- [Breena] I am so happy you've joined us.
We have a whole team here from the health department
and the Vermont Child Health Improvement Program.
We're also thrilled to have
our Health Commissioner, Mark Levine, with us.
Next slide.
We're gonna kick us off by making sure
that we all come together today in the spirit
of every single one of you is part
of the Perinatal Quality Collaborative
in this great state of Vermont.
What we mean by that is that we're all working together
in different spaces and in the same mission,
which is we're trying to optimize care
and the health outcomes in pregnancy and infancy.
And we do that by working together.
And we also do that because we're VCHIP
using a quality improvement framework.
So what we do all together,
and many of you are part of this,
is we set the priorities together
with the health department, because the health department,
it has all the data and understands what needs attention.
We also do a lot of outreach and education as it relates
to the relationship between some of the content experts
up at UVM and their delivery of healthcare
and all of our hospitals that are in the same pursuit.
We love the quality improvement aspect of it.
And then we circle back and we monitor again
and wonder what else needs attention.
So welcome to the PQC Vermont.
Next slide.
I hope by now we all know how to do Zoom,
but microphones are best muted until you're ready to speak.
We do want you to know about the show captions feature,
which is in your navigation bar,
which will automate the audio for you for captioning.
And then please, please, please, at the very end,
we are quality improvement entity
and we need to know how this went.
And the evaluation matters a lot to us.
So there'll be a QR code at 12:59.
Do not depart, thank you.
Next slide.
Okay, this is our ambitious agenda.
We've welcomed you, we're gonna talk about this long,
long dreamed of initiative to improve the quality
of our birth certificate variables.
We're gonna talk about why,
which 11 variables we picked and why.
And then we're really gonna turn back and thank you
for the input you've already given us
about your individual hospitals
and how you do your process for birth certificate data.
We're gonna talk about the ongoing work
to get some baseline, and then we're going to set up
how we're gonna come alongside you and provide tools
and training as well as set up the year for you
in terms of dates, expectations,
and still leave time for questions.
Next slide.
So here's your team,
and I'm just gonna have people wave,
if people aren't on camera, it's okay,
but our names are here.
So they're calling me the faculty lead.
I think it's because I spent 11 years
at the health department and I care deeply
about the integration of public health
and data into clinical care.
Ilisa, who is here with us somewhere, I think,
big Zoom, is our family child health director.
Katy, give a little wave.
She's gonna be delivering some slides in a minute.
She's our perinatal nurse coordinator
at the health department.
Cindy Hooley, vital stats information manager.
Such a key long-standing role for the great work we do.
Peggy Brozicevic is on camera, thank you, Peggy.
She's our research and statistics chief.
We've got Julie Parent, all roads lead to Julie Parent
if you haven't figured that out yet.
She's our project director, perinatal at QI coach at VCHIP.
And also all roads lead to Angela Zinno,
our project coordinator who keeps the trains running.
And look at how there's just this little outline
of seven women with side parts
and cute little shoulder length hair
at the bottom of the slide.
Next slide, great team.
But really, really, really this is nothing without you,
and boy, do we love our community hospitals.
I said hello to Kate at the onset
because I am a pediatrician,
but I was at Porter Hospital for a long time.
And I sure do know what it's like
to be out there in the world away
from the academic medical center.
And the work that goes on at these hospitals
is so important to the health of pregnant people
and children, and we really need all of you.
Most of you have engaged
and some we're still working on the teaming.
And we're just here today to say, we promise it'll be fun,
and you would be welcomed into this collaboration.
Next slide.
Okay, I have the great pleasure
of introducing Dr. Mark Levine.
It would be shocking to me if folks didn't know,
because this great leader took us through
the most significant public health crisis of our time,
hopefully of a century.
What's so fun about Dr. Levine
is I actually knew him before.
Oops, I knew him before the crisis
and I knew him before he was a health commissioner.
So he joined the health department in 2017.
Wow, we're gonna have to have a 10-year anniversary soon.
So Dr. Levine believes deeply in, what we call,
this nexus of clinical care,
education, public health advocacy.
And what he's really seeking to do is improve
the health of populations through policy
and cultures of health, which is why we're so happy
he's here today to spend a few minutes talking
to you about why this matters
and why we're so grateful you're engaging with us.
Dr. Levine.
- [Mark] Thank you so much, Breena.
And yes, I am going to engage with you
in hopefully acceptable ways,
but maybe provocative ways as well.
So I'm supposed to be giving you
some inspirational comments on this kickoff call
about why is birth certificate accuracy
through data entry so important.
And as you know, you're gonna go through a lot of sessions
that have all kinds of other nice titles to them,
all with this quality improvement initiative in mind.
So I'm gonna set the table a little,
highlight the importance of the topic
and why you should pay attention.
