Quality improvement in healthcare has a long history, traceable to Ernest Codman and the American College of Surgeons, resulting in the Hospital Standardization Program in 1917. Together with the American College of Physicians, American Hospital Association, American Medical Association and the Canadian Medical Association, the Joint Commission on Accreditation of Hospitals was formed in 1951. The Joint Commission adopted the framework developed by Avedis Donabedian, in his landmark articles for measuring quality in healthcare. Donabedian’s framework included measuring structure – the physical and staffing characteristics of caring for patients, process – the method of delivery and outcome- the results of care. This framework for quality improvement remains relevant today.
Perhaps the first quality improvement network in neonatal-perinatal medicine was the Vermont Oxford Network (VON). The VON was formed as a voluntary collaborative group of health professionals committed to improving the effectiveness and efficiency of medical care for newborn infants and their families through research, education, and quality-improvement projects. The research program of the Network includes outcomes research, which attempts to identify and explain variations in clinical practice and patient outcomes among NICUs. Quality improvement is a major focus of the VON. Participating NICUs receive confidential reports which document their performance and allows for comparison of practices and outcomes with other NICUs. These reports assist the members in identifying opportunities for improvement and helps monitor the success of their improvement efforts.
Subsequently, states have formed their own quality organizations, of which the California Perinatal Quality Care Collaborative (CPQCC) is the archetype. Formed from the California Association of Neonatologists, the collaborative is supported financially by private and public funds. The initial focus was the development of perinatal and neonatal outcomes and information, which allowed for data driven performance improvement and benchmarking throughout California. Further, the CPQCC has developed a network of stakeholders consisting of public and private, obstetric and neonatal providers, health care purchasers, public health professionals and private sector health industry specialists.
In June, 2012 the Kentucky Perinatal Quality Collaborative (KPQC) was formally established as a committee of the Kentucky Perinatal Association, seeking to initiate quality improvement programs throughout the Commonwealth. While in the midst of formulating the KPQC structure and function, individual members were involved in quality improvement projects focused in reducing infant morbidity and mortality, including the Eliminating of Early Elective Deliveries and the National NICU Central line Associated Blood Stream Infection collaborative (NCABSI). These projects brought together private, professional, public and philanthropic organizations in a collaborative fashion.
The KPQC has an established executive committee, which is meeting on a regular basis. In addition, the KPQC has identified the first collaborative project, being Neonatal Abstinence Syndrome. The KPQC will continue to foster relationships with stakeholders and build upon its infrastructure, leveraging the unique structure as part of the Kentucky Perinatal Association.