(APHP) Annual Report - Alberta Perinatal Health Program

ALBERTAPerinatal HealthPROGRAM2006–2007Annual Report

APHP - GOVERNANCEAND ACCOUNTABILITY“APHP will increasingly consolidateas a highly performing team andbe positioned as the point ofreference for perinatal-relatedissues for health regions, AlbertaHealth and Wellness, and keystakeholders”.APHP — Governance and AccountabilityThe APHP is accountable to the Minister of Alberta Health and Wellness(AHW) through the tripartite partnership (AMA, Calgary Health Region andCapital Health). The tripartite executive is comprised of the ExecutiveDirector, AMA; Vice President, Calgary Health Region; and Chief OperatingOfficer, Royal Alexandra Hospital, Capital Health. A governance committeecomprised of one staff representative from each of the three partnerorganizations provides the overall direction to the program.In addition to the direct line accountability, the Minister of AHWestablished a perinatal health advisory committee comprised of stakeholderswith an interest and expertise in perinatal health. Members were selectedfrom the regional health authorities (RHAs), academic institutions, privatemedical specialties and government.APHP Organizational Structure 2006/074ALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT

2006-07 EXECUTIVE SUMMARY2006-07 Executive SummaryIn the 2006-07 fiscal year the Alberta Perinatal Health Program (APHP)continued to develop as an organization and meet its goals. Majorachievements during the year included the signing of a Partnership AccordLetter of Agreement, expansion of perinatal education programs to meetneeds across the province, development of a provincial web-based datarepository PeriLink AB , and resolving quality assurance issues.In addition, the program was proactive in taking a lead rolealong with partners (AHFMR, CH, CHR, iCARE, IHE) inorganizing and planning an international consensusdevelopment conference on “Healthy Mothers - HealthyBabies: How to Prevent Low Birth Weight” to be held inCalgary in May 2007.The Alberta Prenatal Record (APR) was revised anddistributed. A Healthy Mothers Healthy Babies Questionnairewas added to the APR to enhance prenatal care.Incrementally, the program is expanding towardfull scope by:a) developing a preconception healthframework and with a plan towardcollecting preconception healthdata; andb) working with public healthpartners to develop provincialstandards for data collection andreporting on postpartumdepression and breastfeeding."Low birth weight babies aremore likely to experiencerespiratory, vision, hearing andcognitive difficulties, are morelikely to require hospitalreadmission and have a higherrate of mortality than babiesweighing more than 2500 grams".- from the Conference programALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT 5

2006-07 REPORT AND OUTLOOK2006-07 Report and OutlookThe Alberta Perinatal Health Program has been organized according to fourcore functions or program areas for operating and reporting: leadership andcoordination, education and consultation, quality and innovation and informationmanagement and research.Mean Maternal Ageat Delivery in AlbertaYearAge2000 28.22001 28.32002 28.32003 28.52004 28.52005 28.5Low Birth Weight among live birthsAge %

2006-07 REPORT AND OUTLOOKView to the future…Over the next three years it is anticipated that the APHP will continue todevelop as a highly performing team and be positioned as the point of referencefor perinatal-related issues for health regions, Alberta Health and Wellness, andkey stakeholders. The Preconception Health Framework and the recommendationsin Consensus Statement developed at the conference on “Healthy Mothers -Health Babies: How to Prevent Low Birth Weight” will provide opportunities forbuilding collaborative relationships with more diverse provincial and nationalstakeholders. New companions to our work may include the Institute of HealthEconomics, the Conference Board of Canada, the Association of Women'sHealth, Obstetrical and Neonatal Nurses, and researchers. Increased involvementat provincial and national levels will influence program plans to addresspopulation health determinants and the full program scope.Education and ConsultationThe core business is to: provide learning opportunities and resources for health professionals,health regions, Alberta Health and Wellness (AHW) and otherstakeholders to achieve best perinatal practice.Through the APHP, Alberta health professionals can access up-to-dateknowledge and skills in neonatal resuscitation, stabilization and support of acutelyill infants, implementation of a new test to screen for preterm labour, care for themother and baby in the antepartum, intrapartum and postpartum periods andpatient safety in obstetrical care.2006-07 Highlights Introduced the new Neonatal Resuscitation Program (NRP)curriculum to health professionals in all nine Alberta health regions.This initiative included providing instructor courses for both newinstructors and renewing instructors, and advising hospitals on thepurchase of newly recommended resuscitation program equipment. Piloted the ACoRN (Acute Care of the At-Risk Newborn) Programwith health professionals. This program provides health professionalswho work in rural and urban settings with the knowledge and skillsneeded to support a high-risk infant following resuscitation andbefore neonatal transport occurs. Developed educational materials for the Introduction of FetalFibronectin Testing (fFN) through the Education Standing Committee.Key partners included physicians and staff. AHW has recommendedthat all Alberta Health Regions offer fetal fibronectin testing (ascreening test for pre-term labour) no later than April 2008.Implemented the MORE OB Program (Managing Obstetrical RiskEfficiently Program) in 62 Alberta facilities, in partnership with thehealth regions and the Society of Obstetricians and Gynaecologists ofALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT 9

