Pediatrix Medical Group (Pediatrix) neonatology teams, in collaboration with hospital partners, launched an ambitious quality improvement initiative in 2007 to improve care provided in neonatal intensive care units (NICUs) across the country. Participating practices hit the enrollment target of 100,000 at the program’s midpoint, ultimately reaching 420,000 patients in 330 NICUs by 2013. Results were remarkable. Not only did more babies survive, they survived with fewer complications. Babies spent less time in the NICU. Parent satisfaction went up. Health care costs went down.
The program’s name – the 100,000 Babies Campaign – stuck, a reminder of a lofty goal set, achieved and surpassed. After the official study period ended, practices continued to implement elements of the Campaign and 100,000 Babies became symbolic of neonatal quality improvement in general. In 2020, Pediatrix will build on the Campaign’s success, not as a quality collaborative, but as a series of tools to empower continuous improvement. New areas of focus and a modified program design will give physicians greater autonomy and flexibility to tailor sustaining programs in their local markets.
“Quality has always been central to everything we do; that applies to both clinical care and program design,” says Mack Hinson, MD, President of Pediatrix and Obstetrix Medical Groups. “Our ‘new’ 100,000 Babies Campaign will continue our longstanding tradition of delivering on our promise of quality to our patients, our hospital partners and even our own clinicians.”
A look back
Most quality improvement collaboratives at the time the campaign was launched focused on a single clinical problem or morbidity. The 100,000 Babies Campaign focused on five. Each area selected had the greatest influence on patient outcomes: enhancing nutrition, improving medication use, reducing central line infections, minimizing mechanical ventilation and reducing suboptimal admission temperatures.
From 2007 to 2013, the program showed simultaneous improvement in processes and patient outcomes. Among the most significant, mortality decreased by 22 percent in very low birth weight infants (babies weighing less than 3 pounds, 4 ounces). Severe retinopathy of prematurity, a cause of blindness in premature babies, decreased by 31 percent. Necrotizing enterocolitis, an intestinal disease which can cause death, decreased by 41 percent.
Pediatrix’s large network of NICUs and annual patient volume was necessary to achieve meaningful results. Today, 1,200+ Pediatrix-affiliated neonatal physicians and 975+ advanced practice providers care for 5,350 babies in NICUs every day. The company’s neonatal outcomes database, the primary mechanism for project data reporting, has reached 24,000,000 patient days. Size alone makes Pediatrix a natural industry leader, but the real driver of success, even a decade later, remains an unwavering commitment to the patient. That commitment is evident in the business and clinical infrastructure that Pediatrix’s parent company, MEDNAX, has developed to support advancement. From the Center for Research, Education, Quality and Safety (CREQS) to the newly established Innovation Center, MEDNAX puts patient needs first by focusing on the tools and resources clinicians need to do their jobs well.
The evolution continues
The continuation of the 100,000 Babies Campaign isn’t so much a reboot as it is an evolution, characteristic of the company’s approach throughout its 40-year history.
The 100,000 Babies Campaign expansion incorporates simulation, best practices during the first 60 minutes after a baby’s birth (referred to as the Golden Hour), and efforts to reduce waste and inefficiency in a variety of areas, such as the discharge process. New elements have clinical, operational and financial implications and are expected to grow based on physician feedback and hospital needs. A priority for the support team is to relieve any barrier to implementation to encourage ongoing participation companywide.
A decade later, the program architects are clear that the 100,000 Babies Campaign will never end, but also note that it is part of a much larger effort.
“Over the past year we’ve continued to grow our research portfolio and expanded our patient safety initiatives through High Reliability Organization training and medical simulation. We’ve also introduced clinical initiatives to improve outcomes for babies born with drug addiction, hearing loss and genetic mutations,” says Ingrid Vasiliu-Feltes, MD, MBA, Chief Quality and Innovation Officer at MEDNAX. The Campaign, she explains, is designed to complement other projects such as value-based care and telehealth, both priorities of MEDNAX’s Innovation Center. “The 100,000 Babies Campaign is another piece of the puzzle.”
Read the study results in Pediatrics, the journal of the American Academy of Pediatrics: A Multifaceted Approach to Improving Outcomes in the NICU: The 100,000 Babies Campaign