APHP Ar June 30 update.qxd - Alberta Perinatal Health Program

ALBERTAPerinatal HealthPROGRAM2005-2006Annual Report

PrinciplesThe APHP is committed to playing a vital role in protecting andpromoting the health of the maternal and infant population ofAlberta. The Tripartite Partnership will endeavour to follow andestablish the following principles:VisionOptimal health for expectant mothers and theinfants that are born each year in Alberta.MissionTo promote maternal health, positive birthoutcomes and healthy infancy by providingprovincial leadership and provincial supportto health regions, health professionals, AlbertaHealth and Wellness and other stakeholders.Table of Contents1 Vision, Mission and Principles2 Message from the Minister3 Message from the Chair4 Message from the Director5 Background to Formation of the APHP6 Governance and Accountability6 APHP Organizational Structure7 2005-06 Executive Summary8 2005-2006 Report of Activities,Progress and Challenges- Leadership and Coordination- Education and Consultation- Information Management- Quality Improvement• Regional health authorities (RHAs) should be supported in away that allows women to go through their pregnancy anddeliver their babies within a safe and supportive environmentas close to their community as possible• That ethical guidance regarding health issues acrossthe spectrum from preconception to healthy childbe developed• That healthy pregnancies and deliveries are recognizedas part of the spectrum of perinatal health• That a focus on primary prevention and promotion of healthychoices must be emphasized for all women and their babiesthroughout the perinatal health period• That the needs of women and their infants with high riskpregnancies are addressed in an equitable manner• That special attention be given to the needs ofat-risk populations• That early identification and intervention is emphasized• That the focus of the program will be on maternal and infanthealth within the context of the family• That a population health based approach will guidethe program• That an outcomes oriented approach will be used to measuresuccess of the programIn addition, the program will reflect principles in providingleadership including:• respect for diversities• healthy work places for staff• value for collaborative processes• use of best evidence to support decisions includingeducational programming18 Financial Summary19 Acronyms and Terms20 Committee Members

MESSAGE FROM THE MINISTEROF HEALTH AND WELLNESSMessage from the Minister of Health and WellnessAlbertans should be proud to know that the Alberta Perinatal HealthProgram (APHP) is in place to support optimal health for expectant mothersand the infants that are born each year in Alberta.This provincial program provides outreach education and consultation tostaff, physicians and midwives practicing in hospitals and communitiesthroughout the province. The program has partnered with the Society ofObstetricians and Gynaecologists of Canada to facilitate a patient safetyprogram. We are proud to support this initiative that has resulted in 98percent of the births in Alberta occurring in facilities where an accreditedpatient safety program is in place.Data collected and monitored by the APHP are available to health regionsto assist them with program planning and evaluation of outcomes. Qualityassurance and quality improvement initiatives lead to innovative practicesand reflective learning. The APHP contributes to solutions to support ruralcommunities to be able to offer maternity services as close to home aspossible. I am most pleased to see that this program works in collaborationwith other programs in the province, including the Health Quality Councilof Alberta.I am confident that this program will continue to strive to contribute to thehealth of infants and families in Alberta and I will look forward to reports fromthe program over the coming years.I wish the APHP every continued success.IRIS EVANSMINISTER OF HEALTHAND WELLNESSSincerely yours,Hon. Iris EvansMinister of Health and WellnessGovernment of AlbertaALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 1

MESSAGE FROM THE CHAIRWILLIAM S. HNYDYK, MDCHAIR, COORDINATINGCOMMITTEEMessage from the ChairThis past year marked a new phase for the Alberta Perinatal HealthProgram as it turned the corner from organizational start up. Despitesignificant challenges along the way, staff and leadership have madeimportant strides in implementation as separate entities have merged tocreate a single, effective program.Excitement about this evolution is widespread, according to the results onan interim evaluation. Stakeholders and partners perceive that a cohesivesingle program has been established with considerable potential to positivelyimpact perinatal health in Alberta. Regional health authority (RHA)representatives are enthusiastic about their involvement and, through thePartnership Accord, are engaged with input into program planning andhelping to make the program operational.Staff have begun a strategic planning process for the next three-yearperiod. Addressing broad program scope (preconception through infancy)with a finite budget will be an ongoing challenge and will require thatactivities are prioritized and roles clearly defined within the program. I haveno doubt that the program's talented and dedicated staff under the directionof our program director are up to the challenge.On behalf of the Coordinating Committee, I invite you to review ourannual report and learn more about our accomplishments over the courseof the past year. Finally, and most importantly, I would like to thank ourprogram director, staff, members of our various standing committees andadvisory committee as well as our regional partners for an extremelysuccessful year.Sincerely,William S. Hnydyk, MDChairAlberta Perinatal Health ProgramCoordinating Committee2ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT

