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- [Breena] I am so happy you've joined us.

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We have a whole team here
from the health department

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and the Vermont Child
Health Improvement Program.

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We're also thrilled to have

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our Health Commissioner,
Mark Levine, with us.

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Next slide.

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We're gonna kick us off by making sure

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that we all come together
today in the spirit

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of every single one of you is part

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of the Perinatal Quality Collaborative

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in this great state of Vermont.

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What we mean by that is that
we're all working together

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in different spaces and
in the same mission,

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which is we're trying to optimize care

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and the health outcomes
in pregnancy and infancy.

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And we do that by working together.

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And we also do that because we're VCHIP

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using a quality improvement framework.

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So what we do all together,

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and many of you are part of this,

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is we set the priorities together

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with the health department,
because the health department,

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it has all the data and
understands what needs attention.

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We also do a lot of outreach
and education as it relates

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to the relationship between
some of the content experts

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up at UVM and their delivery of healthcare

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and all of our hospitals
that are in the same pursuit.

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We love the quality
improvement aspect of it.

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And then we circle back
and we monitor again

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and wonder what else needs attention.

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So welcome to the PQC Vermont.

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Next slide.

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I hope by now we all know how to do Zoom,

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but microphones are best muted
until you're ready to speak.

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We do want you to know about
the show captions feature,

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which is in your navigation bar,

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which will automate the
audio for you for captioning.

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And then please, please,
please, at the very end,

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we are quality improvement entity

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and we need to know how this went.

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And the evaluation matters a lot to us.

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So there'll be a QR code at 12:59.

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Do not depart, thank you.

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Next slide.

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Okay, this is our ambitious agenda.

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We've welcomed you, we're
gonna talk about this long,

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long dreamed of initiative
to improve the quality

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of our birth certificate variables.

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We're gonna talk about why,

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which 11 variables we picked and why.

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And then we're really gonna
turn back and thank you

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for the input you've already given us

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about your individual hospitals

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and how you do your process
for birth certificate data.

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We're gonna talk about the ongoing work

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to get some baseline, and
then we're going to set up

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how we're gonna come alongside
you and provide tools

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and training as well as
set up the year for you

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in terms of dates, expectations,

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and still leave time for questions.

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Next slide.

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So here's your team,

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and I'm just gonna have people wave,

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if people aren't on camera, it's okay,

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but our names are here.

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So they're calling me the faculty lead.

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I think it's because I spent 11 years

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at the health department and I care deeply

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about the integration of public health

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and data into clinical care.

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Ilisa, who is here with
us somewhere, I think,

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big Zoom, is our family
child health director.

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Katy, give a little wave.

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She's gonna be delivering
some slides in a minute.

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She's our perinatal nurse coordinator

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at the health department.

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Cindy Hooley, vital stats
information manager.

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Such a key long-standing role
for the great work we do.

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Peggy Brozicevic is on
camera, thank you, Peggy.

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She's our research and statistics chief.

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We've got Julie Parent, all
roads lead to Julie Parent

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if you haven't figured that out yet.

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She's our project director,
perinatal at QI coach at VCHIP.

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And also all roads lead to Angela Zinno,

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our project coordinator who
keeps the trains running.

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And look at how there's
just this little outline

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of seven women with side parts

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and cute little shoulder length hair

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at the bottom of the slide.

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Next slide, great team.

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But really, really, really
this is nothing without you,

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and boy, do we love our
community hospitals.

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I said hello to Kate at the onset

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because I am a pediatrician,

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but I was at Porter
Hospital for a long time.

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And I sure do know what it's like

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to be out there in the world away

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from the academic medical center.

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And the work that goes
on at these hospitals

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is so important to the
health of pregnant people

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and children, and we
really need all of you.

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Most of you have engaged

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and some we're still
working on the teaming.

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And we're just here today to
say, we promise it'll be fun,

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and you would be welcomed
into this collaboration.

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Next slide.

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Okay, I have the great pleasure

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of introducing Dr. Mark Levine.

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It would be shocking to
me if folks didn't know,

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because this great leader took us through

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the most significant public
health crisis of our time,

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hopefully of a century.

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What's so fun about Dr. Levine

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is I actually knew him before.

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Oops, I knew him before the crisis

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and I knew him before he
was a health commissioner.

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So he joined the health
department in 2017.

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Wow, we're gonna have to have
a 10-year anniversary soon.

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So Dr. Levine believes
deeply in, what we call,

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this nexus of clinical care,

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education, public health advocacy.

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And what he's really
seeking to do is improve

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the health of populations through policy

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and cultures of health,
which is why we're so happy

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he's here today to spend
a few minutes talking

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to you about why this matters

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and why we're so grateful
you're engaging with us.

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Dr. Levine.

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- [Mark] Thank you so much, Breena.

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And yes, I am going to engage with you

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in hopefully acceptable ways,

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but maybe provocative ways as well.

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So I'm supposed to be giving you

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some inspirational comments
on this kickoff call

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about why is birth certificate accuracy

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through data entry so important.

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And as you know, you're gonna
go through a lot of sessions

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that have all kinds of
other nice titles to them,

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all with this quality
improvement initiative in mind.

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So I'm gonna set the table a little,

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highlight the importance of the topic

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and why you should pay attention.

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This is really more
than what it's labeled,

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a birth certificate initiative,
'cause it's really a parent

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and facility worksheet
initiative in a broader sense.

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More on that to come.

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I am gonna discuss those forms,

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and I wanna provide a
little discussion on VCHIP

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and PQC Vermont to provide the
context for this initiative

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and conclude by giving you a perspective

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on the higher significance
of why you're here.

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But first, I did do a little research

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on birth certificates themselves

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and discovered some
fascinating information.

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Now as you know, vital records
in Vermont include births,

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deaths, marriages, civil unions,

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divorces, dissolutions,
fetal deaths, abortions.

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And statutes in 2019
enhanced safety and security,

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trying to protect against
misuse and identity theft

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and who can access the birth certificate,

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which, of course, is a vital record

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that documents the birth of a person.

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Didn't realize that because
we live in this country,

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there can be multiple ways

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of actually documenting just that event

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depending on what jurisdiction
you happen to be in.

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It's the responsibility
of the healthcare system

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to see that birth is properly registered

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with the appropriate government agency.

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The UN says every child has a right

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to a name and a nationality.

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And formal recognition of one's existence

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is essential to accessing so many rights.

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Proving age, nationality,
receiving healthcare,

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going to school, participating in sports,

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being adopted, getting a
passport or marriage license,

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voting, birth in the US
confers citizenship by birth

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though certificate doubly
serves as evidence of this.

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And it's required to be
filled within five days

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by a physician or midwife.

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Now to me, the National
Center for Health Statistics

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has some data requirements
which are pretty straightforward

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about the child and the
parent in terms of names,

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days of birth, addresses,
health information,

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prenatal care received by
the mother, type of birth.

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But much more intrigued comes from looking

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at some of the controversial aspects

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of these seemingly simple documents.

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If you look at our
history in this country,

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birth certificates
unfortunately have been used

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in the wrong way at times,
enforcing racist segregation,

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policies of white supremacy,
erasure of indigenous people,

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allotment of indigenous
lands, adoption laws,

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enforcing gender identity
or transgender rights,

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which, of course, Vermont's
recent legislation stands out

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in a positive way amidst a sea
of negativity on this issue.

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So while the seemingly simple document

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may not superficially look
like it needs QI efforts,

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its potential for misuse should remain

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a perennial point of discussion.

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Now in broadening this discussion

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to public and population house,

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it's great that VCHIP is
running the show here.

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It's 'cause VCHIP is a
population-based child

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and family health services research

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and quality improvement
program at UVM that,

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as Brina herself epitomizes,

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works closely with public health

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as well as the entire clinical sector

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and multiple other
partners, all in an effort

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to optimize the health of
Vermont's children and families.

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So what is PQC Vermont?

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Well, you saw one quick slide.

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There's actually a national
network called NNPQC,

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which has a mission of
supporting the development

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and enhancing the ability

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of state perinatal quality collaboratives

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to make measurable improvements
in statewide maternal

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and infant healthcare and health outcomes.

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They're basically
multidisciplinary teams working

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to improve these outcomes using evidenced

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and foreign practices and
processes like QI principles

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to address gaps in care.

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And there are five areas of
focus on the national level

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which should resonate with everyone.

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Reduce pre-term births,
reduce pregnancy complications

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associated with
hypertension and hemorrhage,

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improve identification of and care

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for infants with neonatal
abstinence syndrome,

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reduce racial and ethnic
and geographic disparities.

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And fifth, reduce cesareans
among low-risk pregnant women.

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So PQC Vermont's obviously
a formal partnership

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of longstanding VCHIP projects
that have joined forces

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to become Vermont's
resource for perinatal care,

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in partnership with the
Department of Health Family

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and Child Health Division
and Health Statistics

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and Informatics Division.

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And it's really trying to
mobilize state networks

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to implement quality improvement efforts

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and improved care for
mothers, babies and families

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by setting perinatal outcome priorities,

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providing outreach and education,

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advancing QI efforts, like the
one you're involved in here,

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and monitoring healthcare outcomes.

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Now let's get down to the work
at hand on the worksheets.

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I am not an OB-GYN, so I never had

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to participate in any of these forms.

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But the parent worksheet on
the child's birth certificate

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includes things like the
mother's marital status,

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education, race, ethnicity,
smoking status, WIC status,

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father, really education, race, ethnicity.

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And then the facility's responsibilities

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involve newborn statistical information,

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going from the Apgars to the birth weight

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to what kind of gestation,

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is the baby breastfed
at discharge, et cetera.

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00:13:11,370 --> 00:13:15,270
Information from a statistical
standpoint on the mother.

258
00:13:15,270 --> 00:13:17,490
Was there a need for transfer?

259
00:13:17,490 --> 00:13:19,290
What's the prior OB history?

260
00:13:19,290 --> 00:13:23,190
Did they have prenatal care
visits and when did they start?

261
00:13:23,190 --> 00:13:25,830
And then medical and health information,

262
00:13:25,830 --> 00:13:27,660
which has a whole host of things

263
00:13:27,660 --> 00:13:29,613
that I'm sure you'll hear more about.

264
00:13:31,530 --> 00:13:35,190
That go from pregnancy
risk factors to labor

265
00:13:35,190 --> 00:13:40,053
to infections during
pregnancy, group B, et cetera.

266
00:13:41,310 --> 00:13:42,900
Now I don't have all the data

267
00:13:42,900 --> 00:13:46,950
on how successful all of
this is actually reported,

268
00:13:46,950 --> 00:13:49,095
but I think the fact
that you're in a quality

269
00:13:49,095 --> 00:13:51,270
and performance improvement initiative

270
00:13:51,270 --> 00:13:52,570
should tell you something.

