COLORADO PERINATAL CARE COUNCIL A. MEETING Colorado Perinatal Care Council, Meeting#: 210 B. DATE July 26, 2013 C. LOCATION Colorado Department of Public Health & Environment Denver, Colorado

D. PARTICIPANTS: MEMBERS, GUESTS AND EXECUTIVE COMMITTEE MEMBERS PRESENT: Vicki Lemmon, Boulder Community Hospital, CPCC Executive Committee Suze Ketchum, Good Samaritan Medical Center Tina Wilson, Montrose Memorial Ellen Duran, North Suburban Medical Center Carrie Andrew, Prowers Medical Center Sharon Hendricks, Prowers Medical Center Steve Holt, MD, Rose Medical Center, CPCC Executive Committee Kathy Pehanich, St. Anthony North Sherrie Williams, University of Colorado Hospital Kathy Andersen, University of Colorado Hospital Sheila Sherman, Vail Valley Medical Center Tracy Heaberlin, Yama Valley Medical Center, CPCC Executive Committee Mary McMahon, National Jewish Hospital, CPCC Executive Committee Courtney Sheffield, Nurse Family Partnership Sheila Kauman, Children’s Colorado David Belenky, MD Ed Donovan, MD, CPCC Executive Committee Consultant Anne Behring, University of Colorado Hospital Cynthia Aubol, University of Colorado Hospital Sally Garcia, University of Colorado Hospital Tina Wilson, Montrose Memorial Hospital Kathy Gaines, CDPHE, CPCC Executive Committee Member Darla Van Essen, Rocky Mountain Hospital for Children Mandy Bakulski, CDPHE Jaen Gerberding, CDPHE Krista Beckwith, CDPJE Eileen Meisner, Good Samaritan Medical Center Kathy Ceballos, University of Colorado Hospital Marianne Neifert, MD, Colorado Breastfeeding Coalition Karen Paulson, Colorado Institute for Matneral-Feetal Health Tammy Lantz, Colorado Preastfeeding Coalition Martha Merrill-Hall, Saint Joseph Hospital Bethany Tucker, Volorado Institure for Maternal-Fetal Health Sheila Sherman, Vail Calley Medical Center Scott Matthews, March of Dimes Jeannine Cabanellas Kidwell, Evans Army Hospital Carolyn Kwernerland, JCPH-HCP Kathy Bolejack, Tri County Health Department

E. HANDOUTS (Available Upon Request) 1. Treasurer’s Report 2. Conference Calendar 3. CPCC Meeting Dates & Locations - 2013 4. Meeting Minutes 5. Community Program Handouts

F. SUMMARY OF THE MEETING 1. Procedural Items a. The Council thanked Joni Reynolds and Karen Treirweiler and her team for hosting the meeting and providing the meeting room, snacks and refreshments. b. Introduction of Council members and guests. c. The Minutes from the May 31,2013 meeting were reviewed and approved d. The Treasurer’s Report was presented by Heather Hagenson in the absence of Sandra Gardner, Treasurer. Two different Treasurer reports were reported – one for the main CPCC checking account and the other for all of the grant money received in 2012 – 2013. e. Additional conferences were noted at the meeting: For a list of upcoming conferences, please refer to the Council’s website at: www.coloradoperinatalcarecouncil.com. f. Executive Committee Report: Peter Hulac, MD, Chairman reported that the CPCC Executive Committee is working on the upcoming agenda for the September and November meetings. The September meeting will be at Vail Valley Medical Center on September 27th, and the November meeting will be at Children’s Hospital on November 22nd. Some of the agenda topics will include: New Treatments for Hep B Positive Pregnant Women, Altitude Guidelines, Nurse Family Partnership, Shared Decision Making The Executive Committee is also currently working on looking for a new Chairman Elect for 2014-2015. If you know of anyone who is interested, email Heather. Voting will be held in November/December. CPCC Executive Committee is reviewing legislative issues in Colorado and new opportunities for our state– Steve Holt will provide an update later this morning. The Executive Committee continues to work on partnerships with CDPHE and the Maternal Child Wellness Programs. The Executive Committee members are also in the process of reaching out to smaller community hospitals and establishing a system to reach out to Level I and II hospitals to increase meeting participation through webinars and conference calls. The CPCC Self-Assessment Guidelines are currently being reviewed and a new system and process for self-assessment guidelines submission is being created. We will begin the new self-assessment guideline submission in November for years 2014 – 2015. Submission will be in an online format. Peter also reported that since CPCC is now receiving more grant money, we want to make sure we have all documents updated and in place. The Executive Committee will begin to file 501(c)3 taxes and our fiscal year will be July 1st – June 30th . Finally, the NICU State Collaborative team continues to work on NCABSI within our state. Dr. Alfonso Pantoja (Paco) will provide a brief update.