MESSAGE FROM THE DIRECTORMessage from the DirectorThe Alberta Perinatal Health Program (APHP) entered into the secondyear of operations with energy and enthusiasm. The major foci were onconsolidating the program, and strategic planning and program delivery.Legal issues relating to transition of the work from three previously existingprograms into the APHP were addressed one by one and with perseverance.At year end, a Partnership Accord Agreement was drafted to declare therelationships of health regions with the APHP.A recent survey conducted as part of our program evaluation highlightedstakeholder satisfaction with APHP education and consultation services, andwith the implementation of the Managing Obstetrical Risk Efficiently(MORE OB ) program. The MORE OB program is a well-received patient safetyinitiative copyrighted and offered with the Society of Obstetricians andGynaecologists of Canada. Several people interviewed expressed surpriseand satisfaction that a new organization could bring tangible benefits soquickly. The program believes that the successes achieved to date may becredited, for the most part, to the working relationships established overmany years.We are confident we can build on the positive attitudes, goodwill andmomentum of the past year to achieve new goals and gradually to expandthe program scope. We will continue to strive to develop our database andand to produce useful reports. The program recognizes the work of theAlberta Medical Association’s Committee on Reproductive Care as itcontinues its role until the new Quality Assurance Standing Committee isestablished under Ministerial Order.It has been a busy year offering both challenges and opportunities. Manyachievements were reached over the past year and the APHP has freshcommitment to many exciting and innovative initiatives that will unfold overthe next three years. I commend the commitment of each of the staff, theCoordinating Committee, the Advisory Committee, participating clinicians.Each of the health regions has been remarkable in its responsiveness torequests for committee membership and in working collaboratively in theinitiation of programs, including MORE OB and Acute Care of the at-RiskNewborn (ACoRN). Finally, we are most grateful for the support fromAlberta Health and Wellness.I invite you to learn more about the APHP.CORINE FRICKDIRECTORSincerely,Corine Frick, R.N., M.N.DirectorAlberta Perinatal Health ProgramALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 3

BACKGROUND FORMATIONOF THE APHP“Committed to supporting perinatalresearch with a view to achievingoptimal health for mothers andinfants in Alberta. The APHP hassupported 16 research projectssince its inception in 2004.”Background to Formation of the AlbertaPerinatal Health Program (APHP)Prior to the formation of the Alberta Perinatal Health Program (APHP) in2004, support to hospitals and professionals in perinatal education, qualityassurance and data management services were provided through threewell-established programs:• The Alberta Medical Association (AMA)'s Committee onReproductive Care, operating under the authority of a MinisterialOrder, with a mandate to monitor and report on perinatal, neonataland maternal deaths and to take steps to ensure quality;• The Northern and Central Alberta Perinatal Outreach Program(NCAPOP); and• The Southern Alberta Perinatal Outreach Program (SAPOP).Each program operated independently under the authority of a separateemployer, with different employment contracts and different mandates.Alberta Health and Wellness (AHW) formally committed to theestablishment of a provincial program in its 2001/02 - 2003/04 BusinessPlan. The existing program funding through the individual programs wouldbe augmented by funding from the September 2000 First Ministers’ EarlyChildhood Development Accord, bringing the total funding for the programto $1.5 million.In July 2003, AHW invited the AMA and the nine regional healthauthorities to submit a proposal to host this program. AHW desired aprogram that would be inclusive of all health regions, encompass a scope ofperinatal health from preconception through one year of age, and reflect apopulation health approach. The AMA, Calgary Health Region (CHR) andEdmonton-based Capital Health (CH) formed a tripartite partnership andresponded with a proposal to undertake the operation and leadership ofthe program under a shared governance model. The tripartite groupproposed formally inviting all other health regions to join the program ina Partnership Accord.AHW approved the proposal and subsequently entered into a grantagreement with the tripartite partnership. Existing staff from the threeprevious programs were transitioned to APHP offices located at theKingsway Professional Building in Edmonton and Foothills Medical Centre,South Tower in Calgary.In October 2004, the APHP received $6.5 million in additional funding toimplement Managing Obstetrical Risk (MOR) over a five-year period. Thisinitiative involves two components: 1) provincial implementation of theManaging Obstetrical Risk Efficiently (MORE OB ) Program, a patient safetyprogram developed by the Society of Obstetricians and Gynaecologists ofCanada (SOGC); and 2) rural strategies for enhancing perinatal health andpatient safety.4ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT

