The Role of Regional Collaboratives: The California Perinatal Quality Care Collaborative Model

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The case for a regional approach to perinatal quality improvement

Improving the outcome of the infants cared for in one's neonatal intensive care unit (NICU) is the main objective of improvement projects that are pursued independently or as a member of a national collaborative. While improving the outcome of patients is a key motivator for NICUs that are members of a regional perinatal quality improvement collaborative, the very nature of the regional enterprise encourages each member to also take on the responsibility of improving the care and outcomes for

The nature of a regional perinatal quality care collaborative

At its heart, a regional quality improvement collaborative is a complex organization with multiple stakeholders. A major challenge to the creation of a regional quality improvement collaborative is how to pull these stakeholders together when many of these stakeholders hold very differing opinions as to how health care should work and what should be its most immediate quality issues. For example, a consumer organization may be primarily concerned with creating regional report cards that allow

Role of the mission statement and definition of organizational philosophy

Although the general goal of any quality improvement collaborative is to improve quality, exactly what is meant by quality improvement and specifically how one will go about achieving it has many interpretations. Because of these many interpretations, creating a mission statement is an essential step in building any collaborative enterprise. In essence, the mission statement addresses who you are, your overarching goal, and how you intend to achieve this goal. Although the collaborative may be

Overview of CPQCC and its organizational structure

The CPQCC is a consortium of NICUs that cares for, collects, and stores clinical data on more than 90% of all neonates who receive neonatal intensive care in California. The CPQCC was initiated in 1997 by the California Association of Neonatologists, with the goal of blending academic and private neonatology into a common body politic to partner with various private and public institutions that share the common goal of improving health care outcomes for mothers and babies in California.

The quality improvement challenge

The quality improvement challenge is threefold: (1) to collect high-quality, reliable data; (2) to transform these data into information by developing risk-adjusted, confidential reports that inform and organize work; and (3) to move from information to action by supporting perinatal providers in their work of improving care and outcomes. First, consider the issue of data. One of the first tasks of the Data Arm was to assess CPQCC's data needs. It was fortunate that all of the original 27 CPQCC

Quality improvement

The Perinatal Quality Improvement Panel (PQIP) is a permanent subcommittee that began with the inception of CPQCC in 1997. Its aim is to support perinatal providers in California in their efforts to continuously improve perinatal outcomes and neonatal care. Important to PQIP's success is its membership and their commitment. The panel is made up of neonatologists, maternal fetal medicine specialists, epidemiologists, and representatives from the CA-MCH, CCS, and Regional Perinatal Programs of

Research

Because the main activities of the CPQCC over the last decade have been focused on building the collaborative and conducting quality improvement initiatives, research has not been a major priority. Moving forward, the goal is to build the research base in the areas of epidemiology/health services research and quality improvement science. One of several CPQCC databases, the All-California Perinatal Quality Improvement Data Resource, links an infant's (1) maternal residential, sociodemographic,

On collaboration

In this brief review the author has tried to present a picture of the aspirations, workings, and achievements of CPQCC, a regional collaboration to improve perinatal care. While it is never easy to align the often differing fundamental positions held by the various member factions and stakeholder groups, the common overarching goal of a universally agreed-upon mission statement can act as a magnet drawing the various components together. Moreover, rapid development of a first quality

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    Quality improvement networks are known to “play a critical role in identifying and addressing shortcomings in care that can lead to potential improvements in outcomes.”24 Examples of other quality improvement networks include the Vermont Oxford Network25 and the California Perinatal Care Collaborative.26 Similar to EPIQ, both of those groups have led quality improvement initiatives that resulted in decreased rates of BPD,27,28 NEC,29 severe ROP,30 and infections,31,32 improved infant growth,33 and increased use of antenatal steroids29,34; however, they are yet to report sustained improvements in neurodevelopmental outcomes associated with their quality improvement initiatives.35

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