Organizing Regional Perinatal Quality Improvement: Global Considerations and Local Implementation

After completing this article, readers should be able to: 1. List the primary steps in organizational development of a regional perinatal quality improvement program. 2. Describe opinion-making, practice-enabling, and audit and feedback strategies. This case study provides information on key decisions and critical steps for those implementing regional perinatal quality improvement (QI) programs. Designers and developers should be cognizant of the considerable evidence base and theoretical work that can guide program development. Such evidence and theory are contained in sidebar reviews and commentary that accompany this description of the development of the California Perinatal Quality Care Collaborative (CPQCC). The authors recognize that others might and should act on the evidence differently according to local circumstances. Perinatal-neonatal leaders in California have been addressing perceived concerns relating to the quality of care for decades. From the pioneering work of Williams (1) to more recent Perinatal Profiles of risk-adjusted hospital level perinatal-neonatal mortality, (2) significant hospital-specific variations in mortality have persisted. Such differences persist even after adjusting for level of care and case mix across institutions. (3) In addition, both Wirtschafter and associates (4) and Wilson and colleagues (5) have described variation within hospital networks operated by large California health maintenance organizations. Increasingly, California’s leaders became aware that both private and public payers were concerned about how and who should address the issue. (See Sidebar #1) | Contemporary writers echo previous generations’ concern for attending to the quality of care. Galvin and McGlynn (1) cite public surveys that indicate increasing appreciation of and interest in quality, paralleling the public’s embracing of automobile safety and environmental issues. Steffen (2) suggests that “(high) quality care is the capacity of the elements of that care to achieve legitimate medical and non-medical goals.” Blumenthal (3) reviews the evolution of definitions of quality and notes the preeminence of the one formulated by the Institute of Medicine in 1990: Quality consists of the “degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” (4) Public and payer attention to the value of the care rendered follows from the concerns over ever-rising health care costs. Blumenthal (3) argues that physician understanding and expertise about the nature of quality is both expected and required. The inclusion of “competence in perinatal quality assessment/improvement” is under consideration by the Sub Board for Neonatal/Perinatal Medicine. | || * References 1. Galvin RS, McGlynn EA. Using performance measurement to drive improvement: a road map for change. Med Care . 2003;41:I-48–I-60[OpenUrl][1][PubMed][2][Web of Science][3] 2. Steffen GE. Quality medical care. JAMA . 1988;260:56–61[OpenUrl][4][CrossRef][5][PubMed][6][Web of Science][7] 3. Blumenthal D. Quality of care—what is it? N Engl J Med . 1996;335:891–894[OpenUrl][8][CrossRef][9][PubMed][10][Web of Science][11] 4. Lohr KN, ed. Medicare: A Strategy for Quality Assurance. 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