BACKGROUNDFORMATION OF APHPAPHP — Governance and AccountabilityThe APHP is accountable to the Minister of AHW through the tripartitepartnership (AMA, Calgary Health Region and Capital Health). The tripartiteexecutive is comprised of the Executive Director, AMA; Vice President,Calgary Health Region; and Chief Operating Officer, Royal AlexandraHospital, Capital Health. A governance committee comprised of one staffrepresentative from each of the three partner organizations provides theoverall 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 or expertise in perinatal health. Members were selectedfrom the regional health authorities (RHAs), academic institutions, privatemedical specialties and government.APHP Organizational Structure 2005/06ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 5

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGES2005-06 Report of Activities, Progressand ChallengesIn the early stages of the APHP, four functions or program areas wereidentified as categories for operating and reporting: leadership and coordination,education and consultation, information management and quality improvement.Leadership and CoordinationFormation of CommitteesWork on establishing the program Standing Committees commenced in early2005. Terms of Reference were drafted by the director and programcoordinators, and approved by the Coordinating Committee. The programcommittees established by the end of March 2006 were:• Coordinating Committee, meeting on a monthly basis• Advisory Committee, meeting three to four times per year• Education Standing Committee, meeting on a quarterly basis• Information Management Standing Committee, meeting semi annually• Quality Improvement Standing Committee, meeting semi annually• Partnership Accord, meeting two or three times per yearTerms of Reference were established for a Quality Assurance (QA) StandingCommittee which is to replace the AMA Committee on Reproductive Care.However, the new committee to be operated under the umbrella of the APHPhas not yet been granted protection under Alberta's Evidence Act and istherefore not yet formally established. The program is working with AHW tosecure such protection through a Ministerial Order. Until this is resolved, theAMA Committee on Reproductive Care continues to meet.Strategic PlansIn line with the program's business plan requirements, strategic plans weredeveloped for the education and consultation, information management, andquality improvement functional areas in the spring of 2005.New TechnologiesAn ad hoc Prioritization Committee was established and has met on severaloccasions to develop a protocol for prioritizing new technologies. The committeeidentified four technologies for possible provincial implementation and submittedthem for consideration through the Alberta Health Technology Decision Process(AHTDP). By the end of March 2006, the executive committee of AHWapproved and implemented technology decision processes for the followingareas: fetal fibronectin testing for preterm labour, newborn metabolic screeningfor MCAD and other inborn errors of metabolism, newborn screening for cysticfibrosis, and newborn hearing screening.ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 7

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGES"In 2004, over ¾ of stillbirths(78.2%) and neonatal deaths(83.2%) were low birth weight(

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGESLeadership and CoordinationMilestones and Key Activities - April 1, 2005 to March 31, 2006April - June 2005 July - September 2005 October - December 2005 January - March 2006• 2nd staff retreat held• Partnership Accord (PA)Terms of Reference draftedand shared• Strategic plans for IM andQI completed and approvedby CoordinatingCommittee• Evaluation frameworkcompleted and submittedto Coordinating & AdvisoryCommittees & PartnershipAccord• Quarterly reporting systemestablished andimplemented• Program committeestructure established; firstmeetings held• APHP participation inOntario research initiativeto validate prioritizationprocess for new technology• IM information analystrecruited• Letter to RHAsrecommending standardpaper speed of 1 cm/minfor all fetal heart ratetracings• Letter to SOGC to requestsamples of 1cm/min paperspeed fetal heart ratetracings to be included inthe MORE OB educationalmaterials• Education Coordinator,Rural focus recruited• Partnership Accord Termsof Reference adopted• Education & consultationstrategic plan approved byCoordinating Committee• RFP & posting for IM dataarchitect, epidemiologist& preconception healthcoordinator• Communication planapproved by CoordinatingCommittee• Preconception healthproposal developed &submitted• Low birth weight (LBW)Action Plan drafted• Preconception healthcoordinator recruited• LBW Working Groupestablished• Data collection forinterim evaluation ofAPHP underway• Partnership Accordmeetings held byvideoconference involvingacute care & public healthRHA representatives• Ad hoc Prioritizationmeeting to review in-vitrofertilization (IVF) proposal• APHP web site live;including education eventscalendar and Q&A re:Notice of Birth Form• Marketing firm selected fordevelopment of APHPpromotional materials• Core team leadersestablished for fourcore functions• Orientation ofPreconception HealthCoordinator• Documentation providedfor Ministerial Order toenable quality assurancedesignation under AlbertaEvidence Act• Interim Program Evaluationreport submitted• Developed programpromotional materials asper communications plan• Established a Low BirthWeight Working Group,including a planningcommittee to propose andimplement a national/international conferencein 2007 to determinefactors contributing to lowbirth weight and toprioritize interventions• 3rd Staff Retreat held witha focus on team building.• Legal consultationsregarding PartnershipAccord Agreementmaking progressALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 9