271
00:13:53,430 --> 00:13:56,340
And improving the consistency
of data collection

272
00:13:56,340 --> 00:13:58,680
and reporting, reliability,

273
00:13:58,680 --> 00:14:02,880
accuracy and adherence
to a defined standard

274
00:14:02,880 --> 00:14:05,283
is what quality improvement is all about.

275
00:14:07,410 --> 00:14:10,740
There's a few tidbits I
picked out about giving birth

276
00:14:10,740 --> 00:14:13,623
in Vermont or New Hampshire in 2021.

277
00:14:15,030 --> 00:14:18,780
Out of 5,000 plus live births,

278
00:14:18,780 --> 00:14:22,143
13.8% of them occurred in New Hampshire.

279
00:14:23,580 --> 00:14:26,910
3.3 out of every 100 live births occurred

280
00:14:26,910 --> 00:14:28,323
out of the hospital.

281
00:14:29,280 --> 00:14:30,360
I thought that was low.

282
00:14:30,360 --> 00:14:32,260
I thought it would be higher actually.

283
00:14:33,510 --> 00:14:37,080
38% used Medicaid as the primary payer

284
00:14:37,080 --> 00:14:38,823
for delivery services.

285
00:14:39,690 --> 00:14:43,263
28% were enrolled in WIC during pregnancy,

286
00:14:44,490 --> 00:14:48,930
and almost 90% of infants
were breastfed upon discharge.

287
00:14:48,930 --> 00:14:51,030
I don't know how many states can say that.

288
00:14:52,560 --> 00:14:53,853
Congratulations.

289
00:14:55,350 --> 00:14:58,770
Now some truths and five pivotal points

290
00:14:58,770 --> 00:15:00,900
to make regarding the kind of data

291
00:15:00,900 --> 00:15:04,620
that these examples
illustrate and why this data

292
00:15:04,620 --> 00:15:07,773
is so essential to public
health and the people we serve.

293
00:15:08,910 --> 00:15:12,510
First, birth certificate
data is the foundation

294
00:15:12,510 --> 00:15:14,070
of public health decisions

295
00:15:14,070 --> 00:15:16,473
about improving maternal infant health.

296
00:15:17,700 --> 00:15:20,850
Where and how else would we
get the kind of information

297
00:15:20,850 --> 00:15:25,020
I detailed that is present on
these certificates and forms,

298
00:15:25,020 --> 00:15:28,110
and how could we develop
policies and practices

299
00:15:28,110 --> 00:15:30,520
if we didn't have proper characterization

300
00:15:31,753 --> 00:15:34,860
of problems through a
comprehensive and accurate data set

301
00:15:34,860 --> 00:15:37,083
to provide a data-driven approach?

302
00:15:37,980 --> 00:15:41,310
Surveillance, of course, is
critical to public health.

303
00:15:41,310 --> 00:15:44,340
It's one of its core responsibilities

304
00:15:44,340 --> 00:15:47,100
whether we're in the
problem formulating phase

305
00:15:47,100 --> 00:15:49,023
or the health outcomes review.

306
00:15:50,490 --> 00:15:53,400
Second, we use birth certificate data

307
00:15:53,400 --> 00:15:56,250
to improve care for pregnant people,

308
00:15:56,250 --> 00:15:59,190
birthing parents and babies.

309
00:15:59,190 --> 00:16:02,550
And I will beg forgiveness
for this being the first time

310
00:16:02,550 --> 00:16:05,100
I use the term pregnant people,

311
00:16:05,100 --> 00:16:09,210
because so much of what we
actually are talking about

312
00:16:09,210 --> 00:16:11,400
in these forms and everything actually

313
00:16:11,400 --> 00:16:14,370
is not as advanced as the
words pregnant people.

314
00:16:14,370 --> 00:16:17,880
It continues to use
the word pregnant women

315
00:16:17,880 --> 00:16:19,593
or mothers, or what have you.

316
00:16:20,640 --> 00:16:23,220
But anyways, it is
important to know things

317
00:16:23,220 --> 00:16:26,190
like the timely involvement
in prenatal care,

318
00:16:26,190 --> 00:16:29,580
maternal health factors
impacting your pregnancy,

319
00:16:29,580 --> 00:16:32,790
the frequency with which
prematurity exists,

320
00:16:32,790 --> 00:16:36,150
the need for transfer to
higher levels of care,

321
00:16:36,150 --> 00:16:39,870
delivery issues, is the
parent poised to be prepared

322
00:16:39,870 --> 00:16:42,360
and successful for breastfeeding?

323
00:16:42,360 --> 00:16:45,990
And then pair the data with
evidence-based solutions.

324
00:16:45,990 --> 00:16:48,540
Understanding where the
critical partnerships are

325
00:16:48,540 --> 00:16:52,050
between the healthcare system
and state health programs

326
00:16:52,050 --> 00:16:54,633
and community-based organizations.

327
00:16:55,470 --> 00:16:56,590
There's a lot of work

328
00:16:57,568 --> 00:17:00,900
our health statistics
division does with the data.

329
00:17:00,900 --> 00:17:01,905
Everybody knows PRAMS,

330
00:17:01,905 --> 00:17:05,223
the Pregnancy Risk
Assessment Monitoring System.

331
00:17:06,390 --> 00:17:08,460
They use that where birth certificate data

332
00:17:08,460 --> 00:17:09,993
are used for sampling.

333
00:17:11,580 --> 00:17:13,380
We monitor key indicators

334
00:17:13,380 --> 00:17:16,533
for birth certificates to
assess trends over time.

335
00:17:18,540 --> 00:17:22,530
Third, monitor population health.

336
00:17:22,530 --> 00:17:25,500
I'm so grateful that
Vermont does not share

337
00:17:25,500 --> 00:17:27,540
in the heart-rendering maternal

338
00:17:27,540 --> 00:17:30,060
and infant mortality statistics

339
00:17:30,060 --> 00:17:33,690
so many of our states are confronted with,

340
00:17:33,690 --> 00:17:35,433
notably many in the South.

341
00:17:36,330 --> 00:17:39,240
But having mortality and morbidity data

342
00:17:39,240 --> 00:17:42,420
and being able to examine
these from a racial

343
00:17:42,420 --> 00:17:45,840
and SES equity position is critical

344
00:17:45,840 --> 00:17:49,050
to practicing public
and population health.

345
00:17:49,050 --> 00:17:51,120
And we all know the important linkages

346
00:17:51,120 --> 00:17:55,620
between these statistics and
the health-related social needs

347
00:17:55,620 --> 00:18:00,360
of many in our population when
it comes to access to wealth,

348
00:18:00,360 --> 00:18:04,860
housing and food security,
transportation opportunities,

349
00:18:04,860 --> 00:18:08,463
access to services, access
to quality healthcare.

350
00:18:10,140 --> 00:18:13,770
Fourth, solve public health
problems at the local,

351
00:18:13,770 --> 00:18:16,290
state and federal levels.

352
00:18:16,290 --> 00:18:18,720
Clearly we look at a lot of our data

353
00:18:18,720 --> 00:18:22,320
from a geographic equity position as well.

354
00:18:22,320 --> 00:18:27,150
And in Vermont, the importance
of rurality is ever present.

355
00:18:27,150 --> 00:18:29,490
It can play a role in prevention efforts,

356
00:18:29,490 --> 00:18:33,150
resource allocation,
programmatic initiatives

357
00:18:33,150 --> 00:18:37,560
to address the whole continuum
of equity-related factors.

358
00:18:37,560 --> 00:18:41,220
Not to mention access to
healthcare and quality of care

359
00:18:41,220 --> 00:18:44,313
that is available on a
local or regional basis.

360
00:18:45,180 --> 00:18:48,060
And finally, making wise decisions about

361
00:18:48,060 --> 00:18:52,260
where to spend limited
dollars, helping public health,

362
00:18:52,260 --> 00:18:56,910
the healthcare system, policy
makers and political leaders

363
00:18:56,910 --> 00:19:00,120
make the often very tough decisions,

364
00:19:00,120 --> 00:19:03,660
and to be strategic and prioritize

365
00:19:03,660 --> 00:19:06,783
how to move health outcomes
in a positive direction.

366
00:19:08,010 --> 00:19:11,190
So I hope your work in this
learning series will enable us

367
00:19:11,190 --> 00:19:14,760
to move forward in all
of these lofty goals

368
00:19:14,760 --> 00:19:17,933
and help accomplish many of VCHIP's

369
00:19:17,933 --> 00:19:21,150
and PQC Vermont's significant goals

370
00:19:21,150 --> 00:19:24,660
that they have for their overall work

371
00:19:24,660 --> 00:19:28,440
as well as this particular
quality improvement initiative.

372
00:19:28,440 --> 00:19:31,623
Thanks for allowing me to
provide the initial comments.

373
00:19:33,030 --> 00:19:34,800
- [Breena] Thank you so much, Dr. Levine.

374
00:19:34,800 --> 00:19:38,310
Wow, I'm glad we recorded that.

375
00:19:38,310 --> 00:19:40,080
So there it is.

376
00:19:40,080 --> 00:19:42,787
I'm gonna ask Angela put
the slides back up for us.

377
00:19:42,787 --> 00:19:44,730
You're welcome to stay

378
00:19:44,730 --> 00:19:46,650
or you probably have other things to do,

379
00:19:46,650 --> 00:19:48,120
but we're so grateful you came,

380
00:19:48,120 --> 00:19:52,890
and looking forward to having
you at more PQC events.

381
00:19:52,890 --> 00:19:54,633
Thanks for understanding us.

382
00:19:56,400 --> 00:19:59,823
Katy Leffell, up you go, next slide.

383
00:20:00,800 --> 00:20:01,830
- [Katy] Okay, all right.

384
00:20:01,830 --> 00:20:03,960
So thank you, Dr. Levine.

385
00:20:03,960 --> 00:20:05,580
And this is just a little bit

386
00:20:05,580 --> 00:20:07,650
about our birth certificate data.

387
00:20:07,650 --> 00:20:10,050
So we collected more than
100 pieces of information

388
00:20:10,050 --> 00:20:12,930
on birthing people and babies,

389
00:20:12,930 --> 00:20:15,810
and birth certificate
staff are on the front line

390
00:20:15,810 --> 00:20:18,330
and assuring this accuracy.

391
00:20:18,330 --> 00:20:20,910
And you're such a vital
part of the healthcare team,

392
00:20:20,910 --> 00:20:24,510
and I've got to meet some of
you, and Julie and Angela,

393
00:20:24,510 --> 00:20:26,133
have met a lot more of you.

394
00:20:27,510 --> 00:20:29,880
Sometimes you're in other
buildings or other floors,

395
00:20:29,880 --> 00:20:34,880
but you're all really, really
vital with this information.

396
00:20:35,550 --> 00:20:38,850
And then Dr. Levine
indicated some of the uses,

397
00:20:38,850 --> 00:20:40,890
but it's used not only locally in state

398
00:20:40,890 --> 00:20:42,480
but also by our national partner.

