Presentation on theme: "Secretary’s Advisory Committee on Infant Mortality November 15, 2012"— Presentation transcript:
1Collaborative Improvement & Innovation Network (CoIIN) to Reduce Infant Mortality Secretary’s Advisory Committee on Infant MortalityNovember 15, 2012Reem M. Ghandour, DrPH, MPACOIN Coordinator / Senior Public Health AnalystU.S. Department of Health and Human ServicesHealth Resources and Services AdministrationMaternal and Child Health BureauOffice of Epidemiology and ResearchThank you for this opportunity to provide an UPDATE on the Collaborative Improvement & Innovation Network to Reduce Infant Mortality as a lot has happened since we last spoke about this initiative in July.In the simplest terms, this is an initiative designed to bring the science of quality improvement and collaborative learning to bare on the challenge of infant mortality beginning in the 13 southern states.
2What is a CoIN?A CoIN, or Collaborative Innovation Network, has been described as a team of self-motivated people with a collective vision, enabled by the Web to collaborate in achieving a common goal by sharing ideas, information, and work.1Key Elements of a CoINBeing a “cyber-team” (i.e. most CoIN work will be distance-based);Innovation comes through rapid and on-going communication across all levels;Work in patterns characterized by meritocracy, transparency, and openness to contributions from everyone.Adapted to reflect focus on both innovation and improvement yielding a Collaborative Improvement & Innovation Network to Reduce Infant Mortality.JUST AS A REMINDER….this initiative is grounded in the model developed by Dr. Peter Gloor and is highly influenced by a couple of key characteristics of this model:COIN relies on people working in a CYBERTEAM. This is important b/c most of us still relay on relationships that are based on face to face contact and the trust that that can engender. We’re asking people to collaborate successfully in a whole new way.It is a model that requires everyone to be part of the solution – ex of clinical setting.IN IT’S IDEAL FORM, Interactions and team processes are characterized by transparency and meritocracy WHICH ENABLES that diffuse communication and decision-making.AS A REMINDER….WE’VE ADAPTED….1 Gloor PA. Swarm Creativity: Competitive Advantage through Collaborative Innovation Networks. New York: Oxford University Press, 2006.
3Infant Mortality CoIIN: History and Vision Started in Southern states:Born out of January 2012 Infant Mortality Summit in New Orleans, LA for Regions IV and VI as well as previous state-level work by ASTHO and March of Dimes.Designed to address stated needs :Support collaborative learning, innovation, and quality improvement efforts to reduce infant mortality and improve birth outcomes;Apply evidence-based strategies to reduce infant mortality;Stimulate action across states, among many partners.Lifespan: months (beginning July 2012) with nation-wide expansion planned.Developed and implemented in ongoing partnership with ASTHO, AMCHP, March of Dimes, CityMatCH, CMS, and CDC and other public and private partners.Foci, activities, and outcomes are Team driven.In the most concrete sense, this was born out of the January summit that occurred last winter in NoLa. + previous work by ASTHO and others.Underscore – we moved very quickly on this initiative in part to be responsive to the states that participated in the January Summit and in part to build on the momentum that we anticipated coming out of the June 14th Announcement by Sec Sebelius at the Child survival Call to Action for a National Strategy to reduce infant mortality.
4CoIIN Design Strategy Teams State Teams Common Strategies for Regions IV and VIPromote smoking cessationExpand Interconception Care in MedicaidReduce elective deliveriesEnhance perinatal regionalizationPromote safe sleepStrategy Leads (2-3 topical experts)Data and/ or Methods ExpertsStaff support (MCHB & Partner Organizations)State Representatives Average peopleStrategy TeamsState Health OfficialsMCH staffMedicaid staffPrivate partnersAverage 7-15 peopleState TeamsWhat’s happing and Who is doing it.Private Partners: academic experts, March of Dimes, clinical providers, health plans, etc.State Team members comprise the bulk of the membership of the Strategy Teams that work together to tackle these 5 common areas identified by the states a little over a year ago.Contract Team with expertise in quality improvement + Advisory Panel of Experts
5Define Scope and Nature of the Problem Build and Sustain Cyberteams CoIIN: Work to DateDefine Scope and Nature of the ProblemEstablish quality improvement Aims for each Strategy.AimsIdentify state-level opportunities to achieve Aims.StrategiesSelect measures to track progress towards Aims over the next mo.MeasuresBuild and Sustain Cyberteams
6Aims & Strategies: Increase Safe Sleep Practices AIM: Increase infant safe sleep practices by 5% by December 2013 in Regions IV and VI states and reduce disparities in sleep-related infant deaths.Infant care-giver KAB and practicesStandardized training within provider systemsStrategic alliancesSTRATEGIESInfant Caregiver Behavior:-Target Audience: day care workers, child care providers, churches, baby sitters, etc.-Focus: Knowledge, attitudes and beliefs in support of safe sleep behavior, and increase in adoption of safe sleep promotion practicesTraining Standardized:-Target Audience: Systems that house OB, Pediatrics, nursing staff, discharge planners, home visitors, clinic staff, etc.-Focus: Enact policies through these provider systems that require the modeling and promotion of safe sleep recommendationsStrategic Alliances:-Target Audience: Non-traditional partners like AARP, Sororities, Civic Groups, students, volunteers, Girl Scouts, etc.--Focus: Expand network of organizations that endorse AAP safe sleep recommendations