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGES"The MORE OB program has beenremarkably effective at improvinginterdisciplinary communicationbetween nursing and medical staffat both a local and regional level,which has inspired policy changesand improved patient care".Family Practice PhysicianLevel 1 Hospital, AlbertaEducation and ConsultationEducation and consultation services were funded by the general APHPgrant, except for the MORE OB patient safety program and rural strategiesfunded by the Managing Obstetrical Risk (MOR) grant.MORE OBAt the end of the 2005-06 year, APHP was ahead of target with theprovincial implementation of Managing Obstetrical Risk Efficiently Program(MORE OB ), with all health regions enrolled in the program. MORE OB is acontinuous patient safety program of the Society of Obstetricians andGynaecologists of Canada (SOGC) that focuses on managing clinicalobstetrical risk and the prevention of adverse events. Each of Alberta's ninehealth regions voluntarily committed to participation in MORE OB and hasbeen responsible for organizing facilities in their region to participate in theprogram. Once a hospital committed to participation, physicians, nurses,midwives and other health professionals involved in the provision of labourand birth care commenced with the program.Work funded through the MOR grant is ahead ofschedule. Original planning anticipated 500participants would begin the MORE OB program ineach of the five years of funding. However, in the first14 months of the MORE OB program there were inexcess of 1,900 participants enrolled. The faster thananticipated enrollment is a welcomed developmenttowards achieving the goal of optimal obstetrical carein Alberta. At year end, more than 98% of births inAlberta occurred in facilities participating in theMORE OB ProgramIn October 2005 four Alberta physiciansreceived the necessary training to become MORE OBRegional Trainers for Alberta. During the year theSOGC provided 14 Module 1 training days in Alberta,as well as seven Module 2 training days. Sixteenhospitals progressed to Module 2 of theMORE OB training.The MORE OB tuition paid in 2005/2006 was higherthan anticipated due to the faster than anticipatedenrollment. A request was made to Alberta Healthand Wellness to reallocate budget for tuition to coverthe costs. The tuition costs will balance out over thegrant funding period and will not exceed the allocated$4,050,000.Health regions continue to identify challenges theyface that impact local implementation of the MORE OBprogram. These challenges include the recruitmentand retention of staff, workload of MORE OB initiatives,budgeting for backfill costs, and the resistance of10ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGESsome key stakeholders. One issue to be resolved is that the process forevent tracking – a quality improvement feature of the MORE OB program – isnot compliant with Alberta legislation. APHP has been working with legalcounsel and the SOGC to establish an event tracking process that iscompliant with provincial legislation.Despite the challenges in implementation of the MORE OB Program,preliminary reporting from the SOGC shows growth in both MORE OBcontent knowledge and change in the obstetrical culture. Anecdotalevidence from health professionals who are participating in the MORE OBProgram has been most positive. A contract is in place for CharisManagement Consulting Inc. to conduct a formal evaluation of initiativesfunded through the MOR grant."Overall, MORE OB has caused asignificant improvement inteamwork. Through MORE OB we allhave the same basic knowledgebase and it helps level the playingfield and supports teamwork. Werecently had a shoulder dystociaand there was no need for concernas both the physician and nursingstaff knew what to do".Manager of Labour and DeliveryLevel II HospitalEducation and ConsultationMilestones and Key Activities - April 1, 2005 to March 31, 2006April - June 2005 July - September 2005 October - December 2005 January - March 2006MORE OB• 2 Health Regions initiateMORE OB• Planning for Module 2Outreach Education• Fundamentals inObstetrical Nursing• Introduction to ObstetricalNursing Course provided in3 health regions• Telehealth sessions• Fetal Health Surveillance• Postpartum Assessment• Experience of HighRisk PregnancyACoRN• Planning for programimplementation initiatedNRP• 1 Instructor course and1 Provider courseSTORC• Planning begins• Education Coordinatorrecruited to developrural strategiesMORE OB• 1,562 participants areunderway in MORE OBat 43 sitesOutreach Education• Options for FHScurriculum explored• Responded to educationrequests from 2 regionsand Paramedic Program• Liaison with RHAs,AADAC, FASD, & AlbertaBreastfeeding Committee• Collaboration withU of C re: 2005/2006videoconference programACoRN• Action plan and budgetdeveloped to pilot ACoRNprovider workshopsNRP• 2 Provider coursesSTORC• Provincial committeeestablished to develop ruralstrategies curriculumMORE OB• All 9 health regions arenow engaged in MORE OB• 4 physicians prepared asregional trainers• poster presented at Halifax5 Patient Safety ConferenceOutreach Education• Fetal Health Surveillance.• Fundamentals inObstetrical Nursing• Ongoing RHA liaisonand supportACoRN• 13 ACoRN instructorsprepared and registered• Pilot provider workshopheld in Medicine HatNRP• Need for NRPinstructors assessedSTORC• Curriculum planningcommenced at 2 dayworkshop hosted by APHPMORE OB• A total of 1,983 seatshave been purchased forthe MORE OB program• 56 Hospitals areparticipatingOutreach Education• Developed 3 ElectronicFetal Monitoring (EFM)case studies to enhanceFetal MonitoringEducation Module• Strategy developed withpartners for physicianeducation regarding alcoholuse in pregnancyACoRN• Provided workshop inCalgary and Edmonton forneonatal transport team• Provided workshop toneonatologists, neonatalnurse practitioners andNICU educators in Calgary• Provided first pilotworkshop to level 1 facilityin BonnyvilleNRP• 1 Provider courseSTORC• Planning second workshopfor curriculum development• E-learning format exploredALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 11

