10/12/22: Using Data to Better Understand Inequities in Care and Outcomes: A Deep Dive into Premier’s Perinatal Collaborative

Thank you for participating in this month’s Maternal Health Hub Learning Community session on Using Data to Better Understand Inequities in Care and Outcomes: A Deep Dive into Premier’s Perinatal Collaborative, featuring Deb Kilday (Principal, Women and Infant Services Line, Premier) and Jennifer Flynn (Senior Director of State Affairs, Premier). View the slides here and recording here.

Deb presented on Premier’s work in the maternal space, which began in 2019 when Premier launched their Bundle of Joy campaign, a public commitment to raise the bar on quality and safety in delivery to care to mothers and babies. The campaign included a three-pronged approach:

1. A web-based maternal and infant dashboard, a large analytic platform that pulled standardized data from over 1300 participating hospital members. Over 100 metrics relating to the quality of maternity and infant care were included.
2. A research database containing inpatient and outpatient, deidentified, and disaggregated data on over 1 million births a year. Premier dug into this data to provide an analysis on the impact of the care provided during the delivery period on maternal outcomes, from 2008-2018.
3. A perinatal collaborative made up of 12 hospitals, that leverages analytics, education, and best practices to accelerate performance improvement in maternity care. This pilot collaborative provided participants with an initial baseline measurement of their performances and practices, and then tracked their improvement on one of 17 focus areas. The collaborative ran from 2019-2021; findings from the collaborative will be published in the coming months.

In 2021 HHS approached Premier to collaborate in two areas. The first was to leverage the resource database mentioned above, to analyze the effects of specific maternal and infant attributes on overall health outcomes from 2008 onwards. The second was to expand Premier’s existing Perinatal Collaborative to 220 hospitals representing all 50 states and District of Columbia.

Built upon what Premier learned in their pilot collaborative, the HHS Perinatal Collaborative focuses on implementing best practices to improve outcomes in 23 focus areas relating to maternal and infant health. Participating hospitals use Premier’s analytics and support to improve performance in a focus area, and also have access to a learning community that shares learnings between the participants. To ensure a focus on patient voices throughout, Premier partnered with the National Birth Equity Collaborative and MoMMA’s Voices.

The collaborative is currently finishing the baseline year during which the Premier team conducts a high reliability assessment – following the mom and baby through a day in the hospital – to identify the practices and programs currently used by the participating hospital. This assessment is then used to develop a roadmap to guide the participating hospital’s journey to improve care in their chosen focus area. Each participating hospital is paired with a subject matter expert and analyst to help make the needed changes.

Participants in the collaborative have access to Premier’s maternal and infant dashboard, which has been updated to include over 150 maternal and infant metrics that can be stratified to the patient and provider levels. This includes data on SDOH, identified via z-codes, which Premier did note the ongoing challenge of getting consistent  z-code reporting. A unique aspect of Premier’s dashboard is that mom and baby’s data are linked, so that providers can see the impact of a mom’s health on their baby, and vice versa.

In the future, Premier is planning to look at the care continuum for maternity care. In an upcoming pilot program, Premier will pull together outpatient data, EHR data, and provider notes into a dashboard, to be able to track the patient for a full year post-birth.

Below is a summary of the Learning Community’s discussion with Premier following the presentation:

• One participant asked about the uptake of incorporating z-coding in daily workflow, as they struggle to get providers to use the codes. Premier shared that they face similar challenges with participating providers. In the learning community, the collaborative is working to standardize the collection of z-codes.
• A participant queried how Premier avoids redundancy, as many hospitals are already working on their own quality initiatives. Debra shared that this came up many times in planning conversations. The collaborative is structured so that participants can choose their own focus areas. The collaborative also provides support to existing quality improvements that the participant may already have underway.
• A participant was curious how the collaborative supports nurses and midwives in quality work. Debra shared that no two hospitals are approaching it the same way, but many are seeking to do this work from an interdisciplinary team approach. Midwives are a part of the provider team that participates in these initiatives.
• A member was curious if Premier would be able to assess whether certain outcomes are correlated with the makeup (including which department serves as lead) of the participating hospital’s team, to understand how different departments within a hospital affect the overall success of the effort. In the baseline period, Premier did collect data that allows them to create a profile that includes team characteristics. They will be able to aggregate and stratify that profile to identify if different team makeups impacted the results.
• A participant asked about the partnership with NBEC and MoMMA’s Voices. An important aspect of this collaboration is that these organizations bring patient voices to the table to share their experiences, especially during the baseline period in which many design decisions were made. Further, with NBEC, Premier has looked at their learnings around implicit bias training, and how these can be integrated into the quality improvement work.

If you have any further questions, please contact Deb Kilday (deb_kilday@premierinc.com).