Wrapping Up Maternal QI Initiatives: PROVIDE & MORE Focus on Sustainability

| Chiles Center, FPQC, Maternal and Child Health

The Florida Perinatal Quality Collaborative (FPQC) has had an exciting Spring as the Promoting Primary Vaginal Deliveries (PROVIDE) and the Maternal Opioid Recovery Effort (MORE) Initiatives conclude. Virtual celebration meetings with teams were held on May 4th, 2022 for PROVIDE and May 17th, 2022 for MORE, with over 180 participants between both meetings. These celebrations recognized hospitals for their many successes and discussed how to sustain their successes and momentum achieved during the initiatives. 

Dr. William Sappenfield, FPQC Director, opened the meetings with a special thank you for hospital teams’ efforts during these challenging times of COVID-19 pandemic and continued staffing issues. He recognized how hospitals remained engaged with FPQC as they learned how to work through several surges of the pandemic and gave one “final push” for PROVIDE and MORE. Dr. Estefania Rubio, FPQC Data Manager, presented overwhelmingly positive outcome data, sharing progress made in many areas. PROVIDE successes included improved completion of induction and pre-cesarean checklists, and improved staff education on pain management, labor support, latent labor management, labor progress, and active labor management. MORE successes included improved rates of Hepatitis C screening; as well as improved screening for other infectious disease/mental health comorbidities, education on Narcan use, and referrals to a postpartum visit. For both initiatives, Dr. Rubio also encouraged the ongoing work of sustaining and even improving on initiative gains, as well as continuing to give attention to areas where teams may have struggled.

Kelly Rogers from the Florida Department of Health was a featured guest during the PROVIDE webinar. She thanked the teams and encouraged a continued focus to meet the Healthy People 2030 goal of 23.6% for NTSV cesareans. Dr. Chris Cogle, Florida Medicaid Chief Medical Officer, was a featured guest during the MORE event and thanked the teams for their efforts to better support mothers with substance use disorder/opioid use disorder (SUD/OUD).  

Dr. Maya Balakrishnan, FPQC Associate Director of Quality, summarized the importance of sustainability with quality improvement initiatives. She emphasized as initiatives end, progress can backslide. However, improvement can be sustained through standardization of tasks, accountability, visual management (seeing the data), problem solving, and escalation of concerns. Hospital teams learned they can tailor their strategies depending on their goals and desired improvements.

PROVIDE Teams at an FPQC Labor Support Workshop

Drs. Karen Bruder and Julie DeCesare, PROVIDE Physician Leads, stressed key sustainability components including labor support, pre-cesarean huddles with a checklist, and using the “What Can Florida Do to have California’s Rates?” checklist. Dr. Jan Lanouette, MORE Physician Lead, emphasized the importance of screening for SUD/OUD, referring to treatment and continuing to work on Naloxone (NARCAN) distribution for all women with diagnosed SUD/OUD discharged from the hospital.

At the MORE event, FPQC was honored to hear from Helena Girouard, who is in recovery and is now a community liaison for women affected by OUD/SUD. Her personal story is an inspiration for all clinicians working to help affected women and families. Afterward, Jennifer Williams from the Department of Children and Families discussed how hospitals can provide Naloxone kits at discharge for women with SUD.

Nurses sharing their MORE education and Naloxone (NARCAN) distribution successes

PROVIDE Nurse/Physician dyads also reported on their hospital groups: Nancy Travis and Chadwick Leo, Kim Huber and Cole Greves, Jane James and Karen Harris, Carol Lawrence and Julie DeCesare, and Leah Williams-Jones and Karen Bruder. Summaries of each team’s successes and plans for sustainability were shared. MORE nurse/physician coaches reported on the progress of their hospital groups: Jan Lanouette and Lindsay Greenfield, Pam Carbiener, Tracy Blue, and Amanda Snyder all gave summaries of each group’s successes and plans for sustainability.

A highlight at each celebration was the “Star Hospital Awards.” Hospitals that met criteria on participation on coaching calls, data submission, improvement on structure measures, and improved outcome measures were recognized. Each hospital received a certificate from FPQC listing their stars.

Dr. Sappenfield thanked all the hospitals again for their commitment to improving health care quality and working with FPQC. He especially thanked them for making a difference for all mothers, babies, and families across the state of Florida.

More information about PROVIDE and MORE is available at http://www.fpqc.org

Hospital teams should stay tuned for FPQC’s next maternal health QI Initiatives set to launch in October and March: 1) Postpartum Access and Continuity of Care (PACC). PACC is in development with hospital leaders, federally qualified health centers, inpatient and outpatient clinicians, community members, birth workers, and other perinatal health advocates from across Florida, and 2) a new focus on social determinants of health.