RELATIONSHIPS & PERFORMANCE

QUALITY IMPROVEMENT

MedStar Adverse Outcome Index Analytic Project and Related Perinatal Analyses
In 2017, MedStar Health contracted with NPIC to create Adverse Outcome Index (AOI) reports for seven hospitals, in addition to summary reports provided to their system leadership. NPIC worked with MedStar to identify best format and detailed display of their data. Case lists for each time period selected were made available to MedStar Health for review and auditing purposes as appropriate. NPIC worked closely with the MedStar team to review and analyze historical obstetric claims data using the Adverse Outcome Index tool to help inform this project.
Agency for Healthcare Research and Quality (AHRQ) Safety Program for Perinatal Care (SPPC)
The Agency for Healthcare Research and Quality (AHRQ) developed the Safety Program for Perinatal Care (SPPC) in order to improve the patient safety culture of L&D units and decrease maternal and neonatal adverse events resulting from poor communication and system failures. This program extends AHRQ’s existing Comprehensive Unit-based Safety Program to L&D units and offers hospitals an approach to improving the unit patient safety culture and obstetric care processes to eliminate patient safety failures as a cause for adverse maternal and neonatal events. Program design, implementation support, and evaluation were provided by a national team composed of staff from AHRQ, RTI International, and the National Perinatal Information Center in addition to expert clinical faculty from a variety of organizations. NPIC collected and provided outcome data from participating hospitals and reported on nineteen outcome metrics, including the Adverse Outcome Index metrics, before implementation and post-implementation.
Perinatal Performance Information Project Defense Health Agency (DHA)
This project provides the Defense Health Agency (DHA), Office of Chief Medical Officer and all Military Treatment Facilities (MTFs) providing perinatal care with quarterly benchmarking reports comparing each facility’s volume, utilization, case mix, quality and outcomes to civilian hospitals in the NPIC proprietary Perinatal Center Data Base (PCDB). In addition, we provide a series of specialty reports on selected topics designed to aid DHA monitor performance and demonstrate/improve quality of care within the MHS.
Maryland Patient Safety Center (MPSC)
A three year initiative to test, adopt, and implement evidence-based improvement strategies to improve patient safety in the labor and delivery units of twenty-six hospitals in Maryland and the District of Columbia. NPIC provided comparative outcome data for the baseline period (the period prior to the initiation of the perinatal initiative), and ten follow-up AOI Quarterly Monitoring Reports for the post-implementation period. Each report displayed a 90% confidence interval around the hospital’s quarterly rate, as well as an analysis to determine if there was a statistically significant change from baseline to follow-up. In addition to hospital specific reports, aggregate data summary reports were provided to the project’s Planning Committee and NPIC staff participated in writing a report summarizing the success of the teams’ efforts and the project as a whole.
Premier Perinatal Safety Initiative (PPSI)
A perinatal safety initiative with the goal of improving patient safety and reducing risk exposure of the perinatal services at sixteen participating hospitals belonging to the American Excess Insurance Exchange (AEIX), a hospital-owned and controlled excess professional liability company managed by Premier Insurance Management Services (PIMS), a subsidiary of Premier. NPIC provided participating hospitals with comparative outcome data, including the Adverse Outcome Index, for the period prior to the initiation of the PPSI (baseline period), and quarterly for the post-training period. Participating hospitals received data for their own hospital as well as aggregate comparative data for a group of participating and non-participating hospitals. The PPSI encompassed a number of components including the identification of structural differences across the hospitals; analysis and initiation of process improvement activities using care bundles, team simulation, and common language training; surveys of safety culture and patient satisfaction, along with internal and external benchmarking of outcome measures to demonstrate improvements in patient safety.
Harvard Risk Management Strategies Foundation Team Performance Plus (TPP™)
NPIC was the data partner for the Harvard Risk Management Strategies Foundation TPP™ team training program. TPP™ is a comprehensive program – by clinicians, for clinicians – that provides interdisciplinary team training for obstetricians, midwives, nurses, and anesthesia providers to ensure safer deliveries, reduce the occurrence of preventable errors, and minimize litigation exposure. The team training program tracks ten adverse events before and after the team training intervention. Each adverse event is weighted and three indices are calculated: the Adverse Outcome Score, the Weighted Adverse Outcome Score, and the Severity Index. NPIC worked closely with the principals at TPP™ to develop the methodology to extract and calculate the indices using the administrative data set and supplemental files with select perinatal variables. NPIC and TPP™ reviewed the AOI algorithm to refine the identification of adverse events using administrative data as well as looking for the correct methodology to case mix adjust the measuresbased on the clinical profile of presenting patients.