2006-07 REPORT AND OUTLOOKPictured below is “Noelle” - asimulation mannequin beingused in a MORE OB workshopfor physicians and nurses atthe Big Country Hospital inOyen, Alberta.Canada (SOGC). At year end, more than 2,100 healthprofessionals in Alberta were participating in this obstetricalpatient safety initiative. The vast majority of sites participating inthe program were progressing through the three MORE OBmodules as scheduled, despite the challenge of an increasingworkload in obstetrical units due to the increasing number ofbirths in the province. There is increasingly strong anecdotalevidence of the positive effects of MORE OB in establishing aculture of greater attention to patient safety.Piloted the STORC (Strategies for Teaching Obstetrics to Ruraland urban Caregivers) curriculum in partnership with the nineAlberta Health Regions and the Northwest Territories. Thiscurriculum, prepared through the partnership, is designed tosupport health professionals who are new to the obstetrical area.The curriculum will be accessed by health professionals in thecommunity where they live.Provided obstetrical patient simulation mannequins to each ofAlberta’s health regions to increase teaching capacity for theNRP, MORE OB and STORC programs.Photo above: Liz Duncan, Regional PerinatalEducator for PHR with “Noelle”.Photo above: Dr. Jeffery assisting in“Noelle’s” delivery.View to the future…In collaboration with the Education Standing Committee and the STORCcommittee, the APHP education team is well positioned to continueproviding educational support for Alberta health professionals. The APHPBusiness Plan and Grant Proposal for 2007/2010 include establishing aprocess to enable the education team to respond more effectively torequests for information /education strategies. Three key planning initiativesinvolving the Education team are:1) Building and implementing an education strategic planbased on the outcomes of the consensus conference on“Healthy Mothers - Healthy Babies: How to Prevent LowBirth Weight” in May 2007;2) Working with the Canadian Perinatal Programs Coalition todevelop an educational curriculum based on the new FetalHealth Surveillance Guidelines (FHS) that are scheduledto be released by the (SOGC) in 2007-08; and3) Developing and implementing an education strategic planto address recommendations in the preconception healthframework.10ALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT

2006-07 REPORT AND OUTLOOKHealth Care Facility Births, 2005Health care facility births = number of live born and still born infants delivered inAlberta health care facilities in 2005 including births before admission to hospital.Midwife and home attended births are excluded.ALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT 11

