Maternity Care Moving from Vision to Action through the TMC Partnership!
In this Issue: There's a toolkit for that! | NQF seeking perinatal care and reproductive health measures | Act locally, inspire globally | New state resources reveal 4-fold variation in birth charges | New Canadian consensus report addresses maternity care decision making | At Intermountain, process improvement drives quality, value
This month's eNews brings new resources for transforming maternity care, from an inventory of improvement toolkits to new state charts to galvanize action to rein in unwarranted cost variation.
This month also marks the launch of a new and exciting resource, The Transforming Maternity Care Blog. The blog will feature news, opinion, and analysis from our senior staff. We'll highlight innovative and effective quality improvement efforts, introduce readers to inspiring leaders and thinkers, analyze health care trends that affect childbearing women and newborns, and share opportunities and resources for all maternity care stakeholders. Stop by the blog to read about an innovative approach to getting more consumers and their advocates "at the table" and an in-depth interview about shared decision making with Lyn Paget from our collaborating partners, the Foundation for Informed Medical Decision Making. Join the conversation, and let us know what you want to hear more about on the blog.
Take Action: Help Transform Maternity Care
There's a toolkit for that!
What are you trying to improve about maternity care? Chances are, there's a toolkit for that. Do you want to improve your hospital's performance on NQF-endorsed quality measures like elimination of early elective deliveries? Do you want to address safety problems in your maternity unit? Do you want to implement an apology and disclosure program for clinicians? Make your clinic more woman- and family-friendly? Improve breastfeeding rates? Increase VBAC access? Implement obstetric safety drills? Engage and communicate with consumers to enhance maternity care quality? Quality improvement organizations offer toolkits for all of these concerns and more.
Improvement toolkits offer step-by-step guidance, case studies, self-assessment tools, evaluation plans, sample policies, documentation templates, and other resources to guide quality improvement efforts. Check out our full inventory of improvement toolkits, and contact us if you know of an effective toolkit that's not listed.
NQF Perinatal Care and Reproductive Health Project seeking Steering Committee members and new quality measures
The National Quality Forum (NQF) is gearing up to increase the number and scope of perinatal and reproductive health quality measures and to engage new leaders in endorsing and maintaining these measures. Perinatal core measures already endorsed by NQF are driving quality improvement efforts in areas including elimination of early elective deliveries, exclusive breastfeeding during hospitalization, reduction of cesarean in low-risk first time mothers, and appropriate care of infants in the neonatal intensive care units. Performance measurement and leveraging of results are crucial strategies for improving the quality and value of maternity care, and new, robust quality measures are urgently needed.
The 90-day call for nominations of measures and Steering Committee members opens July 18. Participation on the Steering Committee requires a significant time commitment and a high level of understanding of quality issues. For more information, visit NQF's web site. All members of the public will be invited to comment on the roster of Steering Committee candidates during a 14-day public comment period beginning September 1 and on the draft measures during a 30-day comment period beginning in January 2012.
Good News from the Field: Partners Putting the Blueprint into Action
Community-based improvement projects act locally, inspire globally
The Transforming Maternity Care Directory is growing, with innovative and effective improvement projects added every week. Many of these projects were developed to address local needs, but offer inspiration and resources for adaptation in other communities. Here's what some community-based TMC Partners are doing:
Are you working to improve maternity care in your community (or beyond)? Add your project to the TMC Directory.
James's Project in Pennsylvania is offering education and advocacy services for parents, clinicians and other infant caregivers to help them safely navigate the health care system and reduce medical errors.
- Purple Lotus Doulas in Missouri and the Hudson Perinatal Consortium in New Jersey have innovated new models for ensuring low-income women have access to doula support.
- Bloomington Area Birth Services in Indiana has established a taskforce to improve identification and treatment of women with perinatal mood disorders.
Consider This: Resources to Expand Your Vision for Improvement
Whats the price tag to give birth in your state?
If you give birth in a Maryland hospital, your hospital will charge about $5500 if you have an uncomplicated vaginal birth and about $6800 if you have an uncomplicated cesarean section. Move just up the coast to New Jersey and triple or even quadruple those numbers. The hospital now charges more than $18,000 for the same vaginal birth and a whopping $26,000 for the same cesarean. Move to a state with a birth center, like California or Washington, and the facility charge drops to as low as $2000 for an uncomplicated vaginal birth.
How does your state measure up? Childbirth Connection has just posted Average Facility Labor and Birth Charges by Site and Method of Birth for the 35 states for which data are available. Our continually updated national charges chart is one of our most widely used resources. We're glad to now provide new state charts and a companion Quick Facts sheet to advocates and policy makers to address maternity care value at the state level.
Canadian consensus report addresses decision-making and evidence-based care
The 2011 Turning the Tide: Balancing Birth Experience and Interventions for Best Outcomes consensus conference brought together a diverse group of stakeholders in maternity care to present and discuss evidence regarding the impact medical interventions, specifically electronic fetal monitoring, induction of labor and epidural anesthesia, have on a woman's experience of labor and birth. The conference was hosted by British Columbia Women's Hospital's Cesarean Task Force and the Power to Push Campaign, the UBC Collaboration for Maternal and Newborn Health, and Perinatal Services BC (PSBC).
The final consensus report was released earlier this month and provides a robust plan for improving shared decision making, interprofessional collaboration, and evidence-based care. Recommendations in the report are relevant to many of our Blueprint for Action focal areas, including decision making and consumer choice, health professionals education, clinical controversies, workforce composition and distribution, and coordination of care across time, settings, and disciplines.
Cause for Optimism: Maternity Care Moving in the Right Direction
At Intermountain, process improvement drives quality, value
James, B. C., & Savitz, L. A. (2011). How Intermountain trimmed health care costs through robust quality improvement efforts. Health Affairs, 30(6), 1185-1191. doi:10.1377/hlthaff.2011.0358 (abstract)
A recent paper in Health Affairs describes how Intermountain Healthcare, an integrated health system in Utah and Idaho, has improved quality while substantially lowering costs across their system. The effort has emphasized processes rather than outcomes of care, because data from their robust clinical and administrative information systems revealed that outcomes were similar across providers while resource utilization varied markedly. Focusing on the process of care rather than individual clinicians, while simultaneously providing feedback to clinicians on their care processes, resulted in over 100 successful clinical improvement initiatives across various disciplines.
Notably, one of the earliest and most successful process improvement programs was implemented in their maternity care unit, where in 2001 Intermountain hospitals implemented a new policy to discourage elective inductions. The change resulted in decreases in both NICU admissions and cesareans, and Intermountain estimates that elective induction protocol reduces health care costs in Utah by $50 million per year. The paper addresses current perverse payment incentives that that hinder replication of this successful program in other settings.