399
00:20:42,480 --> 00:20:46,650
So it's really important,
this accurate information.

400
00:20:46,650 --> 00:20:49,980
And it's consistent source
of health information

401
00:20:49,980 --> 00:20:53,610
on all Vermont babies and new
mothers and birthing people.

402
00:20:53,610 --> 00:20:58,610
And also, it impacts your own
hospital performance records

403
00:20:59,070 --> 00:21:02,376
and adherence to best
practices and perinatal care.

404
00:21:02,376 --> 00:21:06,000
So it impacts the way that
your hospital shows up as well.

405
00:21:06,000 --> 00:21:07,203
So next slide.

406
00:21:09,720 --> 00:21:13,360
Okay, so this is talking
a little bit about

407
00:21:14,850 --> 00:21:18,240
how we use it with the
Perinatal Quality Collaborative.

408
00:21:18,240 --> 00:21:22,890
So you're seeing two different
reports that we produce.

409
00:21:22,890 --> 00:21:25,620
I'm saying we, it's
really the PQC and VCHIP,

410
00:21:25,620 --> 00:21:27,780
but I, you know, help
participate a little bit

411
00:21:27,780 --> 00:21:30,000
when I say I'm gonna use we.

412
00:21:30,000 --> 00:21:34,140
So anyways, the first one is
for the community hospitals.

413
00:21:34,140 --> 00:21:38,070
They do a huge amount of
work to produce this report

414
00:21:38,070 --> 00:21:40,260
and then present it to
the community hospitals.

415
00:21:40,260 --> 00:21:43,350
Many of you have been,
I'm sure, a part of that,

416
00:21:43,350 --> 00:21:46,050
and there's a lot of
discussion about the data

417
00:21:46,050 --> 00:21:48,240
and the accuracy of the
data and all those pieces,

418
00:21:48,240 --> 00:21:50,790
'cause it's so important for representing

419
00:21:50,790 --> 00:21:53,310
your own hospital's performance.

420
00:21:53,310 --> 00:21:56,160
And then last year, we had the first

421
00:21:56,160 --> 00:22:00,120
perinatal public health
report, which is a report

422
00:22:00,120 --> 00:22:02,553
that we produced that's a little bit more,

423
00:22:03,717 --> 00:22:05,880
it's the public facing and
public health versions of it.

424
00:22:05,880 --> 00:22:10,880
So it's not so much all,
just only the clinical

425
00:22:11,400 --> 00:22:13,650
and sort of the data that we produce

426
00:22:13,650 --> 00:22:14,520
for the community hospitals.

427
00:22:14,520 --> 00:22:17,440
But this is also something
that the communities can use

428
00:22:18,358 --> 00:22:19,980
and see sort of where they are

429
00:22:19,980 --> 00:22:24,543
as far as data contrasting
with other regions as well.

430
00:22:25,548 --> 00:22:26,648
So next slide, please.

431
00:22:27,660 --> 00:22:30,120
And this is talking a little bit about

432
00:22:30,120 --> 00:22:34,290
how we use the birth
certificate data internally

433
00:22:34,290 --> 00:22:35,970
for the department of health

434
00:22:35,970 --> 00:22:37,800
and the family and child health division.

435
00:22:37,800 --> 00:22:40,342
So we use it a lot for finding

436
00:22:40,342 --> 00:22:43,920
and applying for grant opportunities.

437
00:22:43,920 --> 00:22:47,160
For instance, so we've
got this enhancing reviews

438
00:22:47,160 --> 00:22:49,530
and surveillance to
eliminate maternal mortality,

439
00:22:49,530 --> 00:22:52,680
which is a big CDC grant that
is funding a lot of our work

440
00:22:52,680 --> 00:22:57,480
around reviewing and addressing
perinatal death in Vermont.

441
00:22:57,480 --> 00:23:01,083
So any death in the pregnancy
or full year postpartum.

442
00:23:02,040 --> 00:23:06,360
And then we also use it for
the WIC program, the Women,

443
00:23:06,360 --> 00:23:09,660
Infants and Children
Supplemental Nutrition Program,

444
00:23:09,660 --> 00:23:12,330
the Perinatal Quality Collaborative
Capacity Building grant.

445
00:23:12,330 --> 00:23:14,913
So that's a grant that's
funding a lot of the work,

446
00:23:16,470 --> 00:23:17,880
that's we're talking about today

447
00:23:17,880 --> 00:23:21,780
and a lot of other projects as well.

448
00:23:21,780 --> 00:23:24,090
We also have a grant we applied

449
00:23:24,090 --> 00:23:26,640
for maternal health innovations,

450
00:23:26,640 --> 00:23:29,130
which is another big grant
we're funding out this summer.

451
00:23:29,130 --> 00:23:31,680
We just also have another grant

452
00:23:31,680 --> 00:23:35,010
that was around maternal mental health

453
00:23:35,010 --> 00:23:36,840
and perinatal mental health.

454
00:23:36,840 --> 00:23:39,330
So it funds a lot of grant opportunities

455
00:23:39,330 --> 00:23:42,123
for us here in the state.

456
00:23:43,440 --> 00:23:45,513
All right, next slide.

457
00:23:46,466 --> 00:23:49,440
So this is talking a little
bit about some of the things

458
00:23:49,440 --> 00:23:51,360
that we've learned from
our visits with you,

459
00:23:51,360 --> 00:23:53,520
which have been so fun.

460
00:23:53,520 --> 00:23:57,900
So we have learned that, not surprisingly,

461
00:23:57,900 --> 00:24:00,300
data entry processes
vary quite considerably

462
00:24:00,300 --> 00:24:01,500
from facility to facility.

463
00:24:01,500 --> 00:24:03,210
So we're seeing lots
of different processes

464
00:24:03,210 --> 00:24:05,640
and learning some best
practices already around

465
00:24:05,640 --> 00:24:08,133
what really has worked
well for some hospitals.

466
00:24:08,970 --> 00:24:11,190
The quality assurance and audit process,

467
00:24:11,190 --> 00:24:13,740
again, varies at each facility.

468
00:24:13,740 --> 00:24:16,590
So that's learning again,
a lot of the variations

469
00:24:16,590 --> 00:24:18,993
that are working or maybe
not working as well.

470
00:24:20,040 --> 00:24:22,830
Some facilities have modified the parent

471
00:24:22,830 --> 00:24:24,900
and facility worksheets to meet the needs

472
00:24:24,900 --> 00:24:27,510
of the hospital and your
data entry processes.

473
00:24:27,510 --> 00:24:28,860
So a little bit of variation there,

474
00:24:28,860 --> 00:24:31,320
which has been really interesting.

475
00:24:31,320 --> 00:24:34,980
And then the challenges with
completing the data entry,

476
00:24:34,980 --> 00:24:38,333
because sometimes, you know,
you're looking through the EMR

477
00:24:38,333 --> 00:24:40,830
or the EHR and you're not
finding what you're looking for,

478
00:24:40,830 --> 00:24:42,750
or it's located in different places.

479
00:24:42,750 --> 00:24:44,370
Sometimes it's not integrated well

480
00:24:44,370 --> 00:24:45,540
and you have to do a lot of digging.

481
00:24:45,540 --> 00:24:47,430
Different people have different accesses.

482
00:24:47,430 --> 00:24:51,420
We're finding a lot of
issues like that as well.

483
00:24:51,420 --> 00:24:53,880
And then also just some
questions sometimes that come up

484
00:24:53,880 --> 00:24:56,790
around the actual wording on
the forms and what they mean

485
00:24:56,790 --> 00:25:00,570
and on the parent forms and
things like that as well.

486
00:25:00,570 --> 00:25:02,610
And I believe this may be my last,

487
00:25:02,610 --> 00:25:03,990
no, it's not my last slide.

488
00:25:03,990 --> 00:25:05,313
Nevermind, next slide.

489
00:25:06,540 --> 00:25:11,540
All right, so this is just
some photos of our experiences

490
00:25:12,330 --> 00:25:16,020
with coming to visit you
guys all at your facilities.

491
00:25:16,020 --> 00:25:20,040
And you'll see our process
there with the sticky notes

492
00:25:20,040 --> 00:25:24,450
and the big Post-It pages and
lots and lots and lots of pens

493
00:25:24,450 --> 00:25:27,600
and office supplies out on the
table to try to get an idea

494
00:25:27,600 --> 00:25:30,540
of your workflows at
every different hospital.

495
00:25:30,540 --> 00:25:32,280
And you guys were really
generous with your time

496
00:25:32,280 --> 00:25:34,830
to come and meet with
us and take the time.

497
00:25:34,830 --> 00:25:37,320
And like it says here, we had all sorts

498
00:25:37,320 --> 00:25:40,410
of different people coming,
health information management,

499
00:25:40,410 --> 00:25:44,100
OB, pediatrics, certified
nurse midwives, nurses,

500
00:25:44,100 --> 00:25:45,450
nursing assistants like you all,

501
00:25:45,450 --> 00:25:46,800
you all really came forward

502
00:25:46,800 --> 00:25:50,160
to help represent your facilities

503
00:25:50,160 --> 00:25:52,203
and help us collect this information.

504
00:25:53,460 --> 00:25:55,413
And then next slide.

505
00:25:57,180 --> 00:26:00,330
Feedback, so I referenced a
little bit about this already,

506
00:26:00,330 --> 00:26:02,520
but recommending updated language

507
00:26:02,520 --> 00:26:04,353
on the parent facility worksheets,

508
00:26:05,400 --> 00:26:07,500
some of that we can do on our own

509
00:26:07,500 --> 00:26:09,930
and sometimes it takes some okay

510
00:26:09,930 --> 00:26:12,393
from higher up national folks as well.

511
00:26:13,380 --> 00:26:14,213
But we're working out,

512
00:26:14,213 --> 00:26:16,760
we're definitely passing the
feedback on from you guys.

513
00:26:17,610 --> 00:26:19,560
And enhanced communication
between clinical

514
00:26:19,560 --> 00:26:21,030
and health information management staff.

515
00:26:21,030 --> 00:26:24,240
So not surprisingly, sometimes,
like we talked about,

516
00:26:24,240 --> 00:26:26,430
sometimes they even separated far away

517
00:26:26,430 --> 00:26:28,290
in space but also in role.

518
00:26:28,290 --> 00:26:30,750
So sometimes, we just need to help

519
00:26:30,750 --> 00:26:32,610
make those connections a little tighter

520
00:26:32,610 --> 00:26:35,100
or tell like this
facility does it this way,

521
00:26:35,100 --> 00:26:36,510
maybe this will work for your facility.

522
00:26:36,510 --> 00:26:38,910
So we're kind of doing that work.

