To view the goals and key interventions for the PA PQC’s initiatives in 2022, please view the documents below.
- document Maternal Substance Use Driver Diagram
- document Substance Exposed Newborn Driver Diagram
- document Immediate Postpartum LARC Driver Diagram
- document Moving on Maternal Depression (MOMD) Change Package
- document PA AIM Severe Hypertension and Disparities Bundle
All of the PA PQC’s initiatives in 2022 will follow the timeline depicted below. This page contains additional details about each period: the recruitment period, the implementation period, and the sustaining period.
Birth hospitals can formally join or re-commit to their existing PA PQC initiative(s) by submitting this form to: (1) select the initiative(s) for the Implementation Period; (2) create or update their multi-disciplinary PA PQC healthcare team (including representatives from the participating hospitals); (3) agree to work towards the initiative’s goals; and (4) agree to follow the expectations for the implementation and sustaining periods.
- The “ spreadsheet PA PQC healthcare team ” is meant to be comprised of a multi-disciplinary team with representatives from the inpatient setting, affiliated outpatient clinics, and community-based partners. The PA PQC healthcare team still needs to register via the hospital that is affiliated with the PA PQC.
- The PA AIM initiative also involves: (a) executing a document Memorandum of Understanding (MOU) and Data Use Agreement (DUA) since the information collected through PA AIM is shared with other groups beyond the PA PQC, and (b) completing a spreadsheet Hospital Demographics File for the national AIM Data Center. Both documents can be submitted to firstname.lastname@example.org. (If your hospital participated in the PA AIM initiative in 2021 and is continuing to participate in PA AIM in 2022, please email the PA PQC at email@example.com to request and update your 2021 Hospital Demographics File). The PA AIM initiative is part of the national Alliance for Innovation on Maternal Health (AIM).
During the Implementation Period, the PA PQC healthcare team is expected to do the following for the initiative they join with guidance from their PA PQC quality improvement coach:
- Further form, structure, and expand your multi-disciplinary PA PQC healthcare team
- Prioritize the initiative-specific key interventions to adopt based on your current condition
- Develop and implement a quality improvement plan and protocols with your team to translate the key interventions into practice, making continuous improvements
- Complete quarterly initiative-specific surveys to track your team’s impact on the structure measures compared to your peers in the PA PQC (Due by the end of the month that follows each calendar quarter—April 30, July 31, Oct 31, and Jan 31—with reminders from PA PQC coaches in the middle of the month)
- Submit quarterly aggregated data (numerators, denominators, medians) for the PA PQC process and outcome measures via the PA PQC data portal and annually by race/ethnicity to track your improvement over time compared to your peers (Due by the end of the month that follows each calendar quarter—April 30, July 31, Oct 31, and Jan 31—with reminders from PA PQC coaches in the middle of the month)
- Submit at least one Quality Improvement Report Out, using the QI Report Out Template (Due one week prior to each quarterly PA PQC Learning Session—meaning due on March 24, June 23, September 7, and December 7 for 2022—with reminders from PA PQC coaches two weeks prior to the due date
- Attend the quarterly PA PQC Learning Sessions
To further support the PA PQC healthcare teams, the teams have the option to participate in the following:
- Participate in the initiative-specific PA PQC Virtual Meetings for peer-to-peer learning in-between the quarterly Learning Sessions
- Request trainings via this form on key interventions related to the PA PQC maternal substance use or substance-exposed newborn (SEN) driver diagrams (PA PQC healthcare teams that are participating in the maternal substance use or substance exposed newborn initiatives are eligible to request these trainings)
- Request trainings via this form on IPLARC insertion and removal (PA PQC healthcare teams that are participating in the IPLARC initiative are eligible to request these trainings)
- Apply for Quality Improvement Awards based on the milestones your team achieves each quarter.
Minimum Criteria for Staying Involved in the PA PQC During an Implementation Period
The PA PQC recognizes it takes time to achieve the seven participation expectations listed above during the Implementation Period. As a result, the PA PQC also has a minimum set of criteria for staying involved in the PA PQC during the Implementation Period. This includes all of the following:
- Submitting a QI Report Out, using the QI Report Out Template, during a six-month period;
- Submitting a quarterly initiative-specific survey during a six-month period;
- Having at least one hospital-level representative attend a quarterly Learning Session during a six-month period, AND
- Submitting at least one quarter’s worth of aggregated data for the PA PQC process and outcome during a 12-month period.
If any of the above minimum criteria are not achieved, the PA PQC healthcare team will automatically be put on pause in terms of their participation, meaning the hospital will not be counted as a PA PQC birth hospital and they will not be eligible for the Quality Improvement Awards. Once this occurs, the PA PQC healthcare team will be contacted by the PA PQC’s leadership to discuss a re-engagement plan or to identify a future date to re-consider engagement in the PA PQC. PA PQC teams can re-engage in an initiative at any time by re-submitting the form in the “How to Get Involved” section.
Each Implementation Period will be following by a 12-month Sustaining Period. A PA PQC healthcare team enters a Sustaining Period when the team’s:
- QI Report Outs or Surveys indicate that at least one key intervention from a PA PQC initiative was implemented while participating in that initiative, AND
- submitted data for a related process or outcome measure shows that the PA PQC healthcare team’s goal was achieved and is starting to be sustained over time.
The PA PQC anticipates that it will take about 12 months to enter a Sustaining Period.
While in a Sustaining Period for the key intervention implemented during the Implementation Period, PA PQC healthcare teams will be expected to submit the same survey and measure(s) quarterly that the team submitted during the Implementation Period. These are the only two expectations during the Sustaining Period (e.g., the QI Report Outs do not need to be submitted during the Sustaining Period). To enable PA PQC teams to know whether they are in an Implementation or Sustaining Period for a key intervention, the PA PQC will maintain a record of whether a PA PQC healthcare team is in the sustaining or implementation period for both past and current PA PQC initiatives. PA PQC healthcare teams can email their coach or firstname.lastname@example.org to ask about their status.
Form to Join or Re-Commit to a 2022 PA PQC Initiative
default PA PQC Healthcare Team Form
default Training Request Form for Maternal Substance Use and SEN Initiatives
default Training Request Form for IPLARC Initiative
document PA AIM MOU and DUA
default PA AIM Hospital Demographics File