Medicaid and CHIP Promising Practices

Name of Practice: Neonatal Quality Improvement Initiative

Abstract:

In 2006, the catheter-associated blood stream infection (CABSI) rate in 13 of the California Children's Services (CCS) approved Regional Neonatal Intensive Care Units (NICUs) was 4.32 infections per 1,000 catheter days. The CCS program partnered with the California Children's Hospital Association (CCHA) and the California Perinatal Quality Care Collaborative (CPQCC) to implement the Neonatal Quality Improvement Initiative (NQI). The purpose of this Initiative is to eliminate CABSIs and other hospital-acquired infections in Regional NICUs. During the first year of the NQI, CABSIs in the participating facilities were reduced by 25 percent. DHCS estimates that the NQI produced total savings to Medicaid and other payers of $2.5 million in the first six months of the project.

Challenge:

:
CABSIs are an important cause of increased morbidity, mortality, and costs in hospitalized patients. In 2006, the CABSI rate in 13 of the CCS program's approved Regional NICUs was 4.32 infections per 1,000 catheter days (i.e., a day in the hospital that a patient has an indwelling catheter). The CCS program is California's Title V program for Children with Special Health Care Needs and is administered by the Department of Health Care Services (DHCS), the same State agency that administers the Medicaid program. According to the Kaiser Family Foundation (http://www.statehealthfacts.org/profileind.jsp?cat=4&sub=57&rgn=6), Medicaid accounted for 45 percent of total California births in 2003, 4 percentage points above the national average. Thus, high infection rates in the NICU would also likely contribute significantly to poor birth outcomes and increased costs for the Medicaid program.

Approach::

In 2007, the CCS Program partnered with the California Children's Hospital Association (CCHA) and the California Perinatal Quality Care Collaborative (CPQCC) to implement the Neonatal Quality Improvement Initiative (NQI). The purpose of the initiative is to eliminate CABSIs and other hospital-acquired infections in Regional NICUs, which serve patients covered by Medicaid and other payers.

In the first year of implementation, 8 children's hospitals, 4 University of California Medical Centers, and the 13 health care facilities that comprise Sutter Memorial Medical Center participated in the NQI. Participating health care facilities followed guidelines established by the California Perinatal Quality Care Collaborative (CPQCC) to set goals for reducing infection. The CCS program utilized Federal Title V funds and financial support from the participating facilities to reimburse faculty, develop a website, and maintain an electronic mailing list.

The participating facilities received instruction in quality improvement, reviewed performance data, identified common improvement goals, and implemented clinical interventions developed through analyses of the processes of care, literature review, and site visits. NQI staff conducted biweekly phone calls and hosted three learning sessions during the first year. These forums created opportunities for health care facilities to share lessons learned.

In 2008, the other 9 CCS approved Regional NICUs joined the collaborative to increase the total number of participating health facilities to 22.

Results:

Catheter-associated blood stream infections were reduced by 25 percent in the first year of the initiative. Between 2006 and 2007, the CABSI rate in the 13 participating NICUs declined from 4.32 infections to 3.22 infections per 1,000 catheter days. DHCS estimates that the NQI produced total savings to Medicaid and other payers of $2.5 million in the first six months of the project.

This initiative also contributed to the participating facilities making changes in clinical protocols that can help prevent future hospital acquired infections, such as improved hand hygiene, widespread use of chlorhexidine, and improved configurations of lines, especially umbilical lines. The State also noted that the NQI helped improve coordination with departments in the participating health care facilities, such as radiology and anesthesia, involved in neonatal care.

Further Information::

Contact:

Marian Dalsey, M.D., MPH
California Department of Health Care Services
P.O. Box 15559
Sacramento, California 95899
916-327-3076
marian.dalsey@dhcs.ca.gov

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