523
00:26:38,910 --> 00:26:40,200
Definitely need to provide training

524
00:26:40,200 --> 00:26:42,210
and educational
opportunities for your teams

525
00:26:42,210 --> 00:26:45,030
to clarify definitions
and medical terminology

526
00:26:45,030 --> 00:26:47,760
that's been identified many facilities,

527
00:26:47,760 --> 00:26:49,980
and we haven't done a statewide training

528
00:26:49,980 --> 00:26:53,700
on birth certificate
data in a very long time.

529
00:26:53,700 --> 00:26:54,963
So we need to do that.

530
00:26:58,159 --> 00:27:00,060
And just like raising up that awareness

531
00:27:00,060 --> 00:27:01,950
around the overall
appreciation of the role

532
00:27:01,950 --> 00:27:04,680
of the birth certificate,
health information staff,

533
00:27:04,680 --> 00:27:07,470
hugely important, and again,

534
00:27:07,470 --> 00:27:09,420
often doesn't receive necessarily

535
00:27:09,420 --> 00:27:12,240
that training or support
that they might need.

536
00:27:13,248 --> 00:27:16,440
And maybe we need to do a better
job at the state with that.

537
00:27:16,440 --> 00:27:19,560
So providing additional information tools.

538
00:27:19,560 --> 00:27:24,300
So a reference guide
for you all, best tips,

539
00:27:24,300 --> 00:27:26,430
best practice learned
from different facilities

540
00:27:26,430 --> 00:27:28,350
and sharing that information with you

541
00:27:28,350 --> 00:27:30,870
around in the informative pieces.

542
00:27:30,870 --> 00:27:34,473
So next slide, I think I pass it off now.

543
00:27:36,120 --> 00:27:37,110
- [Breena] Thanks, Katy.

544
00:27:37,110 --> 00:27:40,140
I did wanna give Peggy space
for a sec if she wants.

545
00:27:40,140 --> 00:27:41,370
There are a couple other ways

546
00:27:41,370 --> 00:27:43,770
that the health department
uses this important data

547
00:27:43,770 --> 00:27:46,260
that we wanted to highlight for you.

548
00:27:46,260 --> 00:27:50,130
Peggy, did you wanna tell
your favorite ways, yes?

549
00:27:50,130 --> 00:27:53,097
- [Peggy] Yes, I'm Peggy Brozicevic

550
00:27:53,097 --> 00:27:57,180
and I'm with the division of
statistics and informatics.

551
00:27:57,180 --> 00:27:59,620
So the birth file is one of the most used

552
00:28:00,526 --> 00:28:03,060
in health statistics.

553
00:28:03,060 --> 00:28:08,060
And Dr. Levine has
referenced our PRAMS project,

554
00:28:08,580 --> 00:28:12,630
which is the survey of women
who recently gave birth.

555
00:28:12,630 --> 00:28:16,650
And we use the birth file
not only to select the women

556
00:28:16,650 --> 00:28:21,240
for our sample but the addresses
for those first contact.

557
00:28:21,240 --> 00:28:24,420
Then because the two files are linked,

558
00:28:24,420 --> 00:28:28,500
we're able to skip asking
mothers some questions such as,

559
00:28:28,500 --> 00:28:31,890
you know, their marital
status or their education,

560
00:28:31,890 --> 00:28:34,530
or questions about the
infants such as birth weight

561
00:28:34,530 --> 00:28:38,250
or weeks gestation, because
we include that information

562
00:28:38,250 --> 00:28:41,310
from the birth file in our analytic file.

563
00:28:41,310 --> 00:28:43,200
And then we have it for our analysis.

564
00:28:43,200 --> 00:28:46,770
And this is a CDC funded program,

565
00:28:46,770 --> 00:28:51,770
and the research file is
used not just by Vermont,

566
00:28:52,830 --> 00:28:57,830
the Vermont PRAMS program, but
there's a all-site database

567
00:28:58,950 --> 00:29:01,740
that's made available to researchers.

568
00:29:01,740 --> 00:29:05,460
Other uses include vital records,

569
00:29:05,460 --> 00:29:08,460
produces a weekly report on new births

570
00:29:08,460 --> 00:29:10,920
that have been entered
into the birth file,

571
00:29:10,920 --> 00:29:12,570
and they send that information

572
00:29:12,570 --> 00:29:15,510
to the newborn screening
program so that they can check,

573
00:29:15,510 --> 00:29:18,260
make sure that there's no
babies that have been missed.

574
00:29:19,530 --> 00:29:22,650
My team produces surveillance reports

575
00:29:22,650 --> 00:29:24,690
both for all resident births,

576
00:29:24,690 --> 00:29:26,490
but then again a second report

577
00:29:26,490 --> 00:29:31,383
for just those records
where WIC is indicated,

578
00:29:32,640 --> 00:29:36,990
and that is made available
then to the WIC program.

579
00:29:36,990 --> 00:29:39,700
We maintain a much larger spreadsheet

580
00:29:42,120 --> 00:29:45,813
with just all sorts of variables
from the birth certificate.

581
00:29:46,680 --> 00:29:50,010
As again Dr. Levine had referenced,

582
00:29:50,010 --> 00:29:52,680
we're monitoring those all the time

583
00:29:52,680 --> 00:29:55,773
for trends and for discontinuities.

584
00:29:56,910 --> 00:29:59,370
I also wanna mention that NCHS,

585
00:29:59,370 --> 00:30:01,380
which you'll hear a lot about

586
00:30:01,380 --> 00:30:03,573
and you'll see on your guides,

587
00:30:04,620 --> 00:30:08,220
makes a research file
available nationally.

588
00:30:08,220 --> 00:30:10,500
And so that's used by researchers.

589
00:30:10,500 --> 00:30:12,930
It's used, for example,
by the March of Dimes

590
00:30:12,930 --> 00:30:15,243
to produce their perinatal report,

591
00:30:16,110 --> 00:30:19,020
which includes data on every state

592
00:30:19,020 --> 00:30:22,440
and then makes comparisons
across the state,

593
00:30:22,440 --> 00:30:26,220
across these measures
to the national data.

594
00:30:26,220 --> 00:30:29,820
So thank you, and I will
turn it back to Breena.

595
00:30:29,820 --> 00:30:31,560
- [Breena] Thanks, Peggy.

596
00:30:31,560 --> 00:30:35,610
So there's your why, I'm
learning a lot today.

597
00:30:35,610 --> 00:30:36,660
This is great.

598
00:30:36,660 --> 00:30:38,340
I did wanna acknowledge in the chat too

599
00:30:38,340 --> 00:30:40,560
that our friend Jade, hi, Jade.

600
00:30:40,560 --> 00:30:44,610
Jade reminds us too that our
midwives also do the births.

601
00:30:44,610 --> 00:30:47,250
They actually do the worksheets
and fill out in about 2%

602
00:30:47,250 --> 00:30:51,600
of the births, an added awesome
member of this great team.

603
00:30:51,600 --> 00:30:54,450
Okay, so here we go.

604
00:30:54,450 --> 00:30:58,620
So the reason we've done the
why, we've gotten us all into

605
00:30:58,620 --> 00:31:02,130
this important shared space
that this data matters.

606
00:31:02,130 --> 00:31:03,900
This is not data that gets collected

607
00:31:03,900 --> 00:31:06,360
and goes onto some shelf
and gets all dusty.

608
00:31:06,360 --> 00:31:10,200
This is real-time super important data.

609
00:31:10,200 --> 00:31:13,740
So like all good data,
it has an opportunity

610
00:31:13,740 --> 00:31:17,340
to improve in terms of its accuracy.

611
00:31:17,340 --> 00:31:20,160
So the way we're gonna do this
quality improvement project

612
00:31:20,160 --> 00:31:22,380
is we're really, we've
learned from many states

613
00:31:22,380 --> 00:31:24,240
that are a little bit ahead of us on this,

614
00:31:24,240 --> 00:31:28,110
that it helps to pick
a handful of indicators

615
00:31:28,110 --> 00:31:31,590
that you can really use as your process

616
00:31:31,590 --> 00:31:34,860
to understand how data gets collected

617
00:31:34,860 --> 00:31:36,150
and sent to the health department

618
00:31:36,150 --> 00:31:40,290
and then comes back or
is communicated with.

619
00:31:40,290 --> 00:31:43,350
And then that process
would then help inform

620
00:31:43,350 --> 00:31:45,360
the whole set of indicators.

621
00:31:45,360 --> 00:31:47,940
This was not trying to pit
indicators against each other

622
00:31:47,940 --> 00:31:51,870
or us having any, you know,

623
00:31:51,870 --> 00:31:54,720
deep attachment to
these 11 that we picked.

624
00:31:54,720 --> 00:31:56,730
But we did have a process ourselves

625
00:31:56,730 --> 00:31:57,960
with our health department colleagues

626
00:31:57,960 --> 00:31:59,820
thinking about relevance,

627
00:31:59,820 --> 00:32:01,170
and we'll talk about that in a second.

628
00:32:01,170 --> 00:32:05,370
So we wanna make sure to
improve the accuracy of these 11

629
00:32:05,370 --> 00:32:07,830
as a way to improve the whole darn thing.

630
00:32:07,830 --> 00:32:11,190
But we also wanna learn
and share with each other

631
00:32:11,190 --> 00:32:13,680
about what you're doing,
because we've already learned

632
00:32:13,680 --> 00:32:15,270
from these hospital site visits

633
00:32:15,270 --> 00:32:17,490
that you guys have worked out some stuff,

634
00:32:17,490 --> 00:32:21,420
that we VCHIP loves to take
someone else's hard work

635
00:32:21,420 --> 00:32:23,040
and give it to the other hospitals

636
00:32:23,040 --> 00:32:25,595
that haven't done that yet.

637
00:32:25,595 --> 00:32:29,430
And we call it, Angela has to
help me stealing shamelessly.

638
00:32:29,430 --> 00:32:31,380
And there's some funny term we use.

639
00:32:31,380 --> 00:32:34,680
And then we want to then
learn from each other,

640
00:32:34,680 --> 00:32:35,790
become a resource for you

641
00:32:35,790 --> 00:32:39,120
to share all the great tools you're using.

642
00:32:39,120 --> 00:32:41,970
And then we wanna continue to
have an educational process

643
00:32:41,970 --> 00:32:45,390
whereas you have new people
come on and staff changes,

644
00:32:45,390 --> 00:32:47,940
and there's this ongoing observation

645
00:32:47,940 --> 00:32:50,520
that the quality of the birth
certificate data matters

646
00:32:50,520 --> 00:32:52,350
to this huge team of people.

647
00:32:52,350 --> 00:32:56,010
So you've become extremely important

648
00:32:56,010 --> 00:32:58,320
in the world that you already were.

649
00:32:58,320 --> 00:33:00,330
But as we turn more attention to this,

650
00:33:00,330 --> 00:33:01,860
we're getting even more interested

651
00:33:01,860 --> 00:33:05,340
in your collaborative
process in your hospital.

652
00:33:05,340 --> 00:33:06,173
Next slide.

