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Transforming Our Future
Jeffrey D. Horbar MD Chief Executive and Scientific Officer Vermont Oxford Network Jerold F. Lucey Professor of Neonatal Medicine University of Vermont Burlington, VT Dr. Jeffrey Horbar is a board-certified neonatologist and clinical scientist with extensive experience in clinical research and its application to the improvement of
neonatal care. He is currently the Jerold F. Lucey Professor of Neonatal Medicine at the University of Vermont College of Medicine, Chief Executive and Scientific Officer of Vermont Oxford Network and Co-Editor of the Neonatal Review Group of the Cochrane Collaboration. Dr. Horbar has been responsible for the development of the Vermont Oxford Network Database which is used by over 950 NICUs around the world to monitor and improve outcomes for high risk infants and their families. Annual Quality Congress Plenary Session, Saturday, October 3, 2015 Transforming Our Future Objective: Challenge 2 key assumptions about the opportunities to minimize mortality and morbidities in neonatal care and the importance of deep family engagement to accomplish this goal.
Transforming Our Future
Jeffrey D. Horbar MD
October 3, 2015 1
Annual Quality Congress Chicago, IL October 3, 2015
Transforming Our Future
Jeffrey D. Horbar MDProfessor of Pediatrics University of Vermont
Chief Executive and Scientific OfficerVermont Oxford Network
Disclosure
I am the Chief Executive and Scientific Officer of the Vermont Oxford Network.
I will not be discussing the unlabeled use of any commercial product.
VisionTo build a worldwide community of practice dedicated to providing every newborn infant and family with the best possible and ever improving medical care.
1000 Newborn Units 32 Countries
Over 500 teams since 1995
Parents as Team Members and Faculty
Transforming Our Future
Jeffrey D. Horbar MD
October 3, 2015 2
60
70
80
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100
110
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130
BE
NE
FIT
ME
TR
IC
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
POD GroupEntire VON
Courtesy Joe Kaempf, MDAdapted from Kaempf JW et al. JAMA Pediatrics 2015;169:459‐465
10 Units in NICQ POD Improved 34%
Benefit Metric includes 8 major morbidities
STATES TOGETHER
Edward DonovanFaculty Leader
Roni ChristopherQuality Improvement Facilitator
Wide Variation Among States in 2014Mortality
NEC
CLD
Late Infection
Severe ROP
Severe IVH
State Transfer Networks
II
I
I
I
I
I
I
II
II
II
II
III
III
III
IV
I
I
III
I
I
III
IV
I
Practices in Switzerland and VONInfants 501 to 1500 gm 2010 to 2012
0%
20%
40%
60%
80%
100%
AntenatalSteroids
DR CPAP Ventilation Surfactant Human Milk
Switzerland US
Adams M, Bucher HU, Roth‐Kleiner M et al. VON Annual Quality Congress 2015
Daniele Ehret, MD, MPHDirector of Global Health, VON
Vermont Oxford Network Volunteers
Global Health at VON
Transforming Our Future
Jeffrey D. Horbar MD
October 3, 2015 3
Professor Bogale WorkuExecutive Director
Ethiopian Pediatric Society
Drs. Asrat, Goitom, and HailuAttending NeonatologistsAddis Ababa, Ethiopia
Welcome to our Ethiopian Colleagues
Our Challenge
To dramatically reduce if not entirely eliminate the major morbidities for
VLBW infants .
Relative Changes 2004 to 2014
‐50%
‐40%
‐30%
‐20%
‐10%
0%
Infection sROP sIVH Death PVL NEC CLD Ptx
Death or Morbidity for VLBW Infants
44%
68,173 VLBW Infants in 2014
Morbidities in 2014
0%
5%
10%
15%
20%
25%
30%
35%
Infection
sIVHsROP
PTX PVL
CLD
NEC
Morbidities in 2014
Transforming Our Future
Jeffrey D. Horbar MD
October 3, 2015 4
CLD 2800
Infection 2500
NEC 680
Severe ROP 600
Severe IVH 430
PVL 420
PTX 400
Risk adjusted estimates based on infants 501 to 1500 grams at 932 NICUs in 2014
Avoidable Morbidity for Infants and Families
1000 NICUs Improving Together!