Creation of the Neonatal Quality Improvement Collaborative of Massachusetts (NeoQIC) in 2006
NeoQIC first came together from 2002-2004 with respected leaders, all Massachusetts NICUs, MDPH, and outside consultants. Despite the time and energy put into the collaborative, it did not quite stick. In 2006, renewed interest in a neonatal statewide collaborative arose and NeoQIC began hosting biannual meetings starting in 2007 with all ten Level III NICUs in the state and nine members of the Vermont-Oxford Network. The group reached agreements on goals and data and have gradually increased the scope of activities ever since.
NeoQIC’s early work focused on comparative data reports, benchmarking, QI education, and review of best practices. Topic areas included infection, retinopathy of prematurity (ROP), nutrition, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH). NeoQIC added Massachusetts Department of Public Health (MDPH), Massachusetts Perinatal Quality Collaborative (MPQC), and the New England Neonatal Quality and Safety Forum with March of Dimes as partners along the way.
MPDH has a long history of collaboration with NeoQIC, including the provision of support for trainings and workshops and alignment of Title V national and state performance measures of very low birth weight (VLBW), breastfeeding, Safe Sleep, and Neonatal Abstinence Syndrome (NAS). NeoQIC’s NAS, Safe Sleep, and Human Milk projects were conducted between 2013 and 2017.
Creation of the Massachusetts Perinatal Quality Collaborative (MPQC) in 2011
In the late 2010s, the Betsy Lehman Center for Patient Safety (BLC) and Medical Error Reduction at Massachusetts Department of Public Health (MDPH) convened an Expert Panel to examine issues of patient safety and quality in Obstetrics across the state. Fredric Frigoletto, MD acted as chair and Bonnie Glass, RN, MN, was Vice Chair. The expert panel also included Hafsatou Diop, MD, MPH, Glenn Markenson, MD, and Ronald Iverson, MD, MPH, who would go on to become founding members of PNQIN. The task force made recommendations on best practices for areas identified as priorities based on statewide data.
Additionally, MPDH, in collaboration with March of Dimes (MoD) and the Massachusetts Chapter of ACOG (MA-ACOG), began organizing meetings among state perinatal stakeholders to address obstetric quality and safety priorities such as early elective delivery and cesarean section rates. In May 2011, MoD sponsored a joint meeting of all Massachusetts perinatal stakeholders, including key organizations like ACNM, AWHONN, and AAFP. This meeting resulted in a consensus that the state needed a regular forum to address perinatal quality issues; thus, the Massachusetts Perinatal Quality Collaborative (MPQC) was created.
MPQC’s early work in partnership with MoD and MA-ACOG initiated the hard stop policy for elective deliveries prior to 39 weeks. In the mid-2010’s, MPQC focused on the dissemination of best practices and toolkits regarding obstetrical hemorrhage and the treatment of severe hypertension in pregnancy. In 2019, MPQC applied for Massachusetts to become a state within the Alliance for Innovation on Maternal Health (AIM) in an effort to address the disturbing rise in maternal mortality and severe maternal morbidity rates across the U.S.
Creation of Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN) in 2016
As a key partner of both MPQC and NeoQIC, Massachusetts Department of Public Health (MDPH) expressed the need for a joint perinatal quality collaborative to expand and enhance quality improvement initiatives. MPQC and NeoQIC worked together as separate entities, as part of the CDC perinatal quality collaborative (PQC) grant program from 2014-2017.
The Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN) was formed in August 2016 to further unite the efforts of MPQC and NeoQIC and affirm the need for multidisciplinary collaboration in perinatal care. In 2017, with continued support from the CDC, PNQIN launched the Perinatal Opioid Project (POP). This initiative brought together MPQC’s previous efforts around maternal opioid use disorder and NeoQIC’s previous efforts around neonatal opioid withdrawal syndrome (NOWS) and neonatal abstinence syndrome (NAS).
The Perinatal Opioid Project helped make PNQIN into a true statewide PQC. This project brought MPQC and NeoQIC together in a formal quality improvement initiative targeting care of the family, rather than the birthing parent or newborn specifically. In addition, POP reached virtually all perinatal and pediatric centers. Furthermore, POP cemented partnerships between PNQIN and multiple state and community organizations, including MDPH, the Massachusetts Health Policy Commission, the Betsy Lehman Center, the Department of Children and Families, the Bureau of Substance Abuse Services, Early Intervention, and more.
In 2021, PNQIN’s award of a line item in the state budget situates it as a program within MDPH Bureau of Family Health and Nutrition. No MDPH regulations impact PNQIN and MDPH’s commitment to supporting PNQIN’s work is longstanding. MPDH and PNQIN have been and remain aligned in the goal of optimizing health and well-being of Massachusetts birthing families through timely access to relevant data, social determinants of health, and eliminating health inequities.
Funding
PNQIN is supported by a combination of grants (current grants include CDC and HRSA funding), funding from the Alliance for Innovation of Maternal Health (AIM), as well as funding directly from a Massachusetts state line item.
References
Diop, H. & Fitzgerald-Lewis, E. (2022, November 10). The Evolution of the Massachusetts Perinatal Neonatal Quality Improvement Network [PowerPoint presentation]. Boston, MA, United States.