653
00:33:07,860 --> 00:33:10,140
So sorry for the small font,

654
00:33:10,140 --> 00:33:13,230
quality improvement people
love a key driver diagram.

655
00:33:13,230 --> 00:33:16,911
The only thing this is is
for us to organize ourselves

656
00:33:16,911 --> 00:33:20,970
around an idea that we're all
moving toward the same aim,

657
00:33:20,970 --> 00:33:22,320
which is that in nine months,

658
00:33:22,320 --> 00:33:25,290
we wanna improve the accuracy
of those 11 indicators.

659
00:33:25,290 --> 00:33:27,570
Pretty simple, and we've
shared today the why.

660
00:33:27,570 --> 00:33:30,360
We wanna do it to support public health,

661
00:33:30,360 --> 00:33:33,750
but also to, you know,
ultimately improve outcomes

662
00:33:33,750 --> 00:33:36,540
for Vermont's pregnant
people and children.

663
00:33:36,540 --> 00:33:38,700
So we're gonna do that by
making sure we all understand

664
00:33:38,700 --> 00:33:40,380
the importance of the
data, which is great,

665
00:33:40,380 --> 00:33:41,970
because that's why we're here today.

666
00:33:41,970 --> 00:33:44,370
We're just kicking off
the shared learning.

667
00:33:44,370 --> 00:33:46,470
What is this data and
why is it so important

668
00:33:46,470 --> 00:33:50,010
to Dr. Levine and everyone else?

669
00:33:50,010 --> 00:33:53,190
Strong communication between
teams and data people,

670
00:33:53,190 --> 00:33:55,860
the clinical teams and the data folks.

671
00:33:55,860 --> 00:33:57,420
I love Vermont so much.

672
00:33:57,420 --> 00:33:59,040
Sometimes you might be related,

673
00:33:59,040 --> 00:34:00,930
sometimes your cousin is the data person,

674
00:34:00,930 --> 00:34:03,000
the health information manager

675
00:34:03,000 --> 00:34:04,320
and you're the nurse manager.

676
00:34:04,320 --> 00:34:06,000
Sometimes you've never met,

677
00:34:06,000 --> 00:34:07,560
and we said that at the beginning

678
00:34:07,560 --> 00:34:09,060
but we're gonna say it a few more times,

679
00:34:09,060 --> 00:34:12,933
because this project is
at its roots relational.

680
00:34:12,933 --> 00:34:15,390
This is about you guys
hanging out with each other

681
00:34:15,390 --> 00:34:16,983
and having a shared mission.

682
00:34:17,820 --> 00:34:19,900
So we wanna do some ongoing training

683
00:34:21,013 --> 00:34:23,520
on what we mean by the indicators,

684
00:34:23,520 --> 00:34:26,790
what is the specific definition.

685
00:34:26,790 --> 00:34:28,260
We have a lot of people who,

686
00:34:28,260 --> 00:34:29,640
at the health department in particular,

687
00:34:29,640 --> 00:34:31,470
who really know what they mean.

688
00:34:31,470 --> 00:34:34,170
And then we know that sometimes
at the hospital level,

689
00:34:34,170 --> 00:34:37,650
it gets a little like, wait,
I don't know how to find

690
00:34:37,650 --> 00:34:39,720
that in the chart or I need some help.

691
00:34:39,720 --> 00:34:42,420
And that's why we've created
this whole team for you

692
00:34:42,420 --> 00:34:45,510
that already existed, but we're
putting us in the forefront.

693
00:34:45,510 --> 00:34:47,550
And then we wanna do
what I just said before,

694
00:34:47,550 --> 00:34:50,370
is just identify best practice
and keeps spreading it,

695
00:34:50,370 --> 00:34:53,400
because we learn so much from you.

696
00:34:53,400 --> 00:34:54,840
And so on the right side,

697
00:34:54,840 --> 00:34:57,480
I'm not gonna show you
that, but it's too small.

698
00:34:57,480 --> 00:34:59,190
But within each of those drivers,

699
00:34:59,190 --> 00:35:02,100
we have a bit of a plan
and they all interrelate.

700
00:35:02,100 --> 00:35:04,050
But this is kicking off today to say

701
00:35:04,050 --> 00:35:07,890
that these drivers are
gonna be our work together

702
00:35:07,890 --> 00:35:09,690
in learning sessions in the future,

703
00:35:09,690 --> 00:35:11,820
the next of which will be in September.

704
00:35:11,820 --> 00:35:12,780
We're gonna give a little break

705
00:35:12,780 --> 00:35:14,910
in the summer to get the data right.

706
00:35:14,910 --> 00:35:15,743
Next slide.

707
00:35:17,610 --> 00:35:22,590
Okay, so what do we expect will
happen and know to be true?

708
00:35:22,590 --> 00:35:25,110
So we're gonna do at least three more

709
00:35:25,110 --> 00:35:28,860
virtual learning sessions with all of you

710
00:35:28,860 --> 00:35:32,160
to kind of dig in deeper to
some of those key drivers

711
00:35:32,160 --> 00:35:34,650
and to talk more with each other.

712
00:35:34,650 --> 00:35:36,180
It won't be so much of this like,

713
00:35:36,180 --> 00:35:38,040
you eat lunch and we talk.

714
00:35:38,040 --> 00:35:40,410
It'll be more sort of learning together

715
00:35:40,410 --> 00:35:42,270
about how to improve our efforts.

716
00:35:42,270 --> 00:35:45,390
And then we are gonna provide,
this is a nice QI strategy,

717
00:35:45,390 --> 00:35:47,220
to have an office hour set up

718
00:35:47,220 --> 00:35:49,800
where you're welcome to
pop on, no obligation,

719
00:35:49,800 --> 00:35:52,920
but it's your place to
get questions answered

720
00:35:52,920 --> 00:35:55,110
on the first Wednesday of
every month from one to two.

721
00:35:55,110 --> 00:35:58,260
And it'll probably
become more clear to you

722
00:35:58,260 --> 00:36:00,930
what your questions are when
you start diving in a bit,

723
00:36:00,930 --> 00:36:03,390
and we'll all be there for you.

724
00:36:03,390 --> 00:36:04,223
Next slide.

725
00:36:06,180 --> 00:36:09,300
Okay, this thing's all about teams

726
00:36:09,300 --> 00:36:10,830
and it's all about relationships.

727
00:36:10,830 --> 00:36:12,780
So we need a clinical lead

728
00:36:12,780 --> 00:36:17,100
and we need a birth certificate
health information manager,

729
00:36:17,100 --> 00:36:18,990
which we shortened to him.

730
00:36:18,990 --> 00:36:22,950
I do not prefer that, but it's so funny,

731
00:36:22,950 --> 00:36:25,170
'cause we only know each other's acronyms

732
00:36:25,170 --> 00:36:26,010
after we learn them.

733
00:36:26,010 --> 00:36:26,970
So that's new for me.

734
00:36:26,970 --> 00:36:28,500
But in that space,

735
00:36:28,500 --> 00:36:30,390
I think you've probably already done this,

736
00:36:30,390 --> 00:36:33,270
but we need at least one
clinical lead and one person

737
00:36:33,270 --> 00:36:36,150
from the information management side.

738
00:36:36,150 --> 00:36:39,330
And that way, the two lead designees

739
00:36:39,330 --> 00:36:41,400
will need to know the
reliable data sources

740
00:36:41,400 --> 00:36:43,740
for those 11 key indicators.

741
00:36:43,740 --> 00:36:45,810
And so you might be the ones

742
00:36:45,810 --> 00:36:47,640
that wanna pop on those office hours

743
00:36:47,640 --> 00:36:50,070
and say, gosh with the breastfeeding one,

744
00:36:50,070 --> 00:36:52,920
we don't know exactly what this
means and we need some help.

745
00:36:52,920 --> 00:36:57,720
And obviously, we want the
leads to gain more knowledge

746
00:36:57,720 --> 00:36:59,670
but have some baseline engagement

747
00:36:59,670 --> 00:37:02,610
in perinatal and newborn health.

748
00:37:02,610 --> 00:37:03,443
Next slide.

749
00:37:05,400 --> 00:37:08,610
And then we wanna make sure that

750
00:37:08,610 --> 00:37:10,260
that clinical lead can communicate

751
00:37:10,260 --> 00:37:12,930
with the rest of the clinical team.

752
00:37:12,930 --> 00:37:15,270
And so when I think about one model

753
00:37:15,270 --> 00:37:16,620
that usually works in this space,

754
00:37:16,620 --> 00:37:18,780
all roads lead to nurse managers, right,

755
00:37:18,780 --> 00:37:20,588
in community hospitals.

756
00:37:20,588 --> 00:37:22,140
And in that nurse manager role,

757
00:37:22,140 --> 00:37:23,610
making sure that everybody knows.

758
00:37:23,610 --> 00:37:25,950
And it's nice to see some of our

759
00:37:25,950 --> 00:37:27,840
other clinical colleagues on as well,

760
00:37:27,840 --> 00:37:30,400
because we really don't
intend for this to be

761
00:37:31,320 --> 00:37:35,310
just two people in
pursuit of this big shift.

762
00:37:35,310 --> 00:37:38,970
So as strong and as often
the communication can be,

763
00:37:38,970 --> 00:37:42,180
and because it's virtual
learning series and sessions,

764
00:37:42,180 --> 00:37:44,250
we'd love as many people
as possible to come on

765
00:37:44,250 --> 00:37:47,280
and just actively or passively listen

766
00:37:47,280 --> 00:37:49,890
to get into this quality improvement space

767
00:37:49,890 --> 00:37:51,810
of this important project.

768
00:37:51,810 --> 00:37:53,760
And then within the birth certificate,

769
00:37:53,760 --> 00:37:55,950
health information manager lead,

770
00:37:55,950 --> 00:37:59,670
there's also another group of people

771
00:37:59,670 --> 00:38:02,580
that you might wanna
organize and encourage,

772
00:38:02,580 --> 00:38:05,310
and not personal, but personnel,

773
00:38:05,310 --> 00:38:06,750
who complete the birth certificate.

774
00:38:06,750 --> 00:38:09,540
So if you obviously have the luxury

775
00:38:09,540 --> 00:38:13,470
or the gift of a nice team
and it goes way beyond you,

776
00:38:13,470 --> 00:38:16,020
the team would really wanna participate

777
00:38:16,020 --> 00:38:18,690
and listen in and learn as well.

778
00:38:18,690 --> 00:38:19,523
Next slide.

779
00:38:21,330 --> 00:38:23,610
Okay, but here's the real deal.

780
00:38:23,610 --> 00:38:26,670
We know that you are completely inundated

781
00:38:26,670 --> 00:38:30,600
with quality improvement and
data collection and pressure.