g. Dr. Alfonso Pantoja (Paco) provided the State Collaborative Committee report. He shared that there are currently 8 NICU’s who are involved in the NCABSI project. CPCC has approved to offer a grant to have one of these units attend the VON conference in October. In addition, the gourp is currently discussing the probiotics protocols, and Paco has shared the Saint Joseph Hospital probiotic guidelines with the other NICU’s.

h. Website Update: CPCC has a new website address. Please visit www.cpcc.co. Please contact Heather Hagenson if you have any ideas or resources that can be added to the website.

The following summaries are from the presentations from the July 26, 2013 meeting: I. Colorado Vital Statistics: Recent Success and Continued Challenges in Fertility, Delivery and Mortality. Presented by Kirk Bol, MSPH, CDPHE Vital Statistics Unit Kirk began his presentation by providing a general overview of Colorado statistics. He then proceeded to review the graphs and chart details of the different categories, Kirk began his presentation with outlining the teen fertility rates, and pointed out that the teen pregnancy rates have been decreasing over the last few years. He then reviewed the live births in Colorado by attendant types and facility type, and then further outlined the live births by method of delivery and selected outcomes, such as preterm birth rates and low birth weights. Kirk further outlined the live births in Colorado with perinatal characteristics by NICU facility for 2012. He then reviewed control charts for current Colorado birth statistics data such as births at <37 weeks gestational age, births at 34-36 weeks gestational age, the percent of births at 34-41 weeks, percent of births at 28-33 weeks, percent of births <28weeks, percent of births at <1500 grams birth weight, percent of births at 24-34 weeks who received antenatal steroids, percent of births at 36 to 38 weeks induced without medical or obstetric indication, percent of births at 34-36 weeks induced or C-Section without medical or obstetric indication, and percent of births at 37-38 weeks induced or C-Section without medical or obstetric indication, Kirk then reviewed the infant mortality statistics by race and ethnicity in Colorado between 1990-2012, Kirk also reviewed he infant mortality rates by underlying cause of death and facility type, including home births, and attendant type. He concluded his data review by outlining the Colorado infant mortality rates among Colorado live births by attendant type and the presence of risk factors. There was a great discussion and several inquiries about the data in Colorado, and how CPCC can partner with CDPHE and hospitals in the state to have an impact on the Colorado date. A copy of Kirk’s presentation can be found on the CPCC website at www.cpcc.co

II. Substance Exposed Newborns Update Presented by Kathryn Wells, MD and Sharon Langendoerfer, MD Dr. Wells and Dr. Langendoerfer jointly presented an update regarding the current work with Substance Exposed Newborns (SEN). They provided an overview of the work that has been done since they presented to CPCC last year, and discussed some of the regional meetings that have occurred throughout the state. They also provided a tour of the SEN website, and some of the great support materials that are available to providers and patients: posters, magnets, brochures, etc. For more information, and to download their materials, you can visit their website at www.coloradodec.org/substanceexposednewborns.html

