Learning Networks for Improvement and Research

1. Learning Networks for Improvement and Research Carole Lannon MD MPH Director, Learning Networks Core Anderson Center for Health Systems Excellence Cincinnati Children’s Hospital Medical Center Principal Investigator, pediatric Center for Education and Research on Therapeutics (AHRQ) Senior Quality Advisor, American Board of Pediatrics

2. Aim: Integrate new knowledge into health care delivery system Improving Child Health Health care delivery Outcomes Research Clinical Trials Translational Research Basic research John Bucuvalas, MD Cincinnati Children’s

3. Learning Networks Multi-site clinical networks Registries/shared data for improvement and research Quality improvement methods (e.g. data over time, small tests of change) Collaborations among multidisciplinary teams of clinicians and staff Engaged patients/ families Serve as laboratories for research Translating research into practice Innovation and discovery Comparative effectiveness

4. Teams Participate in face-to-face learning sessions (~2x/year) Provide process and outcome data monthly Receive individual and aggregate performance feedback report Use monthly webinars & listserv to review data, share challenges & successful strategies “All teach, all learn”

5. Learning Networks in which CCHMC provides QI/data/project management support Regional Ohio Perinatal Quality Collaborative Ohio Solutions for Patient Safety National ImproveCareNow: pediatric inflammatory bowel disease National Pediatric Cardiology Quality Improvement Collaborative Pediatric Rheumatology Care and Outcomes Improvement Network

6. Pediatric inflammatory bowel disease

8. Key Driver Diagram OUTCOMES KEY DRIVERS INTERVENTIONS Global AIM Build sustainable collaborative network where all pediatric gastroenterologists can work together in a compelling process of continuous quality improvement and acquisition of new knowledge that will over the next decade dramatically reduce the morbidity and improve the health and well being of children with IBD. Registry/ Population Management -Consistent, reliable data entry process with population management tool used to manage entire population Accurate diagnosis and disease classification Appropriate drug selection Pre-visit Planning -Clear process and tools for pre-visit planning implemented across clinic with ongoing monitoring for consistency • By December 30, 2012 • Patients in remission >70% • Patients not on prednisone >92% • Appropriate drug dosage >90% • Consistent, reliable care (complete • diagnosis and evaluation bundle) > 90% Appropriate drug dosage Protocols -Protocols for excellent care spread throughout practice with reliability of 90%+. Appropriate drug levels maintained Auditing Delivery of Appropriate Care -Regular use of audit tool with results shared across practice on a daily basis to inform practice changes. Adequate nutritional intake Self Management Support -Self management consistently offered with goals documented for all patients with reliable follow-up Appropriate growth monitoring

9. Remission rate improved % of patients (Crohn’s disease + ulcerative colitis) Remission Mild disease activity Moderate or severe disease activity Data from first 15 centers

10. The Ohio Perinatal Quality Collaborative (since 2007) 24 Neonatal Intensive Care Units (96% preemies) 20 Maternity Hospitals (50% all births)

11. OPQC Neo Key Driver Diagram

12. Insertion Bundle Data

13. Maintenance Bundle Data

14. Infants 22-29 wks discharged with at least one nosocomial infection (VON) 14.3% 18.2% In 15 months, 20% reduction in neonatal infections 40 fewer infections, 7 fewer deaths and 1.1 million dollars in savings

16. NACHRIQuality Transformation NetworkOverview Revised 11.8.2011

17. Quality Transformation Network90 Children’s Hospitals & Growing The Quality Transformation Network (QTN) is a large and growing group of children’s hospitals combining forces to improve care and outcomes for high-impact clinical issues. Participating hospitals are achieving improvements at lower cost, more efficiently, and faster than any single hospital can achieve working independently. Current focus on healthcare associated infections

18. ICU CLABSI Collaborative 2006 CohortInfection Rates Pre- and Post-Collaborative Data through 9/2011

19. Large Volume of Outcome & Process Data Enables Rigorous Analyses to Understand What Works • Impact of line maintenance practices unknown at outset. • Process compliance data collected to understand effect on infection rates. • Aggregating data on practices standardized across many sites yields critical mass of data to analyze. • As line maintenance compliance increases, infection rates decline. Line maintenance compliance increases Infection rate decreases Reducing PICU Central Line–Associated Bloodstream Infections: 3-Year Results; Miller, M et al, Pediatrics, October 2011

20. Infrastructure: Key Ingredients

21. Comprehensive Program Model

22. Sustainability: Key Ingredients

23. Value Proposition

24. Impact of Learning Networks • Improved health outcomes for children • New knowledge and spread • Translate research into practice • Real-time learning about what works • Databases for comparative effectiveness research • Opportunities for collaboration and innovation

25. Interested to learn more? • National Meeting on Collaborative Improvement Networks • November 2011 • Sponsored by American Board of Pediatrics, NACHRI, and CCHMC • Presentations at https://www.abp.org/abpwebsite/moc/collabimp.htm • Pediatrics supplement planned • CCHMC Learning Networks webpage • http://www.cincinnatichildrens.org/19055/learning-networks/ • Contact me at carole.lannon@cchmc.org