This is really more than what it's labeled,
a birth certificate initiative, 'cause it's really a parent
and facility worksheet initiative in a broader sense.
More on that to come.
I am gonna discuss those forms,
and I wanna provide a little discussion on VCHIP
and PQC Vermont to provide the context for this initiative
and conclude by giving you a perspective
on the higher significance of why you're here.
But first, I did do a little research
on birth certificates themselves
and discovered some fascinating information.
Now as you know, vital records in Vermont include births,
deaths, marriages, civil unions,
divorces, dissolutions, fetal deaths, abortions.
And statutes in 2019 enhanced safety and security,
trying to protect against misuse and identity theft
and who can access the birth certificate,
which, of course, is a vital record
that documents the birth of a person.
Didn't realize that because we live in this country,
there can be multiple ways
of actually documenting just that event
depending on what jurisdiction you happen to be in.
It's the responsibility of the healthcare system
to see that birth is properly registered
with the appropriate government agency.
The UN says every child has a right
to a name and a nationality.
And formal recognition of one's existence
is essential to accessing so many rights.
Proving age, nationality, receiving healthcare,
going to school, participating in sports,
being adopted, getting a passport or marriage license,
voting, birth in the US confers citizenship by birth
though certificate doubly serves as evidence of this.
And it's required to be filled within five days
by a physician or midwife.
Now to me, the National Center for Health Statistics
has some data requirements which are pretty straightforward
about the child and the parent in terms of names,
days of birth, addresses, health information,
prenatal care received by the mother, type of birth.
But much more intrigued comes from looking
at some of the controversial aspects
of these seemingly simple documents.
If you look at our history in this country,
birth certificates unfortunately have been used
in the wrong way at times, enforcing racist segregation,
policies of white supremacy, erasure of indigenous people,
allotment of indigenous lands, adoption laws,
enforcing gender identity or transgender rights,
which, of course, Vermont's recent legislation stands out
in a positive way amidst a sea of negativity on this issue.
So while the seemingly simple document
may not superficially look like it needs QI efforts,
its potential for misuse should remain
a perennial point of discussion.
Now in broadening this discussion
to public and population house,
it's great that VCHIP is running the show here.
It's 'cause VCHIP is a population-based child
and family health services research
and quality improvement program at UVM that,
as Brina herself epitomizes,
works closely with public health
as well as the entire clinical sector
and multiple other partners, all in an effort
to optimize the health of Vermont's children and families.
So what is PQC Vermont?
Well, you saw one quick slide.
There's actually a national network called NNPQC,
which has a mission of supporting the development
and enhancing the ability
of state perinatal quality collaboratives
to make measurable improvements in statewide maternal
and infant healthcare and health outcomes.
They're basically multidisciplinary teams working
to improve these outcomes using evidenced
and foreign practices and processes like QI principles
to address gaps in care.
And there are five areas of focus on the national level
which should resonate with everyone.
Reduce pre-term births, reduce pregnancy complications
associated with hypertension and hemorrhage,
improve identification of and care
for infants with neonatal abstinence syndrome,
reduce racial and ethnic and geographic disparities.
And fifth, reduce cesareans among low-risk pregnant women.
So PQC Vermont's obviously a formal partnership
of longstanding VCHIP projects that have joined forces
to become Vermont's resource for perinatal care,
in partnership with the Department of Health Family
and Child Health Division and Health Statistics
and Informatics Division.
And it's really trying to mobilize state networks
to implement quality improvement efforts
and improved care for mothers, babies and families
by setting perinatal outcome priorities,
providing outreach and education,
advancing QI efforts, like the one you're involved in here,
and monitoring healthcare outcomes.
Now let's get down to the work at hand on the worksheets.
I am not an OB-GYN, so I never had
to participate in any of these forms.
But the parent worksheet on the child's birth certificate
includes things like the mother's marital status,
education, race, ethnicity, smoking status, WIC status,
father, really education, race, ethnicity.
And then the facility's responsibilities
involve newborn statistical information,
going from the Apgars to the birth weight
to what kind of gestation,
is the baby breastfed at discharge, et cetera.
Information from a statistical standpoint on the mother.
Was there a need for transfer?
What's the prior OB history?
Did they have prenatal care visits and when did they start?
And then medical and health information,
which has a whole host of things
that I'm sure you'll hear more about.
That go from pregnancy risk factors to labor
to infections during pregnancy, group B, et cetera.
Now I don't have all the data
on how successful all of this is actually reported,
but I think the fact that you're in a quality
and performance improvement initiative
should tell you something.
And improving the consistency of data collection
and reporting, reliability,
accuracy and adherence to a defined standard
is what quality improvement is all about.
There's a few tidbits I picked out about giving birth
in Vermont or New Hampshire in 2021.
Out of 5,000 plus live births,
13.8% of them occurred in New Hampshire.
3.3 out of every 100 live births occurred
out of the hospital.