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGESACoRN ProgramACoRN (Acute Care of at-Risk Newborns) is the new Canadianneonatal stabilization program emphasizing teamwork and aninterdisciplinary approach for immediate management of the at risknewborn. It is designed for health professionals who may be called upon tocare for at-risk newborns and their families, regardless of experience ortraining in neonatal emergencies. The APHP is providing leadership in theAlberta roll-out of the ACoRN Program.The ACoRN program has been piloted in both northern and southernAlberta and program planning is underway based on the evaluation of thepilot. As of December 2005,13 registered instructors for the ACoRNprogram were trained and available to work in partnership with APHP toimplement the program province-wide.Percent of Caesarian Sections toWomen Giving Birth in AlbertaYear %2000 19.92001 22.22002 23.02003 23.9Neonatal Resuscitation ProgramAPHP provides leadership for the provincial implementation of theNeonatal Resuscitation Program (NRP). Staff participate as activemembers in the Alberta Neonatal Resuscitation Program CoordinatingCommittee. In 2005/2006 the APHP continued to provide NRP ProviderLevel and Instructor Level Courses. It is anticipated that a revisedCanadian NRP curriculum will be released in June 2006. The APHP hasbeen actively planning for the training of instructors required with releaseof the new curriculum.Consultation and Education RequestsThe APHP continues to provide education sessions on request, withcontent tailored to meet locally identified needs. In an effort to provideeducation that is accessible for health professionals who work in ruralareas, a number of methodologies have been used, including on siteoutreach education and education provided through Telehealth. Examplesof the recent education topics include fetal health surveillance, newbornassessment, breastfeeding, and nursing assessment and care of thewoman in labour.APHP staff respond to requests for information they receive from RHAswithin the province and from other Canadian jurisdictions (e.g., Yukon).The staff either provide the desired information, or recommend a crediblesource for the information.The APHP staff also influence perinatal care in Alberta through theiractive involvement with partners such as the Alberta BreastfeedingCommittee, the Canadian Association of Rural and Remote Nursing, andthe Alberta Alcohol and Drug Abuse Commission.12ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGESRural Education NeedsA provincial committee with representation from each of the nine healthregions and the Northwest Territories was established to determine ruraleducation needs and provide direction for a program to strengthen theknowledge, skills and confidence of nurses working in rural areas of theprovince. The committee members confirmed the importance of a ruralstrategy, recommended the establishment of a committee to guide thiswork, and suggested that e-learning be considered as a vehicle for providingeducation efficiently to all areas of the province. These recommendationshave been acted on by APHP staff. In partnership with the health regions,the rural strategies work is proceeding by developing Strategies forTeaching Obstetrics to Rural and Urban Caregivers (STORC).“The committee membersconfirmed the importance of arural strategy, recommended theestablishment of a committee toguide this work, and suggested thate-learning be considered as avehicle for providing educationefficiently to all areas of theprovince”.STORC ProgramThrough an extensive process of collaboration, including monthlyTelehealth meetings, conference calls, and a two-day workshop, theSTORC committee has developed a curriculum for nurses who arenew to the obstetrical area. The STORC implementation plan includesPhase 1 implementation of the curriculum in the fall of 2006. As a directevolution from the STORC committee, a chat room was establishedwithin the APHP web site for regional education coordinators to shareinformation and resources.Information ManagementConsolidation of DatabaseThe creation of a five-year consolidated data set was achieved forproduction of the first Provincial Perinatal Report 2000-2004, completed inMarch 2006. It was a challenging task for APHP's information management(IM) staff. Historically each data base was developed separately andinvolved different data elements and data definitions. The architecture forthe new comprehensive consolidated database which will include all of thehistorical data (perinatal and mortality) was achieved in late 2005. Theprocess for migration of all existing data to a single repository is under way.The longer term objective of the IM function is to define and develop newprocesses and solutions to replace the existing applications and expand datacollection to meet the full scope of the program — preconception to oneyear of age.Working Groups for Data Process, Data Elements andProvincial ReportingStaff in the program includes an information management coordinator,two data analysts and contracted consultants in the area of informationtechnology and epidemiology. Three working groups were established toguide and support the work of the IM function.ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 13

