2022-10-21 WHPP Y5 Kickoff

Crystal Nwachuku

Julia Skapik

Andrea Price

Raymonde Uy

Jennifer Du Mond

Jayson Osika

Lisa Romero

Kate Curtis

Ta-Yun Yang

Jena Wallander

Michelle Whitt

Arlene Pena

Valerie Knibb

Ashleigh Sgrulloni

Elliott Main

Terri Deeds

Arlene Cullum

LeeAnn White, NACHC

Nivedita Mohanty

Wanda Montalvo

11:00 to 11:02

Open Call

Crystal

11:02 to 11:10

NACHC Welcome and Introductions

Julia

Julia will ask partners to introduce themselves as well.

Name, Title, Organization, Role

11:10 to 11:15

CDC Welcome and Introductions

Lisa

Name, Title, Organization, Role

11:15 to 11:25

Review Year 4 Accomplishments

Crystal/Jayson

11:25 to 11:35

Review of PAMR Statistics and Emerging Best Practices on Postpartum Care

Elliot

Whitt: Site in Monterey, CA in the process of building in EHR an anemia care plan, which will roll out to the collaborative.

USPSTF Guidelines say low-dose aspirin, but who is getting it, actually using it? EHR can segment those patients who have HTN, elevated blood pressures in the pregnancy.

We can’t put in a recommendation that they get subsequently followed if they are high risk. How can we trigger this without alert fatigue.

Main - Aspirin does not get into the MedRec Reconciliation system; one idea is to give a prescription for aspirin. Has a team working in Epic for the aspirin initiative in S. California

11:35 to 12:05

Design Discussion/Polling

All

• Plan for Y5

  • Data QI - Focus on improving measures that we already have, curating denominators

    • Documentation/completeness of the data

  • Clinical QI - What activities in the health center improve postpartum follow up?

    • Providing services that could improve follow up

• Polling

  • Which measures aligned most with your organization’s ongoing priorities and projects?

  • Which measures did you have the most success collecting?

  • What QI activity are you most interested in implementing to close maternal care gaps in WHPP Year 5?

  • Is there any interest in focusing on the peripartum, postpartum care plan?

Whitt: If Epic, there is a way to do Epic in-patient to Epic outpatient; struggling to get secured messages. The inpatient has to initiate the exchange.

Nivedita (Nita) Mohanty: We encounter challenges with integrating hospital based data into structured fields on the ambulatory side.

Wanda Montalvo: Are health centers working with Doulas? or navigators to help with the handoffs from hospital to health center?

Nivedita (Nita) Mohanty: We encounter challenges with integrating hospital based data into structured fields on the ambulatory side.

Jena Wallender-Gemkow: A lot of information comes from PDF scans, so manual data entry is needed. Can’t be accessed to capture delivery date well, so AC uses estimated delivery date because more consistently documented - it's not ideal.

Nivedita: Some clinicians have privileges at hospitals - but manual piece is still manual entry - where this is not the case, it’s even hard to capture data on the ambulatory side.

Jena and Ta-Yun: Mainly use EDD as default because it is more likely to be there, and then if actual date of delivery, it is added int he dataset

Mohanty: We encounter challenges with integrating hospital based data into structured fields on the ambulatory side.

Pena: eCW but will be OCHIN Epic - same issues - a lot of manual entry into the EHR - both EDD and actual delivery date?

Main: This is foundational - not a minor point!!

Whitt: Pregnancy status given Dobbs is not a good thing because it is transmitted early in the pregnancy. If these data are shared, it could put the woman at risk if she seeks an abortion after.

Jena: We are seeing low utilization of pregnancy status - is that in reaction to Dobbs decision.

Ta-Yun described the elements he looks at. Separating document type if they have pre-natal postpartum listed.

Main: How do we know if the recommendations are occurring within a structured visit?

Whitt: Post Partum express lane drives some - Epic has a pregnancy checklist. If the episode is open, we could put a post-partum checklist in there. Low utilization of pregnancy checklist - have trouble getting members to complete it. We can encourage people to do things, it does not mean that it is done.

Jennifer Du Mond Michele Whitt, does your list of O codes include dx beyond pre-eclampsia, gest htn, gdm that we have been focusing on? E.g. does it also include patients with history of pre-term birth or miscarriage, multiple gestation, etc?

Julia Chart in confluence to validate/code these things where there is variability in defining post partum visit

12:05 to 12:30

Next Steps/Admin

Crystal/Julia

• Charter/EOP/Data Request

• Contracting

• SOW