I thought that was low.
I thought it would be higher actually.
38% used Medicaid as the primary payer
for delivery services.
28% were enrolled in WIC during pregnancy,
and almost 90% of infants were breastfed upon discharge.
I don't know how many states can say that.
Congratulations.
Now some truths and five pivotal points
to make regarding the kind of data
that these examples illustrate and why this data
is so essential to public health and the people we serve.
First, birth certificate data is the foundation
of public health decisions
about improving maternal infant health.
Where and how else would we get the kind of information
I detailed that is present on these certificates and forms,
and how could we develop policies and practices
if we didn't have proper characterization
of problems through a comprehensive and accurate data set
to provide a data-driven approach?
Surveillance, of course, is critical to public health.
It's one of its core responsibilities
whether we're in the problem formulating phase
or the health outcomes review.
Second, we use birth certificate data
to improve care for pregnant people,
birthing parents and babies.
And I will beg forgiveness for this being the first time
I use the term pregnant people,
because so much of what we actually are talking about
in these forms and everything actually
is not as advanced as the words pregnant people.
It continues to use the word pregnant women
or mothers, or what have you.
But anyways, it is important to know things
like the timely involvement in prenatal care,
maternal health factors impacting your pregnancy,
the frequency with which prematurity exists,
the need for transfer to higher levels of care,
delivery issues, is the parent poised to be prepared
and successful for breastfeeding?
And then pair the data with evidence-based solutions.
Understanding where the critical partnerships are
between the healthcare system and state health programs
and community-based organizations.
There's a lot of work
our health statistics division does with the data.
Everybody knows PRAMS,
the Pregnancy Risk Assessment Monitoring System.
They use that where birth certificate data
are used for sampling.
We monitor key indicators
for birth certificates to assess trends over time.
Third, monitor population health.
I'm so grateful that Vermont does not share
in the heart-rendering maternal
and infant mortality statistics
so many of our states are confronted with,
notably many in the South.
But having mortality and morbidity data
and being able to examine these from a racial
and SES equity position is critical
to practicing public and population health.
And we all know the important linkages
between these statistics and the health-related social needs
of many in our population when it comes to access to wealth,
housing and food security, transportation opportunities,
access to services, access to quality healthcare.
Fourth, solve public health problems at the local,
state and federal levels.
Clearly we look at a lot of our data
from a geographic equity position as well.
And in Vermont, the importance of rurality is ever present.
It can play a role in prevention efforts,
resource allocation, programmatic initiatives
to address the whole continuum of equity-related factors.
Not to mention access to healthcare and quality of care
that is available on a local or regional basis.
And finally, making wise decisions about
where to spend limited dollars, helping public health,
the healthcare system, policy makers and political leaders
make the often very tough decisions,
and to be strategic and prioritize
how to move health outcomes in a positive direction.
So I hope your work in this learning series will enable us
to move forward in all of these lofty goals
and help accomplish many of VCHIP's
and PQC Vermont's significant goals
that they have for their overall work
as well as this particular quality improvement initiative.
Thanks for allowing me to provide the initial comments.
- [Breena] Thank you so much, Dr. Levine.
Wow, I'm glad we recorded that.
So there it is.
I'm gonna ask Angela put the slides back up for us.
You're welcome to stay
or you probably have other things to do,
but we're so grateful you came,
and looking forward to having you at more PQC events.
Thanks for understanding us.
Katy Leffell, up you go, next slide.
- [Katy] Okay, all right.
So thank you, Dr. Levine.
And this is just a little bit
about our birth certificate data.
So we collected more than 100 pieces of information
on birthing people and babies,
and birth certificate staff are on the front line
and assuring this accuracy.
And you're such a vital part of the healthcare team,
and I've got to meet some of you, and Julie and Angela,
have met a lot more of you.
Sometimes you're in other buildings or other floors,
but you're all really, really vital with this information.
And then Dr. Levine indicated some of the uses,
but it's used not only locally in state
but also by our national partner.
So it's really important, this accurate information.
And it's consistent source of health information
on all Vermont babies and new mothers and birthing people.
And also, it impacts your own hospital performance records
and adherence to best practices and perinatal care.
So it impacts the way that your hospital shows up as well.
So next slide.
Okay, so this is talking a little bit about
how we use it with the Perinatal Quality Collaborative.
So you're seeing two different reports that we produce.
I'm saying we, it's really the PQC and VCHIP,
but I, you know, help participate a little bit
when I say I'm gonna use we.
So anyways, the first one is for the community hospitals.
They do a huge amount of work to produce this report
and then present it to the community hospitals.
Many of you have been, I'm sure, a part of that,
and there's a lot of discussion about the data
and the accuracy of the data and all those pieces,
'cause it's so important for representing
your own hospital's performance.