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGESTotal Live Births in AlbertaYearNumber2000 37,5322001 38,1612002 39,1202003 40,8112004 41,320Stillbirths > or = 500 gramsin Alberta(year rate per 1,000 total births)YearNumber2003 4.02004 4.7Neonatal Mortality > or = 500grams in Alberta*(year rate per 1,000 live births)YearNumber2003 3.22004 2.6* (birth to 28 days)The Data Process Management Working Group was charged withdeveloping and maintaining the data management procedures, managingdata requests (i.e., from researchers), managing change for new initiativesand developing formal guidelines for the new repository. The Groupreviewed and approved a process for the use of APHP data to supportresearch projects, identified and addressed a privacy concern regarding thecollection and reporting of health care provider information, and developedInterim Data Management Guidelines for the program.The Data Elements Working Group was charged with identifying anddefining data elements for the expanded data repository and maintaining thedata dictionary. A phased in approach is being used for expansion of thedata elements. In 2005/06 the focus was on identification of data elementsfor the prenatal time frame. Through a collaborative effort with the qualityimprovement team, a near final draft of a revised paper prenatal form hasbeen achieved, for implementation in 2006. The revised form will be thesource for prenatal data with development and implementation of anelectronic prenatal record.The mandate of the APHP Provincial Report Working Group is todetermine the report design, define the content, assist in interpreting theanalyzed data and report distribution. The Group provided input andguidance for production of the Provincial Perinatal Report 2000-2004completed in March 2006. The Provincial Perinatal Report was presented ata provincial meeting attended by 70 individuals, with representation from all9 health regions.The report demonstrated provincial and regional level dataover a five-year time frame. Among the interesting trends noted in thereport: the total of births in Alberta is increasing, but the total number ofhospitals providing obstetrical services is declining. In 2000 there were 17 of98 facilities that did not offer obstetrical services and in 2004 there were 29of 98 that did not offer obstetrical services.Identification of Data StandardsThe APHP is playing a key role as a resource in the definition of perinataldata elements and is using a standards-based approach for development ofthe new repository. A submission of perinatal data elements from theexisting data was presented to the Health Information Standards Council ofAlberta (HISCA) in early 2006. The submission was accepted in draft asstandards for perinatal data elements in the province. These standards willbe valuable to other information technology initiatives with development ofelectronic health records.14ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGESAPHP Web siteStaff in the IM functional area were assigned the task of establishing anAPHP web site. This was completed in late 2005 when the web site atwww.aphp.ca went live. In addition to basic program information, the website contains a 'What's New' section on educational activities, as well ascommon questions and answers regarding items of interest such as theimplementation of the revised Notice of Birth form.Research SupportToward achieving its goal of optimal health for expectant mothers and theinfants that are born each year in Alberta, the APHP supported eight researchprojects with data during the year. Such requests are expected to increasesubstantially with the achievement of the new provincial database.Information ManagementMilestones and Key Activities - April 1, 2005 to March 31, 2006April - June 2005 July - September 2005 October - December 2005 January - March 2006• 3 working groupsestablished• Initial data mappingtowards consolidating3 databases• Indicators identified forprovincial perinatal reports• Linkages established withprovince-wide initiatives -Regional Shared HealthInformation Program(RSHIP), & Physicians'Office Support Program(POSP)• Formalized proposals toalign IM strategy with CHRre: new depository• Charter Agreementproposed to CH and CHRfor epidemiological support• Timelines & goals set fordata entry and validation• Data provided to 4 RHAs,incl. data for MORE OBenvironmental scan• Data architect contractedto design new repository• Project Charter approvedfor epidemiology services• Data mapping issuesidentified for consolidationof 3 databases• Interim data managementguidelines drafted• Collaboration and testingof link between APHP(south) perinatal data andMaternal Fetal MedicineGroup (Calgary)• Alignment discussions withCH & CHR for IT servicesand technologicalinfrastructure support• Data Elements WorkingGroup working to reviseprenatal record• Responded to 13data requests• APHP requested RHAwritten support forpresenting RHAcomparative data inperinatal report• New data architecturedeveloped; data elements &definitions confirmed; datamigration rules established• Meeting with HISCA toplan for submission ofAPHP data elements forconsideration as Albertastandards• Requirements forReproductive HealthOutcomes Reportdetermined with AHW• Epidemiological servicesaccessed throughCalgary’s Decision SupportResearch Team (DSRT)• IT services agreementformalized through ProjectCharter with CHR• Completing draft ofPrenatal Record• Process for engagingprivacy experts for ongoingadvice established.• Responded to 27data requests• 5-year combined data setcreated for analysis• perinatal and mortality dataused for first APHPProvincial Perinatal Report• Provincial Report presentedto provincial representatives• Migration rules developedfor migration of existingAPHP data to new provincialrepository to reside onAPHP server• Data elements accepted byHealth Standards Council ofAlberta (HISCA) as draftstandards for Alberta• Issues identified regardinghospital comparativereporting• Collaboration with provincialgroups for standardizationof data collection andreporting of breastfeedingdata and postpartumdepression data• Produced and presented thefirst APHP ProvincialPerinatal Report for2000-2004• Meeting with Freedom ofInformation and Protectionof Privacy (FOIPP)legislation experts plannedALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 15