III. Legislative Update: Quality Care for Moms and Babies Act 2013 Presented by: Steve Holt, MD, FACOG, Vice Chair and Legislative Chair, Colorado Section of ACOG Dr. Holt began the presentation by sharing providing a legislation summary of the bipartisan Quality Care for Moms and Babies Act which supports (if passed) State Perinatal Care Collaboratives to improve the delivery of maternity care in our states and bend the maternity cost curve. The bill would support the establishment and expansion of maternity care collaboratives and establish a standard set of maternity care quality measures for reporting in Medicaid and CHIP and support the development of additional quality measures. Dr. Holt provided an overview of the Qualty Care for Moms and Babies Act of 2013 It was introduced by Senator Debbie Stabenow (MI) and representative Eliot Engel (NY) and will provide $15 million to develop and grow maternal quality collaboratives. The goal is that by influencing adoption of best practices, a collaborative can help to eliminate elective inductions before 39 weeks, increase breast feeding rates and much more. This bill would build on the existing CHIP and Medicaid Adult Health Measure quality reporting programs by supporting the development and implementation of additional maternity care quality measures to assist all providers benchmark their performance. The bill will create a dedicated program within HHS to help establish new maternity care collaboratives and expand existing collaboratives to facilitate the adoption of quality improvement practices. Funding from this bill can support a variety of activities, including facilitating performance data collection and feedback reports to providers, developing, implementing, and evaluating protocols and checklists to foster safe, evidence-based practice, developing the infrastructure needed to support quality collaborative activities, providing technical assistance to providers and institutions to build quality improvement capacity and facilitate participation in collaborative, analyzing blinded liability claims data to improve practice. This will also establishes a national, online clearinghouse to make procedures and tools of maternity care quality collaboratives available to other collaboratives and other groups working on maternity care quality. The bill directs the Agency for Healthcare Research and Quality (AHRQ) to adapt Consumer Assessment of Health Care Providers and Systems (HCAHPS) to better measure the care experience of childbearing women and newborns. The bill authorizes $16 million for this section. Dr. Holt then reviewed current state quality collaboratives. He stated that 31 State have existing Collaboratives that have varying degrees of statewide adoption and collaboration. Some states have a well-defined infrastructure and funding. These states have the ability to collect meaningful data and distribute best practices. Those states with well defined infrastructures are able to share best practices and lessons learned with providers and hospitals that may not typically have access to that type of information-including those in small, rural communities. Steve shared that THERE IS EVIDENCE STATES HAVE IMPROVED THE QUALITY OF CARE, SAVED MONEY AND DECREASED THEIR LIABILITY COSTS AS A RESULT OF THEIR COLLABORATIVE ACTIVIES IN THEIR STATE. He then provided a review of states that have seen successful outcomes under their quality collaboratives. He shared data and results from each of the states, and proposed that Colorado has the potential to create a strong collaborative by evidence of the work that has already been completed in regards to the NCABSI project.For a copy of this presentation, please contact Heather Hagenson at [email protected]

IV. NICU Consortium Update Presented by: Jane Gerberding, RN, BSN – Nurse Consultant, Prevention Services Division Jane presented to CPCC an update from the presentation she provided to the council last year. They have formed a great interdisciplinary team. This Interdisciplinary Institute is intended to provide a forum for health care professionals to share their expertise in the care of premature and high-risk infants and their families as these babies transition home from the hospital. There will be a conference on 11/ 1/2013 that will allow participants to understand how to enhance knowledge of the unique issues related to the health of premature, late pre-term and high-risk infants and their families, including health disparities; Increase communication and continuity of care for premature and high risk infants and their families as they transition home from the NICU; and Increase awareness among hospital and community agency staff about local community, regional, and national resources available to families of premature and high-risk infants and toddlers. The goals of the NICU Consortium update is to optimize the health and developmental outcomes of premature and high-risk infants and toddlers and support their families by sharing best practices, clinical guidelines, and current research with health care professionals and agency staff caring for them

V. Award Presentations Presenter: Scott Matthews, March of Dimes Scott spoke briefly about Colorado prematurity data and the positive outcomes. He then presented the Prematurity Presentation Award to the Colorado Department of Public Health & Environment for the outstanding work that they have done with helping to make this positive change. Presenter: Marianne Neifert, MD and Tammy Lantz Dr. Neifert began her presentation by sharing that 41 of the 53 hospitals have now applied and received the Colorado Can Do 5! BEST Award. Today’s awards were presented to: Evans Army Hospital, Prowers Medical Center, Montrose Hospital, St. Thomas Moore, Vail Valley Medical Center, San Luis Valley Medical Center and Yampa Valley Medical Center. VI. The meeting was adjourned . The next Council meeting is scheduled for September 27, 2013 at Vail Valley Medical Center from 1pm – 4pm. Minutes Respectfully Submitted, Heather Hagenson, CPCC