And then last year, we had the first
perinatal public health report, which is a report
that we produced that's a little bit more,
it's the public facing and public health versions of it.
So it's not so much all, just only the clinical
and sort of the data that we produce
for the community hospitals.
But this is also something that the communities can use
and see sort of where they are
as far as data contrasting with other regions as well.
So next slide, please.
And this is talking a little bit about
how we use the birth certificate data internally
for the department of health
and the family and child health division.
So we use it a lot for finding
and applying for grant opportunities.
For instance, so we've got this enhancing reviews
and surveillance to eliminate maternal mortality,
which is a big CDC grant that is funding a lot of our work
around reviewing and addressing perinatal death in Vermont.
So any death in the pregnancy or full year postpartum.
And then we also use it for the WIC program, the Women,
Infants and Children Supplemental Nutrition Program,
the Perinatal Quality Collaborative Capacity Building grant.
So that's a grant that's funding a lot of the work,
that's we're talking about today
and a lot of other projects as well.
We also have a grant we applied
for maternal health innovations,
which is another big grant we're funding out this summer.
We just also have another grant
that was around maternal mental health
and perinatal mental health.
So it funds a lot of grant opportunities
for us here in the state.
All right, next slide.
So this is talking a little bit about some of the things
that we've learned from our visits with you,
which have been so fun.
So we have learned that, not surprisingly,
data entry processes vary quite considerably
from facility to facility.
So we're seeing lots of different processes
and learning some best practices already around
what really has worked well for some hospitals.
The quality assurance and audit process,
again, varies at each facility.
So that's learning again, a lot of the variations
that are working or maybe not working as well.
Some facilities have modified the parent
and facility worksheets to meet the needs
of the hospital and your data entry processes.
So a little bit of variation there,
which has been really interesting.
And then the challenges with completing the data entry,
because sometimes, you know, you're looking through the EMR
or the EHR and you're not finding what you're looking for,
or it's located in different places.
Sometimes it's not integrated well
and you have to do a lot of digging.
Different people have different accesses.
We're finding a lot of issues like that as well.
And then also just some questions sometimes that come up
around the actual wording on the forms and what they mean
and on the parent forms and things like that as well.
And I believe this may be my last,
no, it's not my last slide.
Nevermind, next slide.
All right, so this is just some photos of our experiences
with coming to visit you guys all at your facilities.
And you'll see our process there with the sticky notes
and the big Post-It pages and lots and lots and lots of pens
and office supplies out on the table to try to get an idea
of your workflows at every different hospital.
And you guys were really generous with your time
to come and meet with us and take the time.
And like it says here, we had all sorts
of different people coming, health information management,
OB, pediatrics, certified nurse midwives, nurses,
nursing assistants like you all,
you all really came forward
to help represent your facilities
and help us collect this information.
And then next slide.
Feedback, so I referenced a little bit about this already,
but recommending updated language
on the parent facility worksheets,
some of that we can do on our own
and sometimes it takes some okay
from higher up national folks as well.
But we're working out,
we're definitely passing the feedback on from you guys.
And enhanced communication between clinical
and health information management staff.
So not surprisingly, sometimes, like we talked about,
sometimes they even separated far away
in space but also in role.
So sometimes, we just need to help
make those connections a little tighter
or tell like this facility does it this way,
maybe this will work for your facility.
So we're kind of doing that work.
Definitely need to provide training
and educational opportunities for your teams
to clarify definitions and medical terminology
that's been identified many facilities,
and we haven't done a statewide training
on birth certificate data in a very long time.
So we need to do that.
And just like raising up that awareness
around the overall appreciation of the role
of the birth certificate, health information staff,
hugely important, and again,
often doesn't receive necessarily
that training or support that they might need.
And maybe we need to do a better job at the state with that.
So providing additional information tools.
So a reference guide for you all, best tips,
best practice learned from different facilities
and sharing that information with you
around in the informative pieces.
So next slide, I think I pass it off now.
- [Breena] Thanks, Katy.
I did wanna give Peggy space for a sec if she wants.
There are a couple other ways
that the health department uses this important data
that we wanted to highlight for you.
Peggy, did you wanna tell your favorite ways, yes?
- [Peggy] Yes, I'm Peggy Brozicevic
and I'm with the division of statistics and informatics.
So the birth file is one of the most used
in health statistics.
And Dr. Levine has referenced our PRAMS project,
which is the survey of women who recently gave birth.
And we use the birth file not only to select the women
for our sample but the addresses for those first contact.
Then because the two files are linked,
we're able to skip asking mothers some questions such as,
you know, their marital status or their education,
or questions about the infants such as birth weight
or weeks gestation, because we include that information
from the birth file in our analytic file.
And then we have it for our analysis.
And this is a CDC funded program,
and the research file is used not just by Vermont,
the Vermont PRAMS program, but there's a all-site database
that's made available to researchers.