RESEARCH

Obstructive Sleep Apnea in Pregnancy Associated with Adverse Maternal Outcomes
Pregnancy and the obesity epidemic impacting women of reproductive age appear to predispose women to obstructive sleep apnea (OSA) in pregnancy. NPIC identified women with a delivery discharge diagnosis of OSA from 2010 to 2014 from its PCDB . The aim of the study was to examine the association between OSA and adverse maternal outcomes in a national cohort.
``Learning to Safely Decrease Cesarean Section Rates`` - Ariadne Labs

“Fixing the Pressure Tank: The Role of Operational Management in Safely Reducing Primary Cesarean Deliveries “

NPIC partnered with Ariadne Labs, on a joint center for health systems innovation, a research project to study the relationship between operational management and institutional cesarean section (C-section) rates. Up to fifty NPIC member hospitals participated in the study.

Upon completion of the study, participating hospitals received valuable benchmarking information on how their own institution compares to others with respect to operational management factors that may impact their risk-adjusted cesarean section rate. Information was designed to be actionable in order to help NPIC members meet expected pay-for-performance targets.

Changes in delivery methods at specialty care hospitals in the United States between 2006 and 2010

Given awareness of increasing rates of labor induction and cesarean delivery, and guidelines to reduce non-medically indicated preterm and early term births, we examined recent trends in delivery methods.

Using data from 2006 and 2010 from 47 hospitals in the NPIC member hospital trend database, we examined (stratified by teaching hospital status): total deliveries, labor inductions, cesarean deliveries, operative vaginal deliveries. Maternal complications (e.g., operative vaginal delivery, hypertension, diabetes) were considered.

A secondary analysis was conducted from a subset of hospitals with a high proportion of maternal-newborn linked records and week-specific gestational age. We examined changes in gestational age at delivery and induction and cesarean delivery by gestational age over time.) » Learn More

``Evaluating maternal and neonatal outcomes: A comparison of 2 models of obstetric care delivery``
NPIC partnered with investigator Sindhu K. Srinivas, MD, MSCE at the University of Pennsylvania, to study the impact of the laborist model of care on maternal and neonatal outcomes through a Health Resources and Service Administration (HRSA) Maternal and Child Health (MCH) R-40 Grant.
Hospitalist Survey Analysis

NPIC surveyed a subset of member hospitals to determine if OB hospitals were covering their service with “laborists” or “OB hospitalists” and if so, their scope of service, and what type of contractual arrangements were being used.

Twenty-eight of the 56 hospitals/regional perinatal centers responded to this survey, a 50% response rate. » View Survey Results

Harvard Risk Management Strategies Foundation Team Performance Plus (TPP™)
NPIC was the data partner for the Harvard Risk Management Strategies Foundation TPP™ team training program. TPP™ is a comprehensive program – by clinicians, for clinicians – that provides interdisciplinary team training for obstetricians, midwives, nurses, and anesthesia providers to ensure safer deliveries, reduce the occurrence of preventable errors, and minimize litigation exposure. The team training program tracks ten adverse events before and after the team training intervention. Each adverse event is weighted and three indices are calculated: the Adverse Outcome Score, the Weighted Adverse Outcome Score, and the Severity Index. NPIC worked closely with the principals at TPP™ to develop the methodology to extract and calculate the indices using the administrative data set and supplemental files with select perinatal variables. NPIC and TPP™ reviewed the AOI algorithm to refine the identification of adverse events using administrative data as well as looking for the correct methodology to case mix adjust the measuresbased on the clinical profile of presenting patients.