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Secretary’s Advisory Committee on Infant Mortality November 15, 2012

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Presentation on theme: "Secretary’s Advisory Committee on Infant Mortality November 15, 2012"— Presentation transcript:

1 Collaborative Improvement & Innovation Network (CoIIN) to Reduce Infant Mortality
Secretary’s Advisory Committee on Infant Mortality November 15, 2012 Reem M. Ghandour, DrPH, MPA COIN Coordinator / Senior Public Health Analyst U.S. Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau Office of Epidemiology and Research Thank 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.

2 What 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.1 Key Elements of a CoIN Being 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.

3 Infant 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.

4 CoIIN Design Strategy Teams State Teams
Common Strategies for Regions IV and VI Promote smoking cessation Expand Interconception Care in Medicaid Reduce elective deliveries Enhance perinatal regionalization Promote safe sleep Strategy Leads (2-3 topical experts) Data and/ or Methods Experts Staff support (MCHB & Partner Organizations) State Representatives Average people Strategy Teams State Health Officials MCH staff Medicaid staff Private partners Average 7-15 people State Teams What’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

5 Define Scope and Nature of the Problem Build and Sustain Cyberteams
CoIIN: Work to Date Define Scope and Nature of the Problem Establish quality improvement Aims for each Strategy. Aims Identify state-level opportunities to achieve Aims. Strategies Select measures to track progress towards Aims over the next mo. Measures Build and Sustain Cyberteams

6 Aims & 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 practices Standardized training within provider systems Strategic alliances STRATEGIES Infant 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 practices Training 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 recommendations Strategic 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

7 Aims & 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 policy Medicaid program design & innovation Medicaid administrative processes Provider KAB & Practices Consumer KAB & Utilization STRATEGIES Medicaid eligibility policy 1115 Waiver (“interpregnancy”) – GA and LA “mentoring” other states Optional eligibility expansion for women (now) ACA Medicaid Expansion January 2014 and beyond Medicaid program design & innovation Targeted (medical assistance) case management Administrative case management Medicaid health homes for women with chronic (and mental) health conditions Medicaid administrative processes Medicaid billing codes and modifiers Reimbursement for services (e.g., case management) Medicaid data (including linkage to vital stats) Provider KAB & Practices Education; Medicaid provider guidance and manuals Emphasis on postpartum visit, including tools and performance monitoring with HEDIS measure Systems coordination / integration (e.g., referral patterns, safety net, Healthy Start) Consumer KAB & Utilization Consumer information materials & social marketing campaigns (including postpartum visits, RLP, family planning, ICC)

8 Aims & 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. Data Maternal Care Policy and Incentives Guidelines for Levels of Care STRATEGIES Data Standardize reporting of national performance measure #17 Standardize Analysis of data (VLBW by place) Maternal Care Develop guidelines for maternal care with other organizations ACOG, Maternal Fetal Medicine AWHONN (based on existing guidelines) Identify barriers to implementation Develop toolkit Policy and Incentives Address hospital reimbursement for NICU babies born in Level II hospitals Address “bundling’ issues related to transport (unbundle transport) Guidelines for Levels of Care Standardize Levels of Care for all states Create back-up procedures in addition to transport, if birth is in hospital with insufficient level of care.

9 Aims & 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 & Practices Consumer KAB & Practices Medicaid Policy STRATEGIES Provider KAB & Practices Provider awareness of resources to support tobacco use cessation Provider education and training around evidence-based cessation interventions Support SYSTEMS and ENVIRONMENTAL CHANGES that enable implementation of smoking cessation best practices at the provider level i.e. protocols Consumer KAB & Practices Ensure the maximum (or full range of) evidence-based, Quitline tobacco cessation service bundle is available to pregnant women who smoke Increase knowledge and use of Quitlines by pregnant and post-partum women Medicaid Policy Conduct a State inventory of current policies / practices regarding Medicaid’s expanded coverage of tobacco cessation services for pregnant and post-partum women Develop alliances and cooperative relationships with State Medicaid programs Endorse a standard of Quitline benefits/services for pregnant and post-partum women and encourage State Medicaid programs to adopt Encourage State Medicaid programs to support State Quitlines through use of Medicaid administrative match funds

10 Aims & 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 & Momentum Data Policy & Environmental Change Provider KAB & Practices Consumer KAB & Practices Leadership & Momentum: Identify leaders/champions Have the right partners at the table Public-Private Collaboration Make a credible case for change: the business case and the human case Data Assess the current situation/establish baseline and gaps Define standard data sources and measures, timelines Improve the quality and timeliness of data Policy & Environmental Change Change Medicaid payment practices Recommend hard stop policies if voluntary not successful Educate legislators and advocates Provider KAB & Practices Identify a physician champion Training for facility leaders re: ACOG guidelines, outcomes Involve Quality and Risk Management staff Consumer KAB & Practices Public education/social marketing about LPT brain development, what is term, risks of early ED Develop list of myths and responses Coordinate messages at federal/national and state/community level

11 CoIIN: 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.

12 CoIIN: Summary A 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.

13 Contact Information Reem M. Ghandour, DrPH, MPA Senior Public Health Analyst Maternal and Child Health Bureau

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