Other uses include vital records,
produces a weekly report on new births
that have been entered into the birth file,
and they send that information
to the newborn screening program so that they can check,
make sure that there's no babies that have been missed.
My team produces surveillance reports
both for all resident births,
but then again a second report
for just those records where WIC is indicated,
and that is made available then to the WIC program.
We maintain a much larger spreadsheet
with just all sorts of variables from the birth certificate.
As again Dr. Levine had referenced,
we're monitoring those all the time
for trends and for discontinuities.
I also wanna mention that NCHS,
which you'll hear a lot about
and you'll see on your guides,
makes a research file available nationally.
And so that's used by researchers.
It's used, for example, by the March of Dimes
to produce their perinatal report,
which includes data on every state
and then makes comparisons across the state,
across these measures to the national data.
So thank you, and I will turn it back to Breena.
- [Breena] Thanks, Peggy.
So there's your why, I'm learning a lot today.
This is great.
I did wanna acknowledge in the chat too
that our friend Jade, hi, Jade.
Jade reminds us too that our midwives also do the births.
They actually do the worksheets and fill out in about 2%
of the births, an added awesome member of this great team.
Okay, so here we go.
So the reason we've done the why, we've gotten us all into
this important shared space that this data matters.
This is not data that gets collected
and goes onto some shelf and gets all dusty.
This is real-time super important data.
So like all good data, it has an opportunity
to improve in terms of its accuracy.
So the way we're gonna do this quality improvement project
is we're really, we've learned from many states
that are a little bit ahead of us on this,
that it helps to pick a handful of indicators
that you can really use as your process
to understand how data gets collected
and sent to the health department
and then comes back or is communicated with.
And then that process would then help inform
the whole set of indicators.
This was not trying to pit indicators against each other
or us having any, you know,
deep attachment to these 11 that we picked.
But we did have a process ourselves
with our health department colleagues
thinking about relevance,
and we'll talk about that in a second.
So we wanna make sure to improve the accuracy of these 11
as a way to improve the whole darn thing.
But we also wanna learn and share with each other
about what you're doing, because we've already learned
from these hospital site visits
that you guys have worked out some stuff,
that we VCHIP loves to take someone else's hard work
and give it to the other hospitals
that haven't done that yet.
And we call it, Angela has to help me stealing shamelessly.
And there's some funny term we use.
And then we want to then learn from each other,
become a resource for you
to share all the great tools you're using.
And then we wanna continue to have an educational process
whereas you have new people come on and staff changes,
and there's this ongoing observation
that the quality of the birth certificate data matters
to this huge team of people.
So you've become extremely important
in the world that you already were.
But as we turn more attention to this,
we're getting even more interested
in your collaborative process in your hospital.
Next slide.
So sorry for the small font,
quality improvement people love a key driver diagram.
The only thing this is is for us to organize ourselves
around an idea that we're all moving toward the same aim,
which is that in nine months,
we wanna improve the accuracy of those 11 indicators.
Pretty simple, and we've shared today the why.
We wanna do it to support public health,
but also to, you know, ultimately improve outcomes
for Vermont's pregnant people and children.
So we're gonna do that by making sure we all understand
the importance of the data, which is great,
because that's why we're here today.
We're just kicking off the shared learning.
What is this data and why is it so important
to Dr. Levine and everyone else?
Strong communication between teams and data people,
the clinical teams and the data folks.
I love Vermont so much.
Sometimes you might be related,
sometimes your cousin is the data person,
the health information manager
and you're the nurse manager.
Sometimes you've never met,
and we said that at the beginning
but we're gonna say it a few more times,
because this project is at its roots relational.
This is about you guys hanging out with each other
and having a shared mission.
So we wanna do some ongoing training
on what we mean by the indicators,
what is the specific definition.
We have a lot of people who,
at the health department in particular,
who really know what they mean.
And then we know that sometimes at the hospital level,
it gets a little like, wait, I don't know how to find
that in the chart or I need some help.
And that's why we've created this whole team for you
that already existed, but we're putting us in the forefront.
And then we wanna do what I just said before,
is just identify best practice and keeps spreading it,
because we learn so much from you.
And so on the right side,
I'm not gonna show you that, but it's too small.
But within each of those drivers,
we have a bit of a plan and they all interrelate.
But this is kicking off today to say
that these drivers are gonna be our work together
in learning sessions in the future,
the next of which will be in September.
We're gonna give a little break
in the summer to get the data right.
Next slide.
Okay, so what do we expect will happen and know to be true?
So we're gonna do at least three more
virtual learning sessions with all of you
to kind of dig in deeper to some of those key drivers
and to talk more with each other.
It won't be so much of this like,
you eat lunch and we talk.
It'll be more sort of learning together
about how to improve our efforts.
