ILPQC leadership has selected HealthLNK to build, maintain, and operate a state-wide registry for data collection and quality improvement in hospitals. Four initiatives have been successfully implemented and more are anticipated to go live in the next year.
Illinois Prenatal Quality Collaborative is a statewide perinatal collaborative that involves all perinatal stakeholders; utilizes data driven, evidence based-practices; improves perinatal quality resulting in improved birth outcomes, improved health for women and infants, and decreased costs. It provides an independent platform to bring groups together to work on QI initiatives at the birthing hospital level. It identifies nurse/physician/quality leadership teams, provide collaborative infrastructure, provide hospitals data support and QI science expertise. It utilizes a statewide database with real-time data collection, analysis & reporting capability.
The two current ILPQC initiatives are:
1. Obstetric QI initiative
Early Elective Delivery (EED) before 39 weeks gestation may result in higher rates of adverse respiratory outcomes, mechanical ventilation, sepsis and hypoglycemia for the newborns (Tita et al., 2009). A study in the American Journal of Obstetrics and Gynecology estimated the cost of such deliveries to be nearly $1 billion dollars per year. The American College of Obstetrics and Gynecology (ACOG) recommends against non-medically indicated delivery prior to 39 weeks and recommends that all hospitals put in place a hard stop policy against this practice.
ILPQC has partnered with the Illinois Hospital Association, March of Dimes, IDPH and HFS to move forward the first ILPQC Obstetric QI Initiative: Reducing Early Elective Delivery in Illinois. Many hospitals are already working on reduction of early elective delivery in Illinois. ILPQC is positioned to assist hospitals with data assessment, obtaining tool kits and focusing on quality improvement by learning from national experts and hearing lessons learned from other hospitals across the state. IDPH has released provisional birth certificate data on early elective delivery to Illinois birthing hospitals. The birth certificate data, although not able to capture all indications for early elective delivery, allows for comparison across hospitals and across time using the same data elements captured from birth certificates across the state. ILPQC is working with hospitals to identify methods of improvement for birth certificate data collection and also to standardize the current data collected on early elective delivery so that accurate rates can be used to assist hospitals with quality improvement efforts across Illinois.
ILPQC, in collaboration with the Illinois Hospital Association and the March of Dimes, is providing a series of OB Quality Boot Camps to Illinois birthing hospitals to provide OB quality learning sessions and a forum for hospitals to ask questions regarding the ILPQC initiative and the IDPH birth certificate data. In addition, ILPQC is working with the ILPQC OB Advisory Workgroup to develop an Early Elective Delivery data form and data dictionary to provide hospitals a standard form that should match the Joint Commission Data that they are already collecting.
HealthLNK team has created data system for ILPQC that allows hospitals to submit Early Elective Delivery data and get monthly reports so that hospitals can assess their progress over time and compare themselves to other hospitals. All hospital data is held securely and hospital names / locations are never reported with the data. The data team is building capacity to pull data directly from EMR’s and from other state data sources to reduce burden while adding value for hospitals.
2. Neonatal QI initiative
As compared with the intrauterine growth of normal term infants, the growth of prematurely born infants is typically delayed. Approximately 90% of VLBW infants fall in the category of extra-uterine growth restriction by 36 weeks post-conceptional age. Poor nutrition is a significant contributory factor and is associated with prolonged hospitalization and an increased risk for poor health outcomes.
The goal of this initiative is to improve the nutritional status of premature infants, particularly VLBW, by instituting early enteral feeding and TPN (total parenteral nutrition) supplementation when indicated. By standardizing the method of early nutrition with increased use of breast milk, appropriate use of TPN together with closely monitoring the growth parameters (weight, length, head circumference) at each NICU, this study is trying to achieve improvement in the growth pattern, therefore diminishing the number of extra-uterine growth restricted infants in Illinois.