7Aims & Strategies: Expand Interconception Care AIM: Modify Medicaid policies and procedures in 5-8 Southern states by December 2013 in order to improve access to and financing of postpartum visits and interconception care case management for women who have experienced a Medicaid financed birth that resulted in an adverse pregnancy outcome.Medicaid eligibility policyMedicaid program design & innovationMedicaid administrative processesProvider KAB & PracticesConsumer KAB & UtilizationSTRATEGIESMedicaid eligibility policy1115 Waiver (“interpregnancy”) – GA and LA “mentoring” other statesOptional eligibility expansion for women (now)ACA Medicaid Expansion January 2014 and beyondMedicaid program design & innovationTargeted (medical assistance) case managementAdministrative case managementMedicaid health homes for women with chronic (and mental) health conditionsMedicaid administrative processesMedicaid billing codes and modifiersReimbursement for services (e.g., case management)Medicaid data (including linkage to vital stats)Provider KAB & PracticesEducation; Medicaid provider guidance and manualsEmphasis on postpartum visit, including tools and performance monitoring with HEDIS measureSystems coordination / integration (e.g., referral patterns, safety net, Healthy Start)Consumer KAB & UtilizationConsumer information materials & social marketing campaigns (including postpartum visits, RLP, family planning, ICC)
8Aims & Strategies: Enhance Perinatal Regionalization AIM: By December, 2013, increase to 90% or by 20% above baseline, mothers delivering at appropriate facilities to include infants less than 32 weeks gestation and/or less than 1500 grams.DataMaternal CarePolicy and IncentivesGuidelines for Levels of CareSTRATEGIESDataStandardize reporting of national performance measure #17Standardize Analysis of data (VLBW by place)Maternal CareDevelop guidelines for maternal care with other organizations ACOG, Maternal Fetal Medicine AWHONN (based on existing guidelines)Identify barriers to implementationDevelop toolkitPolicy and IncentivesAddress hospital reimbursement for NICU babies born in Level II hospitalsAddress “bundling’ issues related to transport (unbundle transport)Guidelines for Levels of CareStandardize Levels of Care for all statesCreate back-up procedures in addition to transport, if birth is in hospital with insufficient level of care.
9Aims & Strategies: Increase Smoking Cessation AIM: To decrease the tobacco smoking rate by 3% among pregnant women in the States of Regions IV and VI by December 31, 2013.Provider KAB & PracticesConsumer KAB & PracticesMedicaid PolicySTRATEGIESProvider KAB & PracticesProvider awareness of resources to support tobacco use cessationProvider education and training around evidence-based cessation interventionsSupport SYSTEMS and ENVIRONMENTAL CHANGES that enable implementation of smoking cessation best practices at the provider level i.e. protocolsConsumer KAB & PracticesEnsure the maximum (or full range of) evidence-based, Quitline tobacco cessation service bundle is available to pregnant women who smokeIncrease knowledge and use of Quitlines by pregnant and post-partum womenMedicaid PolicyConduct a State inventory of current policies / practices regarding Medicaid’s expanded coverage of tobacco cessation services for pregnant and post-partum womenDevelop alliances and cooperative relationships with State Medicaid programsEndorse a standard of Quitline benefits/services for pregnant and post-partum women and encourage State Medicaid programs to adoptEncourage State Medicaid programs to support State Quitlines through use of Medicaid administrative match funds
10Aims & Strategies: Reduce Elective Deliveries < 39 wks AIM: By August, 2013, reduce the proportion of non-medically indicated deliveries < 39 weeks by 33% in the Region IV and VI states.Committed, Collaborative Leadership & MomentumDataPolicy & Environmental ChangeProvider KAB & PracticesConsumer KAB & PracticesLeadership & Momentum:Identify leaders/championsHave the right partners at the tablePublic-Private CollaborationMake a credible case for change: the business case and the human caseDataAssess the current situation/establish baseline and gapsDefine standard data sources and measures, timelinesImprove the quality and timeliness of dataPolicy & Environmental ChangeChange Medicaid payment practicesRecommend hard stop policies if voluntary not successfulEducate legislators and advocatesProvider KAB & PracticesIdentify a physician championTraining for facility leaders re: ACOG guidelines, outcomesInvolve Quality and Risk Management staffConsumer KAB & PracticesPublic education/social marketing about LPT brain development, what is term, risks of early EDDevelop list of myths and responsesCoordinate messages at federal/national and state/community level
11CoIIN: Next Steps (6 months) Region IV & VI Strategy Teams to refine Aims, Strategies, Metrics, Driver diagrams;Implement strategies at State level;Track process and outcome (short and midterm) measures;Plan for 2nd face-to-face meeting (i.e., Learning Session);Expand to Region V (March 2013) and other Regions.
12CoIIN: SummaryA new MCHB-HRSA partnership to accelerate improvements in infant mortality.Designed to help States:Innovate and improve their approaches to reducing infant mortality and improving birth outcomes through communication and sharing across state lines;Use the science of quality improvement and collaborative learning to improve birth outcomes.Part of a portfolio of Public/Private and MCHB efforts to improve birth outcomes.
13Contact InformationReem M. Ghandour, DrPH, MPASenior Public Health AnalystMaternal and Child Health Bureau