Regional Perinatal System (RPS)
>> California Perinatal Quality Care Collaborative (CPQCC)

The California Perinatal Quality Care Collaborative (CPQCC) is an outgrowth of an initiative proposed by the California Association of Neonatologists and supported by the David and Lucile Packard Foundation and the State of California Department of Health Services, Maternal and Child Health Branch.

CPQCC was formed in 1997 and brings together a public-private alliance of stakeholders in the care and outcomes of California's mothers and babies. The collaboration exists to improve the health of pregnant women, infants, and children by collecting high-quality information on perinatal outcomes and resource utilization which then allows for performance improvement and benchmarking processes in perinatal care and neonatal intensive care units throughout California.

The CPQCC Collaborative Network
Over the past several years, CPQCC has been very successful in developing a network of stakeholders interested in improving perinatal health care in California. The CPQCC network consists of public and private obstetric and neonatal providers, health care purchasers, public health professionals and private sector health industry specialists. More specifically, these collaborators include:

• California Association of Neonatologists (CAN)
• American College of Obstetricians and Gynecologists (ACOG)
• California Maternal and Child Health Branch (MCH)
• California Children's Services (CCS)
• California Office of Vital Records (OVR)
• Office of Statewide Health Planning and Development (OSHDP)
• Regional Perinatal Programs of California (RPPC)
• Health Insurance Plan of California
• Pacific Business Group on Health
• David and Lucile Packard Foundation
• The Vermont Oxford Network
• UC Berkeley School of Public Health
• Stanford University's Center for Health Policy and Research (HRP)

The CPQCC Data Center
CPQCC has partnered with the Vermont Oxford Network (VON) and Stanford University's Center for Health Policy and Research (HRP) to collect and analyze perinatal health data used for developing and monitoring perinatal quality health improvement projects initiated by CPQCC. Much progress has been made in the development of CPQCC's data center. A web-based reporting format has been developed over the last year, which allows hospitals to view multiple outcomes and interventions broken down by various categories, such as, birth weight, gestational age, inborn or outborn status, etc. A menu also enables hospitals to view tables and figures by subgroup.

The CPQCC Data Center currently supports two major projects:

1. These distinguished collaborators serve as the CPQCC Executive Committee which meets regularly to debate, review, prioritize, and plan perinatal quality improvement initiatives.
   
   The Vermont Oxford Network - a database enrolling VLBW infants admitted to NICUs worldwide, with 370 member centers and a ten year cohort of clinical data.
2. The CPQCC Selected Big Babies Database - an expanded database enrolling infants with birthweights over 1500 grams who meet specific clinical eligibility criteria, with 60+ member centers in California.

Information generated from these databases, provides CPQCC member hospitals with valuable information that can be used to compare themselves against other unidentified participating hospitals.

In 2000, CPQCC collaborated with Children's Medical Services Branch in producing the CCS reports for 19 CCS hospitals with NICUs. In 2001, CPQCC and CCS finalized the reporting format outlining eligibility requirements for member hospital participation, supplemental information required from participating hospitals, report submission procedures and details for program follow-up and evaluation. Due to the success of the CCS/CPQCC joint reporting program, CPQCC began recruiting hospitals for collection of 2001 data. Twenty-four NICUs participated in the joint CCS/CPQCC reporting project. However, it is expected that there will be a significant increase the number of NICUs participating in the near future, since CCS is now mandating that all CCS-approved hospitals submit annual morbidity and mortality data through participation in CPQCC beginning in January 2004.

The Perinatal Quality Improvement Panel (PQIP)
The Perinatal Quality Improvement Panel (PQIP) is a permanent subcommittee of stakeholders with expertise in the area of quality improvement. Through its efforts, CPQCC is building an effective quality improvement infrastructure at the state, regional, and individual hospital levels. PQIP is responsible for analyzing CPQCC data and reviewing the literature for evidence based best practices in perinatal care. Based on its findings, PQIP defines indicators and benchmarks, recommends quality improvement objectives, provides models for performance improvement, and assists providers in a multi-step transformation of data into improved patient care.

CPQCC Toolkits are one of the quality improvement interventions that have been developed by PQIP. CPQCC Toolkits are designed to promote successful quality improvement activities at the hospital level, based on hospital-specific data. To date, CPQCC has developed a series of toolkits, each focusing on key topics related to perinatal care. These toolkits provide valuable information on the following practices:

• Nosocomial Infection Prevention
• Antenatal Corticosteroid Therapy
• Postnatal Steroid Administration
• Reducing Chronic Lung Disease

CPQCC Toolkits can be downloaded from the CPQCC
website at http://www.cpqcc.org

Additionally, CPQCC offers workshops throughout California where teams of practitioners from member hospitals can work together to develop improvement aims, select processes to improve, develop methods to overcome barriers, and prepare personal action plans.