And then we are gonna provide, this is a nice QI strategy,
to have an office hour set up
where you're welcome to pop on, no obligation,
but it's your place to get questions answered
on the first Wednesday of every month from one to two.
And it'll probably become more clear to you
what your questions are when you start diving in a bit,
and we'll all be there for you.
Next slide.
Okay, this thing's all about teams
and it's all about relationships.
So we need a clinical lead
and we need a birth certificate health information manager,
which we shortened to him.
I do not prefer that, but it's so funny,
'cause we only know each other's acronyms
after we learn them.
So that's new for me.
But in that space,
I think you've probably already done this,
but we need at least one clinical lead and one person
from the information management side.
And that way, the two lead designees
will need to know the reliable data sources
for those 11 key indicators.
And so you might be the ones
that wanna pop on those office hours
and say, gosh with the breastfeeding one,
we don't know exactly what this means and we need some help.
And obviously, we want the leads to gain more knowledge
but have some baseline engagement
in perinatal and newborn health.
Next slide.
And then we wanna make sure that
that clinical lead can communicate
with the rest of the clinical team.
And so when I think about one model
that usually works in this space,
all roads lead to nurse managers, right,
in community hospitals.
And in that nurse manager role,
making sure that everybody knows.
And it's nice to see some of our
other clinical colleagues on as well,
because we really don't intend for this to be
just two people in pursuit of this big shift.
So as strong and as often the communication can be,
and because it's virtual learning series and sessions,
we'd love as many people as possible to come on
and just actively or passively listen
to get into this quality improvement space
of this important project.
And then within the birth certificate,
health information manager lead,
there's also another group of people
that you might wanna organize and encourage,
and not personal, but personnel,
who complete the birth certificate.
So if you obviously have the luxury
or the gift of a nice team and it goes way beyond you,
the team would really wanna participate
and listen in and learn as well.
Next slide.
Okay, but here's the real deal.
We know that you are completely inundated
with quality improvement and data collection and pressure.
And that's the commitment of this team
is to not come in in some space of, you know,
that we've been designing this on some whiteboard
and we've never delivered healthcare
and we don't have any idea what happens in hospitals.
That is completely false.
We are so aware that you have a long list of things
that has to be accomplished in service of so many partners.
You've got regulatory people,
you've got hospital initiatives,
you've got local decisions and then you have VCHIP.
And so in that space, we really wanna identify as the group
that is open to that feedback,
shows up in service of you as a scaffold.
We're not handing you this and saying good luck to you.
And so that space you'll always get, enter with us.
Data, data, data,
and it is getting a little ridiculous out there.
However, this project is at sort of this baseline root
of quality that will really inform
that whole vast array of things we outlined before.
That's not to say other data collection things
aren't helpful or important.
I'm not pitting it against each other.
I just really wanted you to know we have a commitment
to keeping this low burden,
but we still need a level of engagement to achieve our goal.
It's like a nice little balance.
And we want the feedback that this is too hard
or that something isn't understandable,
or that you're really bogged down,
because that's exactly how we learn how to come in.
And this is not like a one and done.
We're gonna be working in the space for a while,
because we are so committed to sort of resetting this team
that comes together around
this really important vital record.
Next slide.
Okay, almost done, and we promise.
So we do organize ourselves around a true approach.
We are not winging this.
So we are currently in phase one,
which is the baseline data collection.
And we are happy to report we have done
that data collection in two of your hospitals.
And that's really not on you
that we had a wonderful fourth year medical student
who did that with us,
and like all good fourth year medical students,
they depart, they have departed.
So we have found another one, maybe not a medical student,
we have found another human that would like to continue
to engage for the rest of your hospitals
to just figure out what are we finding in the chart,
what do we know from vital records to sort of set the table
that we have this discrepancy, which, by the way, we do,
so that this quantifies the discrepancy.
And there's a little bit of a process
to get this person access to your record
so they can do the pre-work, the baseline data collection.
So we really need your help,
because sometimes this gets bogged down in with people
that don't know what we're trying to do.
You know, like the protectors of data,
and we have all of that worked out in a way
that we could show you if your hospital isn't clear
that this would be a good idea.
So that's my short way of saying most of you
are just waiting for us, this nice new person
that we hired, but a few hospitals are sort of wondering.
And any effort in the space
of baseline data collection would be great,
because if we can get that done,
we'll know what the what is.
'Cause we do have to quantify
how much we're seeking to improve.
And then when the intervention of you learning
and everybody working together
on these 11 indicators is over, we will go back
and we'll do that same chart review again
to show the improvement.
And the cool part about a QI project like this,
we're not seeking like some mega thing.
We're showing that with this level of intention
and teaming, we're able to go boop, boop.
So that's very important to us.
And then we also really want
to do some maintenance data collection,
'cause everything about quality improvement
is making sure that a system changed
and that a process changed so that the change is sustained.