2006-07 REPORT AND OUTLOOK“Continuing to work with healthregions to establish facility andregional perinatal quality assurancecommittees and processes”.Quality and InnovationThe core business is to:facilitate and enhance capacity of health regions, healthprofessionals, Alberta Health and Wellness, and otherstakeholders to achieve optimal perinatal practice.A key component to achieving quality improvement in the work of theAPHP is the integration of quality improvement activities within the functionsof leadership and coordination, information management, and education andconsultation. Through communication, integration, and relationship buildinginternally and externally, the program vision and mission can be achieved.A key quality assurance activity within the function of quality andinnovation is continuation of the study of perinatal mortality and morbidityunder the Ministerial Order to the AMA Committee on Reproductive Care.The process of systematic review considers the population healthdeterminants, clinical practices and service delivery. Through this process,quality improvement strategies for optimal practices are identified. Strategiesmay include knowledge transfer, development or implementation of practicetools, and revisions to standard documentation forms. The aggregatedmortality data are used to report trends in perinatal mortality and factorsassociated with adverse outcomes. Recommendations are communicated toindividual practitioners, the Quality Improvement Standing Committee(QISC) and to facility/regional quality assurance committees.Stillbirths > or = 500 gramsin Alberta(rate per 1,000 total births)YearRate2003 4.02004 4.72005 4.2Neonatal Mortality > or = 500grams in Alberta*(rate per 1,000 live births)YearRate2003 3.22004 2.62005 3.3* (birth to 28 days)2006-07 Highlights In discussion with health regions to create facility and/orregional perinatal quality assurance committees. Completed perinatal mortality case reviews for 2005 and 2006. Established QISC and three quality working groups - MaternityHealth-Related Leave, Intrauterine Growth Restriction, andNewborn Re-admission for Jaundice. Identified an issue in reporting fetal growth and identifying fetalintrauterine growth restriction. Communicated these concernsvia the College of Physicians and Surgeons to providers ofdiagnostic imaging. Clarified role of Office of Medical Examiner in investigation ofmaternal deaths and responsibility for autopsy consent. Consulted with the Health Quality Council of Alberta to applythe quality matrix and quality dimensions to the work of APHP indevelopment of perinatal quality indicators and standards. Provided consultation on perinatal mortality review process tohealth regions and other provinces interested in establishing aperinatal mortality review process. Revised and implemented the Alberta Prenatal Record (APR)and Healthy Mother and Healthy Baby Questionnaire as thestandard for documentation, reporting and communicationof prenatal care.12ALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT

2006-07 REPORT AND OUTLOOKParticipated on provincial, national and international workinggroups regarding interpretation of vital statistics birth andstillbirth definitions, stillbirth classification, stillbirth investigationand health care quality measures and indicators, and contributedto an international study of stillbirth classification.Presented about the Alberta stillbirth definitions and stillbirthinvestigations at the International Stillbirth Alliance Conferencein June 2006 in Japan.View to the future…The Quality and Innovation team will continue to work with health regionsto establish facility and regional perinatal quality assurance committees andprocesses. It has been proposed that the APHP Quality Assurance StandingCommittee (QASC) be designated as a quality assurance committee, andthat the work of AMA Committee on Reproductive Care will be transitionedto the QASC. The focus of the study of perinatal mortality will be on provincialsystem issues. Support will continue to be offered to health regions toconduct mortality and morbidity reviews.In collaboration with AHW Surveillance, Service Alberta - Vital Statisticsand the Office of Medical Examiners, it is proposed that a process forexpansion of perinatal mortality review include maternal deaths up to oneyear post-delivery and post-neonatal deaths to one year of age.Strategies will be recommended and implemented with key partners suchas Toward Optimized Practice (TOP) to minimize perinatal mortality andmorbidity. A process will be developed for the dissemination of practiceguidelines, clinical tools and standards to facilitate optimal practice. Thequality dimensions and quality matrix developed by the Health QualityCouncil of Alberta will be applied in the development of perinatal healthquality indicators and measures.Percent of CaesareanSections to Women GivingBirth in AlbertaYear %2000 19.92001 22.12002 22.92003 23.82004 25.22005 25.7Information Management and ResearchThe core business is to:collaborate with health regions, health professionals, AHW, andother stakeholders on activities to monitor and assess the healthstatus of mothers and infants in Alberta.With direction and assistance from the Information Managementand Research Standing Committee and three working groups, theteam worked throughout 2006-07 to ensure health professionals inAlberta have the data and information required to achieve their goalsfor perinatal health.ALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT 13

2006-07 REPORT AND OUTLOOKThe total number of births inAlberta has increased by 12.6%from 1998 to 2005.2006-07 Highlights Development and implementation of the APHP provincial webbasedconsolidated data repository. Migration of existing perinatal and mortality data for 1992-2005 from the legacy databases to the new consolidatedprovincial data repository. Collaboration with Alberta Breastfeeding Committee and thePost Partum Depression Network to develop provincial datastandards for infant feeding and post-partum depressionscreening. These new standards, accepted in draft by theHealth Information Standards Council of Alberta, build on theset of perinatal data standards for labour and birth submittedby APHP in 2006. Provided information for health professionals, health regionsand other stakeholders in response to ad hoc requests. Duringthe year APHP data supported three research projects, andletters of support were provided to assist in four new projectsin 2007-08. Production of the annual provincial perinatal, hospitalcomparativereport was approved by the Council of ChiefExecutive Officers. Development work began for the second annual provincialperinatal, hospital-comparative report.Total Live Births in AlbertaYearNumber2000 37,5312001 38,1602002 39,2082003 40,8132004 41,3212005 42,631View to the future…The team is well positioned for full implementation of the informationmanagement strategic plan in 2007-08. Highlights of the second annualAPHP Provincial Perinatal Report will be presented to health regions andperinatal stakeholders in Alberta in May 2007. The analysis andinterpretation of the data will support APHP, AHW, the health regions, andother stakeholders in achieving optimal health for expectant mothers andthe infants that are born each year in Alberta. With development ofenhanced data capture processes in the provincial data repository, thethree legacy databases will be retired. Continued development andexpansion of the comprehensive, standards-based data repository will be avaluable province-wide source of integrated perinatal health data ofmothers and babies, from preconception to child infancy. Reporting andanalytical capabilities will be enhanced through new reporting and dataextract tools.14ALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT

FINANCIAL SUMMARYAlberta Perinatal Health ProgramSummary of Financial Results2006/07 - Financial Summary (YTD)Description Expenses Budget/Revenue Variance1) General Operating GrantInterest Earned 06/07**Capital Health Benefit Spending*a) Salary & BenefitsCapital Health Benefit Spending*b) Office Expensesc) Consultationd) Committeese) Program Evaluation2) Information Management Special Purpose Fundsa) Working Group Meetingsb) Trial revised paper prenatal record andmaternal screening toolc) Consultation$ 1,496,895.96 1,500,000.00 3,104.04- 2,016.57 2,016.57- 7,633.21 7,633.21838,025.87 841,482.00 3,456.137,633.21 - (7,633.21)247,827.64 331,141.85 83,314.21345,655.44 258,414.15 (87,241.29)22,258.21 41,496.00 19,237.7943,128.80 27,466.00 (15,662.80)289,418.82 297,843.49 8,424.6718,875.58 18,875.58 -7,985.86 16,788.99 8,803.13262,557.38 262,178.92 (378.46)3) Preconception Health Special Purpose Fundsa) Salary & Benefitsb) Consultationc) Committees4) Managing Obstetrical RiskInterest Earned 05/06**Interest Earned 06/07**Capital Health Benefit Spending*a) Capital Health Benefit Spendingb) Tuitionc) Administrative costsd) Coordinator costse) Develop & Implement a Rural Strategyf) MORE OB Provincial Core Training Teamg) EvaluationTotal115,759.79 118,504.40 2,744.6194,002.84 92,133.40 (1,869.44)15,359.48 18,371.00 3,011.526,397.47 8,000.00 1,602.531,885,664.42 2,054,873.30 169,208.8850,989.95 50,989.30 (0.65)- 86,405.30 86,405.30- 5,489.45 5,489.455,489.45 - (5,489.45)1,308,650.00 1,308,650.00 -86,372.21 122,000.00 35,627.79110,435.89 110,681.00 245.11128,539.77 161,670.30 33,130.53180,779.66 281,872.00 101,092.3470,886.89 70,000.00 (886.89)$ 3,851,851.60 $ 4,123,755.02 $ 271,903.42* Additional One-Time Funds were received to offset expenses related to Out of Scope Benefit Spending: $7,633.35 in the Operating Grant; $5,489.46 for theManaging Obstetrical Risk grant.** Interest earned from the Grants is calculated at the end of the fiscal year.ALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT 15

ACRONYMS AND TERMSACoRN - Acute Care of at-Risk NewbornsAHFMR - Alberta Heritage Foundation forMedical ResearchAMA - Alberta Medical AssociationAHW - Alberta Health and Wellness, theprovincial ministry whose mandateincludes perinatal healthAPR - Alberta Prenatal RecordAPHP - Alberta Perinatal Health ProgramCHR - Calgary Health RegionCH - Capital HealthfFN - Fetal Fibronectin TestingFHS - Fetal Health SurveillanceHISCA - Health Information StandardsCouncil of Alberta(iCARE) - Integrated Centre for CareAdvancement Through ResearchIHE - Institute of Health Economics,Alberta, CanadaIM - Information ManagementLBW - low birth weightMOR - Managing Obstetrical RiskMORE OB - "Managing Obstetrical RiskEfficiently", a patient safety programNeonatal - newborn less than 28 days of ageNRP - Neonatal Resuscitation ProgramPA - Partnership AccordPeriLink AB - The Alberta Perinatal HealthProgram’s provincial datarepository.Perinatal Health - Health of mothers andinfants during the period frompreconception up to the firstyear of lifeQASC - Quality Assurance StandingCommitteeQISC - Quality Improvement StandingCommitteeRHA - Regional Health Authorities (usedinterchangeably with health regions)SOGC - Society of Obstetricians andGynaecologists of CanadaSTORC - Strategies for Teaching Obstetricsto Rural and urban CaregiversTOP - Toward Optimized Practice - a groupformed by a trilateral agreement tosupport evidence-based practiceamong physicians and the teamswith whom they work16ALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT

Tripartite ExecutiveBrenda Fischer, Vice President, Child &Women's Health, Calgary Health RegionMike Gormley, Executive Director,Alberta Medical AssociationJoanna Pawlyshyn, Chief OperatingOfficer, Royal Alexandra Hospital,Capital HealthCoordinating CommitteeSelikke Janes-Kelley, Patient CareDirector, Women's Health Program,Royal Alexandra Hospital, Capital Health(CHAIR)Laurie Blahitka, Director, Women'sHealth, Calgary Health RegionDr. William Hnydyk, Assistant ExecutiveDirector, Professional Affairs, AlbertaMedical AssociationCorine Frick, Director, Alberta PerinatalHealth ProgramAlberta PerinatalAdvisory CommitteeCo-chairs:Neil MacDonald, Executive Director,Population Health Strategies Branch,Alberta Health and WellnessDr. Reg Sauve, Professor, Departmentof Community Health Sciences,University of CalgaryMembers:Dr. Karen Benzies, Associate Professor,Faculty of Nursing, University ofCalgaryDr. James (Jay) Cross, Director,Institute of Maternal and Child Health,University of CalgaryDr. Virginia Clark, Family Physician,CalgaryDr. Albert De Villiers, Medical Officerof Health, Peace Country HealthDr. Charlotte Foulston, Pediatrician,Medicine HatDr. Ian Lange, Professor and Head,Obstetrics and Gynecology, Universityof Calgary/Calgary Health RegionDr. Shoo Lee, Scientific Director,Integrated Centre for CareAdvancement Through Research(iCARE), University of Alberta,Capital HealthPenny Lightfoot, Director, PopulationHealth and Research, Capital HealthDr. Brian Muir, Obstetrician, GrandePrairieDr. Carol Rowntree, Family Physician,SundreDelmarie Sadoway, Senior OperatingOfficer, Community Health Services,Primary Care Division, Capital HealthDr. Suzanne Tough, Associate Professor,Department of Community HealthSciences & Pediatrics, University ofCalgaryDr. John Van Aerde, Regional Directorfor Newborn Services, Northern AlbertaNeonatal Intensive Care Program,Clinical Professor, University of AlbertaHeather Young, Director of NursingServices, Health Canada, AlbertaRegion, First Nations and InuitHealth BranchEx Officio Members:Joan Berezanski, Director, Medical CareConsultant Office, Alberta Health andWellnessLaurie Blahitka, Director, Women'sHealth, Calgary Health RegionDr. Xinjie Cui, Manager, SubpopulationSurveillance, Public Health Surveillance& Environmental Health Branch, AlbertaHealth and WellnessCorine Frick, Director, Alberta PerinatalHealth ProgramDr. William Hnydyk, Assistant ExecutiveDirector, Professional Affairs, AlbertaMedical AssociationSelikke Janes-Kelley, Patient CareDirector, Women's Health Program,Royal Alexandra Hospital, CapitalHealthDr. Gloria Keays, Provincial HealthOfficer, Alberta Health and WellnessIrene Mazurenko, Project ManagerPopulation Health Strategies Branch,Alberta Health and WellnessALBERTA PERINATAL HEALTH PROGRAM 2006-2007 ANNUAL REPORT 17

ALBERTAPerinatal HealthPROGRAMDirectorCorine Frick, R.N., M.N.North Office#300 Kingsway Professional Centre10611 Kingsway Avenue,Edmonton, AB T5G 3C8Tel: (780) 735-1000Fax: (780) 735-1024South Office#310 South Tower,Foothills Medical Centre1403 29 Street NWCalgary, AB T2N 2T9Tel: (403) 944-1242Fax: (403) 944-1243Web site: www.aphp.ca