782
00:38:30,600 --> 00:38:32,550
And that's the commitment of this team

783
00:38:32,550 --> 00:38:36,600
is to not come in in
some space of, you know,

784
00:38:36,600 --> 00:38:39,090
that we've been designing
this on some whiteboard

785
00:38:39,090 --> 00:38:40,530
and we've never delivered healthcare

786
00:38:40,530 --> 00:38:42,450
and we don't have any idea
what happens in hospitals.

787
00:38:42,450 --> 00:38:44,040
That is completely false.

788
00:38:44,040 --> 00:38:48,720
We are so aware that you
have a long list of things

789
00:38:48,720 --> 00:38:53,070
that has to be accomplished in
service of so many partners.

790
00:38:53,070 --> 00:38:54,900
You've got regulatory people,

791
00:38:54,900 --> 00:38:57,180
you've got hospital initiatives,

792
00:38:57,180 --> 00:39:01,200
you've got local decisions
and then you have VCHIP.

793
00:39:01,200 --> 00:39:05,040
And so in that space, we really
wanna identify as the group

794
00:39:05,040 --> 00:39:07,710
that is open to that feedback,

795
00:39:07,710 --> 00:39:11,670
shows up in service of you as a scaffold.

796
00:39:11,670 --> 00:39:14,790
We're not handing you this
and saying good luck to you.

797
00:39:14,790 --> 00:39:18,810
And so that space you'll
always get, enter with us.

798
00:39:18,810 --> 00:39:19,980
Data, data, data,

799
00:39:19,980 --> 00:39:22,830
and it is getting a little
ridiculous out there.

800
00:39:22,830 --> 00:39:27,030
However, this project is at
sort of this baseline root

801
00:39:27,030 --> 00:39:30,420
of quality that will really inform

802
00:39:30,420 --> 00:39:33,300
that whole vast array of
things we outlined before.

803
00:39:33,300 --> 00:39:35,220
That's not to say other
data collection things

804
00:39:35,220 --> 00:39:37,170
aren't helpful or important.

805
00:39:37,170 --> 00:39:39,090
I'm not pitting it against each other.

806
00:39:39,090 --> 00:39:41,760
I just really wanted you to
know we have a commitment

807
00:39:41,760 --> 00:39:43,800
to keeping this low burden,

808
00:39:43,800 --> 00:39:47,910
but we still need a level of
engagement to achieve our goal.

809
00:39:47,910 --> 00:39:50,940
It's like a nice little balance.

810
00:39:50,940 --> 00:39:54,000
And we want the feedback
that this is too hard

811
00:39:54,000 --> 00:39:55,710
or that something isn't understandable,

812
00:39:55,710 --> 00:39:57,480
or that you're really bogged down,

813
00:39:57,480 --> 00:40:01,710
because that's exactly how
we learn how to come in.

814
00:40:01,710 --> 00:40:03,300
And this is not like a one and done.

815
00:40:03,300 --> 00:40:06,240
We're gonna be working
in the space for a while,

816
00:40:06,240 --> 00:40:11,240
because we are so committed
to sort of resetting this team

817
00:40:11,670 --> 00:40:13,020
that comes together around

818
00:40:13,020 --> 00:40:15,960
this really important vital record.

819
00:40:15,960 --> 00:40:16,793
Next slide.

820
00:40:18,480 --> 00:40:20,460
Okay, almost done, and we promise.

821
00:40:20,460 --> 00:40:24,030
So we do organize ourselves
around a true approach.

822
00:40:24,030 --> 00:40:26,640
We are not winging this.

823
00:40:26,640 --> 00:40:29,190
So we are currently in phase one,

824
00:40:29,190 --> 00:40:31,440
which is the baseline data collection.

825
00:40:31,440 --> 00:40:33,360
And we are happy to report we have done

826
00:40:33,360 --> 00:40:36,300
that data collection in
two of your hospitals.

827
00:40:36,300 --> 00:40:37,920
And that's really not on you

828
00:40:37,920 --> 00:40:40,680
that we had a wonderful
fourth year medical student

829
00:40:40,680 --> 00:40:42,120
who did that with us,

830
00:40:42,120 --> 00:40:43,980
and like all good fourth
year medical students,

831
00:40:43,980 --> 00:40:47,400
they depart, they have departed.

832
00:40:47,400 --> 00:40:50,340
So we have found another one,
maybe not a medical student,

833
00:40:50,340 --> 00:40:53,520
we have found another human
that would like to continue

834
00:40:53,520 --> 00:40:55,230
to engage for the rest of your hospitals

835
00:40:55,230 --> 00:40:59,280
to just figure out what are
we finding in the chart,

836
00:40:59,280 --> 00:41:02,220
what do we know from vital
records to sort of set the table

837
00:41:02,220 --> 00:41:06,180
that we have this discrepancy,
which, by the way, we do,

838
00:41:06,180 --> 00:41:09,273
so that this quantifies the discrepancy.

839
00:41:11,220 --> 00:41:13,140
And there's a little bit of a process

840
00:41:13,140 --> 00:41:15,360
to get this person access to your record

841
00:41:15,360 --> 00:41:19,020
so they can do the pre-work,
the baseline data collection.

842
00:41:19,020 --> 00:41:20,580
So we really need your help,

843
00:41:20,580 --> 00:41:24,570
because sometimes this gets
bogged down in with people

844
00:41:24,570 --> 00:41:25,830
that don't know what we're trying to do.

845
00:41:25,830 --> 00:41:28,590
You know, like the protectors of data,

846
00:41:28,590 --> 00:41:30,840
and we have all of that
worked out in a way

847
00:41:30,840 --> 00:41:34,740
that we could show you if
your hospital isn't clear

848
00:41:34,740 --> 00:41:36,630
that this would be a good idea.

849
00:41:36,630 --> 00:41:39,030
So that's my short way
of saying most of you

850
00:41:39,030 --> 00:41:41,460
are just waiting for
us, this nice new person

851
00:41:41,460 --> 00:41:45,390
that we hired, but a few
hospitals are sort of wondering.

852
00:41:45,390 --> 00:41:47,580
And any effort in the space

853
00:41:47,580 --> 00:41:49,350
of baseline data
collection would be great,

854
00:41:49,350 --> 00:41:51,570
because if we can get that done,

855
00:41:51,570 --> 00:41:53,400
we'll know what the what is.

856
00:41:53,400 --> 00:41:55,860
'Cause we do have to quantify

857
00:41:55,860 --> 00:41:57,903
how much we're seeking to improve.

858
00:41:58,980 --> 00:42:01,920
And then when the
intervention of you learning

859
00:42:01,920 --> 00:42:04,860
and everybody working together

860
00:42:04,860 --> 00:42:07,890
on these 11 indicators
is over, we will go back

861
00:42:07,890 --> 00:42:10,080
and we'll do that same chart review again

862
00:42:10,080 --> 00:42:12,270
to show the improvement.

863
00:42:12,270 --> 00:42:14,100
And the cool part about
a QI project like this,

864
00:42:14,100 --> 00:42:17,370
we're not seeking like some mega thing.

865
00:42:17,370 --> 00:42:19,470
We're showing that with
this level of intention

866
00:42:19,470 --> 00:42:22,650
and teaming, we're able to go boop, boop.

867
00:42:22,650 --> 00:42:24,450
So that's very important to us.

868
00:42:24,450 --> 00:42:26,460
And then we also really want

869
00:42:26,460 --> 00:42:27,960
to do some maintenance data collection,

870
00:42:27,960 --> 00:42:29,490
'cause everything about
quality improvement

871
00:42:29,490 --> 00:42:32,190
is making sure that a system changed

872
00:42:32,190 --> 00:42:36,450
and that a process changed so
that the change is sustained.

873
00:42:36,450 --> 00:42:39,840
'Cause wouldn't it just be so terrible

874
00:42:39,840 --> 00:42:41,580
if we worked so hard in a space

875
00:42:41,580 --> 00:42:44,100
and then the minute we stepped
away, it went right back?

876
00:42:44,100 --> 00:42:45,570
It's like sphing, sphing.

877
00:42:45,570 --> 00:42:49,230
So come along with us to the three phases.

878
00:42:49,230 --> 00:42:50,063
Next slide.

879
00:42:51,750 --> 00:42:53,640
Okay, so I know you've been
waiting this whole call

880
00:42:53,640 --> 00:42:55,263
for these 11 indicators.

881
00:42:56,340 --> 00:42:58,050
Here they are.

882
00:42:58,050 --> 00:43:00,360
So please forgive the right hand.

883
00:43:00,360 --> 00:43:02,910
We really want a reason and a rationale,

884
00:43:02,910 --> 00:43:05,310
but we're recognizing
that calling something

885
00:43:05,310 --> 00:43:06,810
clinically relevant as opposed

886
00:43:06,810 --> 00:43:09,540
to public health relevance is a binary.

887
00:43:09,540 --> 00:43:12,030
That's not really the way our brains work.

888
00:43:12,030 --> 00:43:16,470
But we called it out
just to really explain

889
00:43:16,470 --> 00:43:20,100
that our public health
colleagues have noticed for years

890
00:43:20,100 --> 00:43:22,410
some things that might not be explained

891
00:43:22,410 --> 00:43:24,210
in a way that are collected properly.

892
00:43:24,210 --> 00:43:27,060
And also, we've just
seen some discrepancies.

893
00:43:27,060 --> 00:43:30,360
And so this is how we wanna
talk about this today.

894
00:43:30,360 --> 00:43:33,900
But it was really a team of clinical folks

895
00:43:33,900 --> 00:43:36,690
and public health folks that
decided on these 11 things.

896
00:43:36,690 --> 00:43:40,140
Pre-pregnancy hypertension,
gestational hypertension,

897
00:43:40,140 --> 00:43:44,160
pre-eclampsia, pre-pregnancy
diabetes, gestational diabetes.

898
00:43:44,160 --> 00:43:46,980
And you can see the
complexities here already.

899
00:43:46,980 --> 00:43:48,690
How on earth are you supposed to know

900
00:43:48,690 --> 00:43:50,550
what happened pre-pregnant?

901
00:43:50,550 --> 00:43:53,490
Well, we are hopeful

902
00:43:53,490 --> 00:43:55,830
that health systems
communicate with each other.

903
00:43:55,830 --> 00:43:57,090
But one of the QI things

904
00:43:57,090 --> 00:43:58,290
that we're really interested in

905
00:43:58,290 --> 00:44:02,250
is when that doesn't happen,
when a primary care situation

906
00:44:02,250 --> 00:44:04,830
where a person is known
to have hypertension,

907
00:44:04,830 --> 00:44:07,470
and that person enters
the pregnancy space,

908
00:44:07,470 --> 00:44:10,140
how does the obstetrical
provider know that?

909
00:44:10,140 --> 00:44:13,980
You know, sounds so silly,
but it is glitchy out there.

910
00:44:13,980 --> 00:44:16,110
So that pre-pregnancy piece matters.

911
00:44:16,110 --> 00:44:18,693
Gestational diabetes
matters, breastfeeding?