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGES“A key aim of quality improvementis to communicate to healthservice providers, health regionsand professional organizationsabout the factors associated withadverse perinatal outcomes andto make recommendations forimprovements.”Quality ImprovementThe quality improvement strategic plan proposed a Quality ImprovementFramework to guide work in quality assurance (QA) and quality improvement (QI)activities. Immediate objectives included ensuring that QA activities undertakenunder the APHP are afforded protection under the Alberta Evidence Act,developing processes for the study of maternal and infant mortality and morbidity,developing standards and criteria for a provincial review process, responding torequests for assistance in QA by RHAs and establishing linkages withRHA/hospital QA committees. Additional objectives included in the strategic planare to establish provincial processes to study postneonatal mortality and maternaland infant morbidity reviews. A key outcome is a communication process forproviding feedback and recommendations to health care providers, health regionsand professional and government bodies.Subsequent to the development of the Quality Improvement Framework, Termsof Reference for two Standing Committees were developed. The QualityAssurance Standing Committee will undertake the study of maternal and infantmortality and morbidity currently undertaken by the AMA Committee onReproductive Care. The Quality Improvement Standing Committee receivesissues arising from the QA committee's work and makes recommendations forstrategies to address these issues. Strategies will be based on evidence foroptimal practice and may include recommending and disseminating practiceguidelines, knowledge transfer, perinatal forms and the development of practicetools. The first Quality Improvement Standing Committee meeting was held inJanuary 2006. Committee members discussed processes for addressing priorityissues identified through the study of perinatal mortality.Issues Identified by ReviewsThe AMA Committee on Reproductive Care continues to conduct themortality reviews under the current Ministerial Order. Examples of the types ofissues identified through the study of perinatal mortality include:• Pathology reporting and follow-up on outcomes of autopsy;• Access to prenatal ultrasound and consultants;• Diagnosis and management of intrauterine growth restriction;• Recognition of non-reassuring fetal heart pattern and action taken;• Storage and security of fetal heart monitoring strips;• Women receiving prenatal care not following through withrecommendations for follow-up appointments or managementrecommendations; and• Women not seeking prenatal care.Collaborations and PartnershipsThe APHP collaborated with many organizations invested in perinatalhealth including:• Establishing an agreement with the Toward Optimized Practice (TOP)group to work collaboratively on perinatal practice issues;• Partnership with Physicians’ Office Support Program (POSP) todevelop electronic specifications for prenatal record;• Collaborating with Southern Alberta Child and Youth Health Network(SACYHN) on development of a maternal prenatal health screening tool;16ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT

