%. Lowest at Cougar3 (1.0%)

  46. B10.02 Rate of pre-eclampsia • General decrease in the trend of rate across hospitals

  47. B10.04 Rate of Supervision of High Risk Pregnancy • ~6% at Poseidon, Achilles, Hera2, Lynx+ • 12.3% of Antares4’s pregnancies classified as high risk; 2x next • <1% at Sirius

  48. B10.04 Rate of Supervision of High Risk Pregnancy • Reported as ICD-10 Z35 • Includes supervision of pregnancy with: • History of abortive outcome • Other poor reproductive or obstetric history • History of insufficient antenatal care • Grand multiparity • Elderly primigravida • Very young primigravida • Due to social problems • Other high-risk pregnancies • High-risk pregnancy, unspecified

  49. B10.03 Rate of Diabetes Diagnosed in Pregnancy • Highest at Antares4 and Achilles at >10% • Lynx >3%

  50. B10.03 Rate of Diabetes Diagnosed in Pregnancy • Trend shows ~30% increase in rate of diabetes diagnosed in pregnancy over the last 3.5 years • New models of treatment