The California Perinatal and Maternal Quality Care Collaboratives (CPQCC & CMQCC)

Presented by:

Debra Bingham MS, RN, Dr. PH Candidate^1,2 and Barbara Murphy, MSN, RN¹

Other Co-Authors:   Elliott K. Main, MD^1,2,3, Shabbir Ahmad, DVM, MS, PhD², and Jeffery Gould, MD, MPH¹

¹California Maternal Quality Care Collaborative / California Perinatal Quality Care Collaborative, Stanford University, Palo Alto, CA;

²California Department of Public Health, Maternal and Child and Adolescent
Health Program, Center for Family Health, Sacramento, CA;

³California Pacific Medical Center, San Francisco, CA.

BACKGROUND:

Modern health care is a complex, loosely coupled system where multiple internal and external pressures retard the diffusion of innovations.  Modern health care’s development of individual silos or microsystems that have minimal interaction and relationship with others make the important task of aligning incentives with quality more difficult and make modern health care highly resistant to change.  Currently it takes approximately 17 years for research to be translated into practice, and even then, new evidence-based care practices are unevenly implemented.  Many traditional “interventions” such as grand rounds, external continuing medical education courses and even, as seen recently, pay-for–performance programs have limited impact for creating change for quality improvement.  New methodologies are needed to more rapidly translate research into action. 

Two long-term, multi-stakeholder quality improvement collaboratives, CPQCC & CMQCC, were formed to improve the outcomes for both the high-risk Neonatal Intensive Care (NICU) populations and the maternal populations in the state of California.  Since 14% of all births in the United States occur in California, 200,000 more births than all of Canada and more births than any other state, improvement initiatives being led within these two California collaboratives have implications for the rest of the country.

PROMISING PRACTICES:  Many traditional strategies such as grand rounds, continuing medical education courses, and pay-for–performance programs have limited impact for creating change and improving patient care structures, processes, and outcomes.  CPQCC and CMQCC, multi-stakeholder quality improvement collaboratives, provide a data-driven model for building partnerships among clinical and public health leaders.  The strategic partnerships bring new insights and increase the rate of diffusion of innovations, benchmarking, and quality care oversight.  The multi-stakeholder approach has been shown to be an effective way to align resources with quality.

OUTCOMES:  126 NICUs participate in CPQCC and submit data to for benchmarking and change analysis.  CPQCC has developed neonatal toolkits.  Outcomes include reduced neonatal length-of-stay by increasing the use of antenatal steroid administration from 50% to 80%.  CPQCC has led an Acquired Infections Collaborative among 20 hospitals. 

CMQCC was formed to improve maternity care.  The linkage of the California Department of Public Health,  Maternal, Child and Adolescent Health Program’s California Pregnancy-Associated Mortality Review (CA-PAMR) to CMQCC is an innovative method for identifying priorities and translating findings into practice.  Examples of putting CA-PAMR’s findings into action include the state-wide Obstetric Hemorrhage Task Force, the OB Emergencies Task Force, and the forging of clinician and public health partnerships through the development of the Local Maternal Care Quality Improvement (LMCQI) projects.