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Dr. Robert Bree Collaborative: Improved Quality and Outcomes through Transparency and Collaboration
Steve Hill, Bree Collaborative Chair
Rachel Quinn, Bree Collaborative Project Manager
Ellen Kauffman, MD, Member of Bree Collaborative OB subgroup & Medical Director of OB COAP
Healthcare PlexusCall, February 20, 2013
Dr. Robert Bree Collaborative - Background• Created by Washington State Legislature in 2011.
• A public/private consortium of health care stakeholders - public and private health care purchasers, health carriers, and providers - working collaboratively to:▫ Identify topics/services where there’s “waste”
or “overuse”▫Recommend best practices based on data and
evidence (if available) to Washington State to improve the quality, outcomes, transparency, and cost-effectiveness of health care
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Dr. Robert Bree Collaborative - Mandate
Annually, must select three health care services/topics with:
• Unwarranted variation• High utilization and/or cost growth trends• A source of waste and inefficiency in care
delivery• Patient safety issues• Inappropriate care• Proven means/strategies to address this topic
(leverage other opportunities)
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Dr. Robert Bree Collaborative - Mandate
For each selected health care topic, the Bree Collaborative must:
•Identify evidence-based best practice approaches using data
•Recommend quality improvement strategies▫Examples: Data collection, Patient Decision
Aids, Centers of Excellence, Provider feedback reports
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“Hook” of Bree Recommendations
•Washington State HCA administrator must review Collaborative recommendations and decide to adopt and apply them to state purchased health care programs, e.g., Medicaid, WA State Employee Health Care Plan, Labor & Industries, Corrections
•Intent is other public and private stakeholders will follow
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Bree Year 1 Topics
•Obstetrics•Cardiology•Avoidable Readmissions
▫Total Knee Replacement and Total Hip Replacement Bundle Payments
•Acute and Chronic Spine Care/Low Back Pain
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Obstetrics Care (OB)
• 1st topic selected • High unwarranted variation• High volume and cost, and patient safety
issue• High priority for employers, especially
Medicaid• Approximately 85,000 births in WA State -
Medicaid pays for half• An opportunity to “scale up” great work
done to date but with employers and health plans at the table
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OB Report
• OB subgroup created in December 2011▫ 4 clinical experts plus employer, health plan,
quality, and hospital representatives▫ Studied best practices, and existing local and
national efforts to scale up strategies statewide• 3 Focus Areas & Goals
▫ Eliminate elective deliveries before the 39th week, without a medical indication
▫ Decrease elective inductions of labor between 39 and up to 41 weeks
▫ Decrease unsupported variation among WA hospitals in the primary (first time) C-section rate
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OB Report Findings & Recommendations• Many reasons for variation:
▫ Maternal requests and provider behavior▫ No universally accepted clinical guidelines or community
standards exist for elective deliveries or elective inductions, or whether or when to perform a C-section once labor has started
• 5 Areas of Quality Improvement – “everyone has a role to play”▫ Commitment to Quality Improvement▫ Evidence-based or tested clinical guidelines and protocols▫ Transparency of data on selected OB procedures, by facility▫ Patient education▫ Realignment of financial and non-financial incentives
• Final OB report adopted by the Bree Collaborative in August 2012 and adopted by WA State in October 2012
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Case Study – Franciscan Health System Management of Early Elective DeliveriesProblem: National Leapfrog data showed
high elective induction rateIngredients for Quality Improvement•Data (chart abstracted)•Leadership: Physician champion & OB
leaders•Engagement of staff at all levels•Provider and patient education•System redesign – Feedback and Reporting,
“Hard Stop”
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Plexus InstituteFebruary 20, 2013
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Bree Recommendations: 3 Goals
Bree Collaborative – Obstetrics Care Topic Report & RecommendationsAugust 2, 2012
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Bree Recommendations: 3 Goals
Bree Collaborative – Obstetrics Care Topic Report & RecommendationsAugust 2, 2012
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Bree Recommendations: Labor & Delivery
ARMUS
Bree Collaborative – Obstetrics Care Topic Report & RecommendationsAugust 2, 2012
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Bree Recommendations: Labor & Delivery
ARMUS
Bree Collaborative – Obstetrics Care Topic Report & RecommendationsAugust 2, 2012
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OB COAP Aggregate
Bree Recommendation #4: Admit Spontaneously Laboring Term Patients with Cervix on Admission >=4
Q1 - Q2 2012
Spontaneously Laboring Term Patients Admitted at >=4 cm): n= 1723 N = (cervix on admission) D = (labor type=sponteanous) + (woa >=37) + (parity CS=0)
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OB COAP Aggregate
Bree Recommendation #4: Admit Spontaneously Laboring Term Patients with Cervix on Admission >=4
Q1 - Q2 2012
Spontaneously Laboring Term Patients Admitted at >=4 cm): n=1681 N = (CS=yes) or (oxytocin=yes) or (reg anesth=yes) or (LOTAD) D = (labor type=sponteanous) + (woa >=37) + (parity CS=0) + (cx on adm)
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Questions? Comments?
Robert Bree Collaborative ▫http://www.hta.hca.wa.gov/bree.html
OB COAP ▫www.qualityhealth.org
• Steve Hill▫[email protected]
• Rachel Quinn▫[email protected]
• Ellen Kauffman, M.D.▫[email protected]
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