'Cause wouldn't it just be so terrible
if we worked so hard in a space
and then the minute we stepped away, it went right back?
It's like sphing, sphing.
So come along with us to the three phases.
Next slide.
Okay, so I know you've been waiting this whole call
for these 11 indicators.
Here they are.
So please forgive the right hand.
We really want a reason and a rationale,
but we're recognizing that calling something
clinically relevant as opposed
to public health relevance is a binary.
That's not really the way our brains work.
But we called it out just to really explain
that our public health colleagues have noticed for years
some things that might not be explained
in a way that are collected properly.
And also, we've just seen some discrepancies.
And so this is how we wanna talk about this today.
But it was really a team of clinical folks
and public health folks that decided on these 11 things.
Pre-pregnancy hypertension, gestational hypertension,
pre-eclampsia, pre-pregnancy diabetes, gestational diabetes.
And you can see the complexities here already.
How on earth are you supposed to know
what happened pre-pregnant?
Well, we are hopeful
that health systems communicate with each other.
But one of the QI things
that we're really interested in
is when that doesn't happen, when a primary care situation
where a person is known to have hypertension,
and that person enters the pregnancy space,
how does the obstetrical provider know that?
You know, sounds so silly, but it is glitchy out there.
So that pre-pregnancy piece matters.
Gestational diabetes matters, breastfeeding?
There's lots of places to find out
about a person's intention to breastfeed,
and whether then they did breastfeed
and finding it in the chart
and also entering it needs some QI.
Assisted ventilation, here come the peds ones,
assisted ventilation after delivery
and whether that baby was transferred,
transported and received a NICU admission.
Hard to get that data sometimes,
'cause the patient's left your shop and it matters.
So the accuracy of that is on our list.
Obviously, premature rupture membranes,
and we're very interested in payer.
So how on earth are we supposed to prioritize
where and when we need health policy change
around insurance if we don't know if there are disparities
among our pregnant people for type of payer?
And that's also should be simple,
but not always in the part of the chart
that we're looking at.
And I'm old enough to remember the search,
'cause it was paper.
But trying to figure out if someone's birth is covered
in the Medicaid program needs attention.
Induction of labor, super important.
And then here's a little quality improvement term.
We don't really need you to learn,
but we need to do, which is called a balancing measure.
When you're looking to change a bunch of stuff,
you have to make sure that you have something
that you're not working on to see
if it inadvertently changed from all your efforts over here.
And it's a way to keep us honest.
Okay, Julie's got a good,
I knew I wasn't gonna describe this quite right.
So Julie wants to make sure we know that these 11 variables,
I did say this earlier, I promise, but I'll say it again.
We picked them to just learn processes.
And then from there, we're expecting
to see a change in all the variables,
or we're expecting you to at least know
where to ask if you don't understand a variable
or if there's confusion about a variable.
And Kimberly, great point,
100 percent you will have those clear definitions
and the part of the quality improvement project
is for us to share the definitions
and for you to say that,
okay, nice try at clarity, not clear, right?
Because that's another place where we think we know
what we're saying and then you can tell us
it's being interpreted differently.
Next slide.
Okay, so the real deep dive here
on the initiative analysis measures.
We're gonna look at percent agreement
between these chart reviews done by magical medical students
or otherwise and what comes in the birth certificate.
And we're gonna look at that by the variable
of the month in the hospital.
So it's just a nice simple design.
And then we wanna see that from that baseline,
there was a percent change.
Oh, it is a medical student.
Yay, Lindsay, okay!
That we're able to go from somewhere to somewhere,
hopefully up, but not up if we're looking
at the percent discrepant.
So we'd like to see a positive change.
And then after that, we need to measure
whether the baseline to the maintenance is also working
for the reasons previously stated.
And then we can also look at what happened at the height
of the, you know, the post intervention should be great,
'cause we focused and worked.
And then it hopefully will be the same as the maintenance,
but if there's a drop, we need to know that too.
Or maybe it's not a drop, it's the other way.
Go ahead, next slide.
So what do we need from you all?
We need for you to look at this list of 11 indicators
and identify and work on something
about their collection that you want to improve.
And we need you to identify your own process
to look at those.
And then we need you on these calls for the shared learning
and to understand where we're gonna learn from each other.
Next slide.
And then what are you gonna get out of this?
A fleece vest that says birth certificate quality project.
Oh no, darn, that wasn't in the budget.
You're gonna get training materials
and tools that you can put into your system
for new hires and for refreshers
and for the ongoing understanding of the importance.
You're gonna have this whole big team,
probably more than you ever wanted,
for office hours, for emails, for consultations.
We'll come to your hospital, we'll do anything you need.
And then you're gonna have improved accuracy and precision,
and you're gonna feel good about how you're contributing
to population health, understanding and improvements.
