Changing Landscape of Quality – Implications for Pediatric Specialties and Data Systems Ramesh Sachdeva, MD, PhD, JD, FAAP, FCCM Chief Scientific Officer, VPS Professor of Pediatrics, Critical Care M EDICAL C OLLEGE OF W ISCONSIN Associate Executive Director Medical Director, Quality Initiatives Director, Department of Subspecialty Pediatrics A MERICAN A CADEMY OF P EDIATRICS

Eight Steps of Change Achieving Change to Improve Quality and Enhance Outcomes Eight Steps of Change Increase Urgency Build the Guiding Team Get the Right Vision Communicate for Buy-In Empower Action Create Short-term Wins Don’t Let Up Make it Stick Creating a climate for change Engaging and enabling the whole organization Implementing and sustaining change Kotter, John P. and Cohen, Dan S. The Heart of Change. Boston: Harvard Business School Press, 2002.

Knowledge Management The DNA of Continuous Learning for QI Knowledge Management Level 1: Standardized Infrastructure for Knowledge Sharing Level 3: Top-Down Retention Measurement Level 5: Organizational Knowledgebase Level 7: Continual Process Improvement Level 2: Top-down Quality-Assured Information Flow Level 4: Organizational Learning Level 6: Process-Driven Knowledge Sharing Level 8: Organizational Self- Actualization In:

Role of the Intensivist Improving care for the child in the PICU

Role of the Intensivist Leadership at the hospital and system level

Role of the Intensivist Impacting child health outcomes

Contemporary View for Data Systems DATA Quality Improvement INFORMATION ACTION Clinical Usability Reliability EHR – Best Practices Validity Risk Adjustment

*(Sachdeva et al., Pediatrics 1999 – HRQOL) Long Term Outcomes* Whole System Measures Emerging View for Data System Integration PICU 30% of kids <2Y admitted to PICU for respiratory diseases were preemies (Gunville et al., J Peds 2010) NICU Prenatal – weight adjusted survival PICU – risk adjusted survival Community 6 Months – significant morbidity (Jones et al., Pediatrics 2006) VPS STS/NSQIP VON PHIS

Future Direction for Data Systems- BIG Data M ARCH 16, 2015 BY L AURA L ANDRON

Pediatric ICU Quality Measures Children's Health Insurance Program Reauthorization Act (CHIPRA) – Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Measures Program (PQMP) Project Management Center of Excellence (PMCoE) – Pediatric Intensive Care Unit (PICU) Quality Measures WAVE 1 Measures – (1) Incidence of Pressure Ulcer-standalone, (2) Risk Assessment for Pressure Ulcer, (3) Screening for Nutritional Status, (4) Red Cell Transfusion WAVE 2 Measures – (1) Composite Measure on Preventable Harm, (2) Incidence of Pressure Ulcer-component, (3) Composite Measure on Patient Comfort, (4) & (5) Pain Management-2components, (6) & (7) Sedation Management-2components, (8) & (9) Iatrogenic Withdrawal Mananagement-2 components

Research – Knowledge Management - Practice Learning from Specialty Networks Research – Knowledge Management - Practice Primary Care Pediatricians Pediatric Subspecialists Practice Transformation Technology Payment Reform Team Based Care Surgery NSQIP Oncology POND4Kids NICU VON GI-IBD ImproveCareNow CCM VPS

If not us, then who? If not now, then when? Dr. M artin Luther King, Jr.

Discussion Questions What changes are needed in the VPS to meet the current needs of hospitals and health systems? SOI models – next generation? Subspecialty modules – PICU? How can quality measures be embedded into VPS to effectively inform public reporting and payment policies? What are solutions to technical barriers to specialty data system integration? Should the VPS become a registry? Role of VPS in informing strategies for integrated delivery systems and ACOs to improve child health population outcomes?