Maternity Care Moving from Vision to Action through the TMC Partnership!
In this Issue: Prize for visualizing variations in maternity care
| New resources to lower rates of early elective deliveries
| Transitioning to comprehensive payment reform
| Secretary Sebelius urges maternity care improvements for Medicaid efficiency
| Webinar will explore shared decision making in maternity care
| Comprehensive patient safety program reduces adverse events, liability costs
Take Action: Help Transform Maternity Care
Childbirth Connection offers prize for visualizing variations in maternity care
Partnering with Health 2.0, Childbirth Connection has issued a challenge to developers to create a data visualization tool that demonstrates geographic variation in access, procedure use, outcomes, and/or costs in maternity care to galvanize state and regional action for quality improvement.
In a blog post, TMC Project Director, Amy Romano, highlights the remarkable tools and apps developed during previous Health 2.0 challenges, bringing data out of the cracks and crevices of government web sites and using it to map teen pregnancy rates against child poverty rates and health services access, or visualizing food deserts and diabetes rates in urban areas. We want to spark the same kind of innovation with maternity care data, and make the data accessible, engaging and relevant for policy makers, grassroots advocates, the media, and other stakeholders.
Teams are forming now and the deadline is March 4. The winning team will receive $2500, a meet a meet and greet with health economist and Health IT pioneer J.D. Kleinke, and the opportunity to demo their data visualization at the Health 2.0 meeting in San Diego before an audience of health and technology leaders.
Good News from the Field: Partners Putting the Blueprint into Action
New resources to reduce early elective deliveries
Childbirth Connection, the Leapfrog Group, and the March of Dimes have partnered to offer a suite of resources to reduce early elective deliveries. The Leapfrog Group, an organization representing employers working to drive quality improvement and value in health care, collected data from 773 hospitals on the "elective deliveries before 39 weeks" quality measure that was endorsed by NQF and adopted by the Joint Commission last year. The results of this hospital quality survey were made available in an online database, for the first time revealing the wide variation across hospitals to childbearing women, policy makers, and payers.
Timed with the release of this data, Childbirth Connection launched a new web resource reviewing the benefits, harms, and appropriate uses of induction of labor. Based on findings from two recent systematic reviews, the information reviews the risks of elective induction and shows that for many common medical reasons given for induction of labor, good quality research on the safety and effectiveness of induction is lacking. The site also offers tips and tools for informed decision making, as well as a handout (PDF) summarizing the labor induction experiences of mothers who participated in the national Listening to Mothers II Survey.
Report details transitional payment reforms that can be implemented on the path toward comprehensive reform
While the Transforming Maternity Care Blueprint for Action calls for comprehensive payment reform to align incentives with quality, such reform can take years to enact. Fittingly, the Blueprint calls for policy makers to implement selected policies immediately to address some severe misalignments in the current payment system.
A new report available from the Center for Healthcare Quality and Payment Reform offers help. Transitioning to Accountable Care describes a range of transitional payment reforms that can enable primary care practices, specialists, and hospitals to deliver significant improvements in cost and quality as they build the capacity to transition to more comprehensive payment reforms. Authored by Harold Miller, who presented a webinar on payment reform to improve maternity care quality late last year, the report recommends transitional reforms including bundling payments to hospitals and physicians, having hospitals and/or physicians agree not to charge more for preventable readmissions to the hospital, and paying based on diagnosis rather than on the specific procedures or treatments performed. The report also presents recommendations for developing a strategy to transition to comprehensive reform and securing buy-in from payers.
Deficit-weary Governors advised to reduce cesareans and preterm births
In a letter outlining state flexibility and federal support available for Medicaid, Health and Human Services Secretary, Kathleen Sebelius, highlighted opportunities to improve efficiency of Medicaid services, citing programs that reduce prematurity, medically unnecessary cesareans, and rehospitalization through payment approaches that align incentives with quality and investment in preventive care like home visitation programs for women with high-risk pregnancies. Sebelius also reviewed services that Governors do not have the flexibility to cut, including reimbursement for nurse-midwifery care, birth centers staffed by licensed midwives, smoking cessation programs for pregnant women, and rural health clinic services.
Consider This: Resources to Expand Your Vision for Improvement
Webinar coming up on February 15: Implementing Shared Decision Making in Maternity Care
Following in our successful TMC Topics webinar series, Lyn Paget, MPH, Director of Policy and Outreach at the Foundation for Informed Medical Decision Making (FIMDM) will present a webinar on implementing shared decision making in maternity care. She'll discuss how shared decision making is different from informed consent and why this genuine patient centered approach is garnering so much attention in the health care quality and patient safety movements. She'll give maternity care clinicians and consumer advocates a grounding in the evidence that supports the use of patient decision aids, federal and state legislation related to shared decision making, the experiences of FIMDM's demonstration cites, and the road ahead as we begin to think about how to bring SDM best practices to maternity care decision making.
This free webinar will take place on Tuesday, February 15 at 12pm EST. Register for this exciting opportunity.
Cause for Optimism: Maternity Care Moving in the Right Direction
Comprehensive patient safety program results in dramatic decrease in adverse events, 99% reduction in malpractice payments
Grunebaum A, Chervenak F, Skupski D. Effect of a comprehensive obstetric patient safety program on compensation payments and sentinel events. Am J Obstet Gynecol. 2011;204(2):97-105. (abstract)
New York Presbyterian Hospital-Weill Cornell Medical Center, a tertiary academic referral center in New York City, reports that following a multi-year, comprehensive patient safety program, sentinel events (maternal deaths and serious newborn injuries) decreased from 5 in 2000 to none in 2008 and 2009 while yearly compensation payments decreased from more than $27 million between 2003 and 2006 to $2.5 million between 2007-2009, a 99% reduction that far offset the cost of implementing the safety program.
Elements of the integrated, comprehensive patient safety program included:
Interdisciplinary team training for all clinical and clerical staff
Electronic medical record documentation of all intrapartum care, with special templates for documenting shoulder dystocia, instrumental vaginal deliveries, and other clinical situations with high risk of injury and liability
Establishment of a chain of communication to ensure a quick resolution to unresolved and urgent issues
Addition of a dedicated gynecology attending, three physicians assistants, and night/weekend laborist to decrease stress on obstetric staff and accommodate reduced residency hours
A policy prohibiting use of misoprostol for cervical ripening, except in cases in which the fetus is nonviable
A standardized low-dose oxytocin protocol for induction and augmentation and several changes, such as premixed solutions and color-coded tubing, to ensure safe administration of oxytocin, magnesium sulfate, and other high-alert medications
A checklist for most important elements of the standardized oxytocin policy
Standardized training for electronic fetal monitoring and adoption of NICHD language for documenting fetal heart rate patterns
Obstetric emergency drills for situations including shoulder dystocia, maternal hemorrhage, and emergency cesarean section
Availability of postpartum hemorrhage kit including all four medications that might be administered to control a hemorrhage
Addition of a full-time patient safety nurse, responsible for team training, emergency drills, and data collection
Implementation of an electronic, online whiteboard to replace the typical dry-erase whiteboard used to communicate basic information about the clinical status of patients admitted to labor and delivery
Routine thromboembolism prophylaxis for women after cesarean section, using lower extremity pneumatic compression devices, medications, or both
24/7 access to standard electronic antepartum records for most patients
Internet-based required reading and testing for all attendings and residents
Early identification of adverse outcomes and potential liability cases and proactive outreach to the patient when a clear medical error was identified, with a goal of an early settlement.