FPQC > Current Projects

In September 2011, the FPQC hosted representatives from nineteen Florida hospitals with Level II and Level III NICUs participating in the Vermont Oxford Network. The goal of the meeting was to review a combined Florida report of neonatal outcomes data (blinded to patient and individual facility identity) to select the most pressing issues for neonatal quality improvements. One of the priority issues identified by comparison to both Florida and National benchmarks was reducing neonatal infections.

The FPQC team made meeting participants aware of an opportunity to partner with the Perinatal Quality Collaborative of North Carolina (PQCNC) on a project to reduce neonatal catheter associated blood stream infections (NCABSI), funded by the Agency for Healthcare Research and Quality through American Hospital Association (AHA). This initiative involved seven other state quality collaboratives in New Jersey, Massachusetts, North Carolina, Colorado, South Carolina, Wisconsin and Hawaii. At that time, sixteen Florida Level III NICUs signed on to implement the existing protocol utilized across the eight-state project.

As part of the FPQC’s first neonatal-focused initiative, these hospital NICU teams joined with the Florida Hospital Association to create their own listserv for communication of specific expertise and experiences in the implementation of best practices. Additionally, the teams began using rapid cycle changes to prioritize, implement and measure local practices in order to achieve improved outcomes. In order to sustain cultural changes, the teams also began adapting portions of “Comprehensive Unit-based Safety Program” (CUSP) developed at Johns Hopkins University and utilized by the AHA in their adult CABSI and CAUTI projects.

Florida’s sixteen NICUs began entering data in December 2011. Currently, the Florida NICUs provide a quarter of the data for the eight-state project and are having a substantial impact on the national progress of the project. Initial results indicate that Florida has outperformed the national average in an increase in central line insertion compliance within the NICU, a reduction of lines in place for babies receiving enteral feeds of more than 120 ml/kg/day and a decrease in the rate of infection in Florida. Detailed results between December 2011 and August 2012 indicated that 92 infections were avoided in Florida - saving 9 lives, reducing length of stay by more than 640 days and saving over $2.7 million.

Funding will continue the NCABSI project for an additional year. The FPQC plans to add new Florida NICUs and survey currently active team leads to better understand the successes and challenges of their participation in the project. For more information or to get involved, please contact the NCABSI project state leader, Dr. Douglas E. Hardy, at dehardy57@icloud.com .

Reducing EED before 39 weeks gestational age is a priority focus area for the Centers for Medicare and Medicaid Services (CMS) because research has shown that by doing so mothers and babies have better health outcomes – including a reduced length of stay, reduced transfer to an intensified level of care and decreased financial costs to the system.* Elimination of EED requires the education, training and support of all perinatal health-related practitioners, advocates, policymakers and payers as well as patients and their families.

Due to the success of the FPQC’s partnership in the March of Dimes (MOD) 2011 Big 5 Project to reduce non-medically indicated deliveries <39 weeks, the FPQC has expanded this initiative to more Florida hospitals by continuing to partner with the MOD and initiating a new partnership with the Florida Hospital Association (FHA). The three organizations, through the Health Research & Educational Trust (HRET) Hospital Engagement Network (HEN), are working together to assist participating hospitals in moving towards the goal of reducing EED to 3% or less by the initiative’s conclusion in December 2013, using the toolkit from the MOD Big 5 Project.

In September 2012, the FPQC provided 18 Florida hospitals with a kick-off training where representatives from the FHA, MOD and hospitals that had participated in the MOD’s 2011 Project spoke about their experiences and suggested aims, potential measures, challenges and opportunities. These representatives also conducted a Q&A with the new hospitals to try to resolve any hesitations and to generate enthusiastic staff buy-in. HRET will support the hospitals as an individual collaborative through best practice webinars, change package options and other tools that will increase the state’s hospital association activities. Additionally, the FPQC will provide ongoing technical assistance to the HEN via monthly coaching calls, offer data consultations, facilitate the involvement of expert speakers for Grand Rounds and utilize the knowledge of the Florida Big 5 Project hospitals.

*The Leapfrog Group, Annual Hospital Survey 2012

The FPQC received a grant from the March of Dimes (MOD) in 2011 to launch a three-year coordinated educational and communications campaign regarding the importance of the last weeks of pregnancy. The goal of the campaign is to raise awareness among providers, payers and policymakers and to change their attitudes and practices.

This campaign will include establishing a Speaker’s Bureau to conduct Grand Rounds and other professional presentations, implementing web-based continuing education programs and developing payer and policymaker executive briefings as well as technical bulletins for presentation and publication. In addition, the FPQC will target online social media platforms anddeploy op-ed pieces. This campaign is in partnership with the Florida Association of Healthy Start Coalition’s parallel consumer campaign on the importance of the last two weeks of pregnancy.

The FPQC plans to use available MOD messages and materials in the campaign. Expert perinatal health-related practitioners and professionals will be recruited from collaborating organizations to serve on a Professional Education Advisory committee to provide their input.

Through increasing awareness among providers, payers and policymakers on this issue, the FPQC hopes to foster intermediate outcomes such as greater readiness to implement hospital perinatal quality improvement (QI) initiatives, policies and procedures regarding appropriate scheduling of deliveries as well as revised insurer policies.

Ultimately, this project aims to impact long-term outcomes vital to the mission of the MOD and the health of Florida’s families including decreasing preterm birth rates, decreasing the number and rate of NMID <39 weeks gestation and decreasing infant morbidity and mortality associated with these deliveries.