912
00:44:20,850 --> 00:44:22,890
There's lots of places to find out

913
00:44:22,890 --> 00:44:24,780
about a person's intention to breastfeed,

914
00:44:24,780 --> 00:44:26,340
and whether then they did breastfeed

915
00:44:26,340 --> 00:44:27,750
and finding it in the chart

916
00:44:27,750 --> 00:44:30,870
and also entering it needs some QI.

917
00:44:30,870 --> 00:44:33,840
Assisted ventilation,
here come the peds ones,

918
00:44:33,840 --> 00:44:35,430
assisted ventilation after delivery

919
00:44:35,430 --> 00:44:37,740
and whether that baby was transferred,

920
00:44:37,740 --> 00:44:40,830
transported and received a NICU admission.

921
00:44:40,830 --> 00:44:42,690
Hard to get that data sometimes,

922
00:44:42,690 --> 00:44:46,560
'cause the patient's left
your shop and it matters.

923
00:44:46,560 --> 00:44:49,710
So the accuracy of that is on our list.

924
00:44:49,710 --> 00:44:51,660
Obviously, premature rupture membranes,

925
00:44:51,660 --> 00:44:54,120
and we're very interested in payer.

926
00:44:54,120 --> 00:44:57,780
So how on earth are we
supposed to prioritize

927
00:44:57,780 --> 00:44:59,880
where and when we need
health policy change

928
00:44:59,880 --> 00:45:03,420
around insurance if we don't
know if there are disparities

929
00:45:03,420 --> 00:45:07,380
among our pregnant
people for type of payer?

930
00:45:07,380 --> 00:45:10,080
And that's also should be simple,

931
00:45:10,080 --> 00:45:11,730
but not always in the part of the chart

932
00:45:11,730 --> 00:45:13,470
that we're looking at.

933
00:45:13,470 --> 00:45:16,500
And I'm old enough to remember the search,

934
00:45:16,500 --> 00:45:17,850
'cause it was paper.

935
00:45:17,850 --> 00:45:20,310
But trying to figure out if
someone's birth is covered

936
00:45:20,310 --> 00:45:24,060
in the Medicaid program needs attention.

937
00:45:24,060 --> 00:45:26,430
Induction of labor, super important.

938
00:45:26,430 --> 00:45:29,389
And then here's a little
quality improvement term.

939
00:45:29,389 --> 00:45:30,600
We don't really need you to learn,

940
00:45:30,600 --> 00:45:33,617
but we need to do, which is
called a balancing measure.

941
00:45:33,617 --> 00:45:35,940
When you're looking to
change a bunch of stuff,

942
00:45:35,940 --> 00:45:38,250
you have to make sure
that you have something

943
00:45:38,250 --> 00:45:40,590
that you're not working on to see

944
00:45:40,590 --> 00:45:43,470
if it inadvertently changed
from all your efforts over here.

945
00:45:43,470 --> 00:45:46,353
And it's a way to keep us honest.

946
00:45:47,310 --> 00:45:48,630
Okay, Julie's got a good,

947
00:45:48,630 --> 00:45:50,430
I knew I wasn't gonna
describe this quite right.

948
00:45:50,430 --> 00:45:54,630
So Julie wants to make sure we
know that these 11 variables,

949
00:45:54,630 --> 00:45:58,170
I did say this earlier, I
promise, but I'll say it again.

950
00:45:58,170 --> 00:46:02,040
We picked them to just learn processes.

951
00:46:02,040 --> 00:46:03,960
And then from there, we're expecting

952
00:46:03,960 --> 00:46:05,820
to see a change in all the variables,

953
00:46:05,820 --> 00:46:08,580
or we're expecting you to at least know

954
00:46:08,580 --> 00:46:11,550
where to ask if you don't
understand a variable

955
00:46:11,550 --> 00:46:14,490
or if there's confusion about a variable.

956
00:46:14,490 --> 00:46:16,230
And Kimberly, great point,

957
00:46:16,230 --> 00:46:19,020
100 percent you will have
those clear definitions

958
00:46:19,020 --> 00:46:22,170
and the part of the
quality improvement project

959
00:46:22,170 --> 00:46:24,240
is for us to share the definitions

960
00:46:24,240 --> 00:46:25,650
and for you to say that,

961
00:46:25,650 --> 00:46:29,670
okay, nice try at
clarity, not clear, right?

962
00:46:29,670 --> 00:46:33,390
Because that's another
place where we think we know

963
00:46:33,390 --> 00:46:35,550
what we're saying and then you can tell us

964
00:46:35,550 --> 00:46:37,680
it's being interpreted differently.

965
00:46:37,680 --> 00:46:38,513
Next slide.

966
00:46:40,530 --> 00:46:43,830
Okay, so the real deep dive here

967
00:46:43,830 --> 00:46:45,570
on the initiative analysis measures.

968
00:46:45,570 --> 00:46:47,100
We're gonna look at percent agreement

969
00:46:47,100 --> 00:46:51,270
between these chart reviews
done by magical medical students

970
00:46:51,270 --> 00:46:54,990
or otherwise and what comes
in the birth certificate.

971
00:46:54,990 --> 00:46:56,790
And we're gonna look
at that by the variable

972
00:46:56,790 --> 00:46:57,840
of the month in the hospital.

973
00:46:57,840 --> 00:47:01,053
So it's just a nice simple design.

974
00:47:02,190 --> 00:47:04,773
And then we wanna see
that from that baseline,

975
00:47:05,850 --> 00:47:07,530
there was a percent change.

976
00:47:07,530 --> 00:47:08,820
Oh, it is a medical student.

977
00:47:08,820 --> 00:47:10,443
Yay, Lindsay, okay!

978
00:47:11,340 --> 00:47:14,130
That we're able to go from
somewhere to somewhere,

979
00:47:14,130 --> 00:47:16,860
hopefully up, but not up if we're looking

980
00:47:16,860 --> 00:47:18,960
at the percent discrepant.

981
00:47:18,960 --> 00:47:21,420
So we'd like to see a positive change.

982
00:47:21,420 --> 00:47:23,250
And then after that, we need to measure

983
00:47:23,250 --> 00:47:26,160
whether the baseline to the
maintenance is also working

984
00:47:26,160 --> 00:47:27,930
for the reasons previously stated.

985
00:47:27,930 --> 00:47:30,690
And then we can also look at
what happened at the height

986
00:47:30,690 --> 00:47:33,257
of the, you know, the post
intervention should be great,

987
00:47:33,257 --> 00:47:35,580
'cause we focused and worked.

988
00:47:35,580 --> 00:47:38,160
And then it hopefully will be
the same as the maintenance,

989
00:47:38,160 --> 00:47:40,800
but if there's a drop,
we need to know that too.

990
00:47:40,800 --> 00:47:42,570
Or maybe it's not a
drop, it's the other way.

991
00:47:42,570 --> 00:47:43,893
Go ahead, next slide.

992
00:47:46,620 --> 00:47:48,543
So what do we need from you all?

993
00:47:49,500 --> 00:47:52,890
We need for you to look at
this list of 11 indicators

994
00:47:52,890 --> 00:47:55,380
and identify and work on something

995
00:47:55,380 --> 00:47:59,163
about their collection
that you want to improve.

996
00:48:00,120 --> 00:48:02,970
And we need you to
identify your own process

997
00:48:02,970 --> 00:48:04,143
to look at those.

998
00:48:04,980 --> 00:48:07,740
And then we need you on these
calls for the shared learning

999
00:48:07,740 --> 00:48:11,433
and to understand where we're
gonna learn from each other.

1000
00:48:12,990 --> 00:48:13,823
Next slide.

1001
00:48:15,060 --> 00:48:17,730
And then what are you
gonna get out of this?

1002
00:48:17,730 --> 00:48:21,870
A fleece vest that says birth
certificate quality project.

1003
00:48:21,870 --> 00:48:25,113
Oh no, darn, that wasn't in the budget.

1004
00:48:28,510 --> 00:48:29,790
You're gonna get training materials

1005
00:48:29,790 --> 00:48:32,130
and tools that you can
put into your system

1006
00:48:32,130 --> 00:48:35,340
for new hires and for refreshers

1007
00:48:35,340 --> 00:48:38,820
and for the ongoing
understanding of the importance.

1008
00:48:38,820 --> 00:48:40,920
You're gonna have this whole big team,

1009
00:48:40,920 --> 00:48:43,230
probably more than you ever wanted,

1010
00:48:43,230 --> 00:48:45,870
for office hours, for
emails, for consultations.

1011
00:48:45,870 --> 00:48:48,840
We'll come to your hospital,
we'll do anything you need.

1012
00:48:48,840 --> 00:48:52,080
And then you're gonna have
improved accuracy and precision,

1013
00:48:52,080 --> 00:48:56,670
and you're gonna feel good
about how you're contributing

1014
00:48:56,670 --> 00:49:00,870
to population health,
understanding and improvements.

1015
00:49:00,870 --> 00:49:04,320
And then you're also gonna start to see

1016
00:49:04,320 --> 00:49:08,490
how your teams can come together,
which is not on the slide,

1017
00:49:08,490 --> 00:49:12,990
but it will feel more connected.

1018
00:49:12,990 --> 00:49:15,840
We hope that it's not an isolating journey

1019
00:49:15,840 --> 00:49:18,210
to be a health information manager

1020
00:49:18,210 --> 00:49:21,510
or someone entering birth data.

1021
00:49:21,510 --> 00:49:22,343
Next slide.

1022
00:49:24,660 --> 00:49:26,190
So here's our intention.

1023
00:49:26,190 --> 00:49:28,560
Is this me, Julie, or do
you wanna do this one?

1024
00:49:28,560 --> 00:49:31,800
I guess I'll keep rolling for time.

1025
00:49:31,800 --> 00:49:34,890
Our intention is to
have a call in September

1026
00:49:34,890 --> 00:49:39,780
about partnering and the work
that we're already promoting

1027
00:49:39,780 --> 00:49:42,450
or asking to do around forming the team

1028
00:49:42,450 --> 00:49:46,170
between HIM and clinical work.

1029
00:49:46,170 --> 00:49:48,000
That's the September call.

1030
00:49:48,000 --> 00:49:50,610
In October, we're gonna look at the tools

1031
00:49:50,610 --> 00:49:52,320
and we're gonna steal from some of you,

1032
00:49:52,320 --> 00:49:54,120
and we're gonna use
some best practice here

1033
00:49:54,120 --> 00:49:57,030
on how to improve your accuracy.

1034
00:49:57,030 --> 00:49:58,920
And then in November,
we're going to identify

1035
00:49:58,920 --> 00:50:01,920
and spread other best
practice with data collection.

1036
00:50:01,920 --> 00:50:05,850
So I'm curious, next slide,

1037
00:50:05,850 --> 00:50:08,060
if we have five minutes here for...