And then you're also gonna start to see
how your teams can come together, which is not on the slide,
but it will feel more connected.
We hope that it's not an isolating journey
to be a health information manager
or someone entering birth data.
Next slide.
So here's our intention.
Is this me, Julie, or do you wanna do this one?
I guess I'll keep rolling for time.
Our intention is to have a call in September
about partnering and the work that we're already promoting
or asking to do around forming the team
between HIM and clinical work.
That's the September call.
In October, we're gonna look at the tools
and we're gonna steal from some of you,
and we're gonna use some best practice here
on how to improve your accuracy.
And then in November, we're going to identify
and spread other best practice with data collection.
So I'm curious, next slide,
if we have five minutes here for...
So a couple things, we can open this up now
to questions for a few minutes.
At the same time, we really want you
to fill out that evaluation, which is a competing priority.
And if you wanna put stuff in the chat,
we're good with that too.
How is this all landing with you all
on this sort of beautiful June day?
Well, some of us that have been around a long time
are so grateful.
Well, we're all grateful,
but those that have been around,
oh, not able to scan the code.
Okay, so in lieu of the code,
we're putting the link in the chat.
Good old-fashioned link.
So there's a little bit of excited energy
among some of us because it's been so long overdue.
So thank you for entering into the space with us.
And it is gonna save you time in the long run,
because there's a lot of coming back around,
you know, editing, I guess,
or Cindy and Peggy would tell me it's a different word.
But you know, the real-time trying to get the data right
is a lot of work for you all.
So by changing our system and our process
and our flow, we're hopeful.
Okay, great feedback here.
So Marissa's saying thanks, which we appreciate.
Monica wonders should we have another check-in
sooner than September?
Seems like it might fall off the priority list
where there's such a large gap.
Okay, I love that feedback.
So our thinking, and we can bring that back to the team,
was we gotta get all this baseline data in.
And that's sort of a July and August situation,
but maybe we should set up an office hours, guys,
this summer and let that self-select.
We don't want teams to feel like they have to dig in yet
till we sort of know the baseline,
but we like that feedback.
It's kind of a hopeful bit of feedback.
Yeah, Kate's asking a good question, Julie,
about an assignment between now and September.
- [Julie] Yeah, actually our goal was that
we took all of the posted information
with the data entry process.
We've changed that into a one-page PowerPoint flow chart,
and our goal was to share that with each team.
So you see kind of the first thing for the team
to know how your data is collected at your hospital
and see where those bottlenecks maybe.
So that was one of the assignment.
And the other assignment is, yeah,
our original thought was that it's always good for team
to see baseline data prior to starting.
And as Breena mentioned, we have two hospitals
who have completed data so far that we can share.
But the other ones, we're not quite there yet.
But do folks have other suggestion?
Are you unmuted, Breena?
- [Breena] Always so funny when that happens.
It's such a great question, Kate,
'cause our intention today was to say bring anybody on
and sort of hear the big milieu
in which we're about to enter.
And then what we're seeking is this teaming.
Who's your clinical lead?
Who's your data health information manager?
And then we really want those two people
to sort of wonder about who the team's gonna be
or who should be the team.
But I think we'll communicate soon by email.
Sort of some pre-work you can be doing
in that teaming space.
But I do think you need the baseline data in your hand
to see the discrepancies,
'cause each hospital is gonna have different indicators
that are off between what's actually happening in the chart.
And you know, I'm not claiming
that the chart is always accurate,
but it has a little bit more opportunity
for accuracy maybe than this data collection
that goes on for vital record birth certificate.
So once you see that you're good on four of them,
but seven are off, then you'll know better what the what is.
But that doesn't mean you couldn't start thinking about
who the team is and how you wanna understand
the current process.
'Cause it's, you know, I used to joke at Porter
that the birth person was like in the attic.
I don't know if that's still true,
so even just knowing where the attic is-
- [Doctor] Definitely, that's still true.
- [Breena] Okay, so that's good, because finding the attic
and wondering what goes on in the attic
is sort of the summer work.
But I like the end of this call,
'cause the clarity that just came in,
that just maybe a little bit of a, you know,
that, like, in high school,
they used to make you read a book
over the summer before school started. (chuckles)
So we'll give you some assignments by email,
sort of that mission if you choose to accept it piece
with the recognition that we're not gonna ask you
to do too much before you have your data.
Does that sound right, Julie, Katie?
- Yes. - Okay.
12:59, team.
Boy, we're so glad you came on,
and now you've seen our faces.
And you know that we're here for you.
And we'd like to hear from you frequently,
'cause we've never done this before either.
We've done a lot of other QI,
but get those learning sessions on your calendar,
but we'll talk to you before the fall.
Last words, Julie, Katy, Peggy, Cindy?
- [Julie] Thank you, everyone, for being here
and taking the time.
- [Peggy] Thank you so much, see you soon.