1038
00:50:09,450 --> 00:50:12,390
So a couple things, we
can open this up now

1039
00:50:12,390 --> 00:50:14,460
to questions for a few minutes.

1040
00:50:14,460 --> 00:50:15,930
At the same time, we really want you

1041
00:50:15,930 --> 00:50:19,743
to fill out that evaluation,
which is a competing priority.

1042
00:50:23,010 --> 00:50:24,450
And if you wanna put stuff in the chat,

1043
00:50:24,450 --> 00:50:26,190
we're good with that too.

1044
00:50:26,190 --> 00:50:28,080
How is this all landing with you all

1045
00:50:28,080 --> 00:50:31,983
on this sort of beautiful June day?

1046
00:50:49,560 --> 00:50:52,020
Well, some of us that have
been around a long time

1047
00:50:52,020 --> 00:50:54,060
are so grateful.

1048
00:50:54,060 --> 00:50:56,130
Well, we're all grateful,

1049
00:50:56,130 --> 00:50:58,110
but those that have been around,

1050
00:50:58,110 --> 00:51:01,050
oh, not able to scan the code.

1051
00:51:01,050 --> 00:51:03,570
Okay, so in lieu of the code,

1052
00:51:03,570 --> 00:51:06,660
we're putting the link in the chat.

1053
00:51:06,660 --> 00:51:08,253
Good old-fashioned link.

1054
00:51:09,630 --> 00:51:13,380
So there's a little bit of excited energy

1055
00:51:13,380 --> 00:51:16,980
among some of us because
it's been so long overdue.

1056
00:51:16,980 --> 00:51:19,773
So thank you for entering
into the space with us.

1057
00:51:20,850 --> 00:51:23,040
And it is gonna save you
time in the long run,

1058
00:51:23,040 --> 00:51:26,550
because there's a lot
of coming back around,

1059
00:51:26,550 --> 00:51:29,853
you know, editing, I guess,

1060
00:51:31,191 --> 00:51:33,420
or Cindy and Peggy would tell
me it's a different word.

1061
00:51:33,420 --> 00:51:37,680
But you know, the real-time
trying to get the data right

1062
00:51:37,680 --> 00:51:39,120
is a lot of work for you all.

1063
00:51:39,120 --> 00:51:40,857
So by changing our system and our process

1064
00:51:40,857 --> 00:51:42,633
and our flow, we're hopeful.

1065
00:51:43,890 --> 00:51:45,360
Okay, great feedback here.

1066
00:51:45,360 --> 00:51:47,850
So Marissa's saying thanks,
which we appreciate.

1067
00:51:47,850 --> 00:51:49,740
Monica wonders should
we have another check-in

1068
00:51:49,740 --> 00:51:51,270
sooner than September?

1069
00:51:51,270 --> 00:51:53,250
Seems like it might fall
off the priority list

1070
00:51:53,250 --> 00:51:55,200
where there's such a large gap.

1071
00:51:55,200 --> 00:51:56,520
Okay, I love that feedback.

1072
00:51:56,520 --> 00:52:00,360
So our thinking, and we can
bring that back to the team,

1073
00:52:00,360 --> 00:52:03,510
was we gotta get all
this baseline data in.

1074
00:52:03,510 --> 00:52:05,670
And that's sort of a July
and August situation,

1075
00:52:05,670 --> 00:52:08,220
but maybe we should set
up an office hours, guys,

1076
00:52:08,220 --> 00:52:12,270
this summer and let that self-select.

1077
00:52:12,270 --> 00:52:16,950
We don't want teams to feel
like they have to dig in yet

1078
00:52:16,950 --> 00:52:19,710
till we sort of know the baseline,

1079
00:52:19,710 --> 00:52:23,403
but we like that feedback.

1080
00:52:24,750 --> 00:52:28,863
It's kind of a hopeful bit of feedback.

1081
00:52:30,030 --> 00:52:31,740
Yeah, Kate's asking a
good question, Julie,

1082
00:52:31,740 --> 00:52:34,053
about an assignment
between now and September.

1083
00:52:35,070 --> 00:52:37,699
- [Julie] Yeah, actually our goal was that

1084
00:52:37,699 --> 00:52:41,916
we took all of the posted information

1085
00:52:41,916 --> 00:52:45,030
with the data entry process.

1086
00:52:45,030 --> 00:52:50,030
We've changed that into a
one-page PowerPoint flow chart,

1087
00:52:50,700 --> 00:52:53,790
and our goal was to share
that with each team.

1088
00:52:53,790 --> 00:52:57,703
So you see kind of the
first thing for the team

1089
00:53:00,300 --> 00:53:05,300
to know how your data is
collected at your hospital

1090
00:53:05,520 --> 00:53:09,750
and see where those bottlenecks maybe.

1091
00:53:09,750 --> 00:53:11,610
So that was one of the assignment.

1092
00:53:11,610 --> 00:53:15,120
And the other assignment is, yeah,

1093
00:53:15,120 --> 00:53:19,050
our original thought was that
it's always good for team

1094
00:53:19,050 --> 00:53:23,820
to see baseline data prior to starting.

1095
00:53:23,820 --> 00:53:27,720
And as Breena mentioned,
we have two hospitals

1096
00:53:27,720 --> 00:53:32,343
who have completed data
so far that we can share.

1097
00:53:33,990 --> 00:53:38,990
But the other ones, we're
not quite there yet.

1098
00:53:39,990 --> 00:53:43,953
But do folks have other suggestion?

1099
00:53:47,640 --> 00:53:49,277
Are you unmuted, Breena?

1100
00:53:50,537 --> 00:53:52,860
- [Breena] Always so
funny when that happens.

1101
00:53:52,860 --> 00:53:54,000
It's such a great question, Kate,

1102
00:53:54,000 --> 00:53:57,480
'cause our intention today
was to say bring anybody on

1103
00:53:57,480 --> 00:53:58,740
and sort of hear the big milieu

1104
00:53:58,740 --> 00:54:00,480
in which we're about to enter.

1105
00:54:00,480 --> 00:54:02,850
And then what we're
seeking is this teaming.

1106
00:54:02,850 --> 00:54:03,990
Who's your clinical lead?

1107
00:54:03,990 --> 00:54:06,810
Who's your data health
information manager?

1108
00:54:06,810 --> 00:54:09,120
And then we really want those two people

1109
00:54:09,120 --> 00:54:14,010
to sort of wonder about
who the team's gonna be

1110
00:54:14,010 --> 00:54:15,540
or who should be the team.

1111
00:54:15,540 --> 00:54:19,290
But I think we'll
communicate soon by email.

1112
00:54:19,290 --> 00:54:21,120
Sort of some pre-work you can be doing

1113
00:54:21,120 --> 00:54:22,920
in that teaming space.

1114
00:54:22,920 --> 00:54:25,990
But I do think you need the
baseline data in your hand

1115
00:54:28,173 --> 00:54:29,827
to see the discrepancies,

1116
00:54:29,827 --> 00:54:34,380
'cause each hospital is gonna
have different indicators

1117
00:54:34,380 --> 00:54:38,670
that are off between what's
actually happening in the chart.

1118
00:54:38,670 --> 00:54:39,750
And you know, I'm not claiming

1119
00:54:39,750 --> 00:54:41,460
that the chart is always accurate,

1120
00:54:41,460 --> 00:54:43,110
but it has a little bit more opportunity

1121
00:54:43,110 --> 00:54:45,720
for accuracy maybe than
this data collection

1122
00:54:45,720 --> 00:54:48,090
that goes on for vital
record birth certificate.

1123
00:54:48,090 --> 00:54:50,850
So once you see that you're
good on four of them,

1124
00:54:50,850 --> 00:54:54,240
but seven are off, then you'll
know better what the what is.

1125
00:54:54,240 --> 00:54:57,300
But that doesn't mean you
couldn't start thinking about

1126
00:54:57,300 --> 00:55:01,260
who the team is and how
you wanna understand

1127
00:55:01,260 --> 00:55:02,883
the current process.

1128
00:55:05,100 --> 00:55:07,110
'Cause it's, you know,
I used to joke at Porter

1129
00:55:07,110 --> 00:55:10,143
that the birth person
was like in the attic.

1130
00:55:11,670 --> 00:55:13,440
I don't know if that's still true,

1131
00:55:13,440 --> 00:55:15,069
so even just knowing where the attic is-

1132
00:55:15,069 --> 00:55:15,990
- [Doctor] Definitely, that's still true.

1133
00:55:15,990 --> 00:55:19,230
- [Breena] Okay, so that's
good, because finding the attic

1134
00:55:19,230 --> 00:55:21,090
and wondering what goes on in the attic

1135
00:55:21,090 --> 00:55:23,910
is sort of the summer work.

1136
00:55:23,910 --> 00:55:25,620
But I like the end of this call,

1137
00:55:25,620 --> 00:55:27,120
'cause the clarity that just came in,

1138
00:55:27,120 --> 00:55:29,460
that just maybe a little
bit of a, you know,

1139
00:55:29,460 --> 00:55:30,480
that, like, in high school,

1140
00:55:30,480 --> 00:55:31,470
they used to make you read a book

1141
00:55:31,470 --> 00:55:35,670
over the summer before
school started. (chuckles)

1142
00:55:35,670 --> 00:55:38,100
So we'll give you some
assignments by email,

1143
00:55:38,100 --> 00:55:40,530
sort of that mission if you
choose to accept it piece

1144
00:55:40,530 --> 00:55:44,610
with the recognition that
we're not gonna ask you

1145
00:55:44,610 --> 00:55:47,133
to do too much before you have your data.

1146
00:55:47,133 --> 00:55:49,503
Does that sound right, Julie, Katie?

1147
00:55:50,490 --> 00:55:51,453
- Yes.
- Okay.

1148
00:55:53,100 --> 00:55:55,170
12:59, team.

1149
00:55:55,170 --> 00:55:57,690
Boy, we're so glad you came on,

1150
00:55:57,690 --> 00:55:59,130
and now you've seen our faces.

1151
00:55:59,130 --> 00:56:01,410
And you know that we're here for you.

1152
00:56:01,410 --> 00:56:04,443
And we'd like to hear from you frequently,

1153
00:56:05,400 --> 00:56:07,740
'cause we've never done
this before either.

1154
00:56:07,740 --> 00:56:09,300
We've done a lot of other QI,

1155
00:56:09,300 --> 00:56:13,710
but get those learning
sessions on your calendar,

1156
00:56:13,710 --> 00:56:15,610
but we'll talk to you before the fall.

1157
00:56:16,950 --> 00:56:21,570
Last words, Julie, Katy, Peggy, Cindy?

1158
00:56:21,570 --> 00:56:23,820
- [Julie] Thank you,
everyone, for being here

1159
00:56:24,780 --> 00:56:25,983
and taking the time.

1160
00:56:27,360 --> 00:56:31,083
- [Peggy] Thank you so much, see you soon.