2005-06 REPORT OF ACTIVITIES,PROGRESS AND CHALLENGES• Participating in a national working group established by theCanadian Perinatal Surveillance System to develop standardsfor registration and reporting of perinatal deaths at borderline viability;• Collaborated with AHW, Vital Statistics, and health regions inrevisions to the Notice of Birth and Stillbirth Form; and• Partnering with Alberta Heritage Foundation for MedicalResearch (AFHMR) on the review of protocols for theinvestigation of stillbirths.“Thank you for your recentletter and helpful remarks - it isgreat to see that the PerinatalHealth Program in this provinceis so active in their follow upof cases.”in a letter from a healthservice provider...Quality ImprovementMilestones and Key Activities - April 1, 2005 to March 31, 2006April - June 2005 July - September 2005 October - December 2005 January - March 2006• Validation and analysis of2003 data from 482perinatal cases and 9maternal deaths• 2004 data for 494 casesand 2 maternal deathsrequested and beingentered into database• 23 cases selected for review• Data review of increasedneonatal mortality rate in 1RHA; assisted with servicereview in another RHA• Linkages established withCanadian PerinatalSurveillance System, VitalStatistics Council ofCanada & SOGC re:stillbirth definitions;AHFMR re: stillbirthinvestigation protocol;Toward Optimized Practice(TOP) re: induction of laborand fetal alcohol spectrumdisorder guidelines; HealthQuality Council re: QIframework; AHW re:Notice of Birth form; andSACHYN re: prenatalscreening tool• Work with AARN re:protocols for communicatingnursing-related concernsresulting from reviews• Revised Alberta PerinatalStudy of Mortality form• Partnership with AMAPhysicians and OfficeSupport System, SACYHN,TOP and InformationManagement re: ElectronicPrenatal Record established• Terms of Reference forStanding Committeesapproved by CoordinatingCommittee• 426 of 494 2004 casesreceived and tracked; 68%entered into database• 61 requests for additionalcase information issued• 65 cases received &tracked for 2005• 32 perinatal mortalitycases reviewed; 15 lettersre: case review outcomessent to primary health careproviders and/or RHAs• Assisted one RHA inconducting a service review• Legal consultation re:APHP QA activities underAlberta Evidence Act• Environmental scan todetermine status ofregional or facility-basedperinatal QA AssuranceCommittees• 25 cases reviewed byCommittee on ReproductiveCare; letters sent toproviders and/or RHAs• Health systems issueswere identified throughcase reviews; issues withreceiving case informationwere communicated to thePartnership Accord• 2004 data entry completed• 155 cases tracked for2005; 70 additional casesreceived; 30 entered intodatabase; 50 requests foradditional informationissued• Document for expandedscope drafted andcirculated for feedback• Provincial implementationof Notice of Birth andStillbirth record (NOB)• Alberta Perinatal Studyform revised with legalconsultation• Initiated review of FetalMovement Count chart andNewborn Record• Revised draft NewbornRecord circulated forfeedback• Charter agreement withTOP re: joint effortsrelating to clinical practiceguidelines drafted• Additional case reviewsconducted• 127 cases entered intomortality database• 42 requests for additionalinformation received• Preparation of mortalitydata and issues identifiedthrough mortality reviewfor APHP report• Preparation of mortalitydata for Alberta Health andWellness reproductiveoutcomes report• Involved TOP in revisionsto Medical Induction ofLabour guidelines• Report on feedback fromphysicians to draft ofrevised Alberta PerinatalRecord received• Process under AMACommittee onReproductive Care Termsof Reference continuinguntil protection for QualityAssurance StandingCommittee is providedunder the AlbertaEvidence Act• First meeting of QualityImprovement StandingCommittee plannedALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 17

FINANCIAL SUMMARYAlberta Perinatal Health Program2005/06 - Financial SummaryDescription Expenses Budget Variance1) Operating Grant 1,414,868.41 1,500,000.00 85,131.59a) Salary & Benefits 803,072.35 841,482.00 38,409.65b) Office Expenses 331,414.85 296,526.00 (34,888.85)c) Consultation 240,489.94 293,030.00 52,540.06d) Committees 12,425.27 41,496.00 29,070.73e) Program Evaluation 27,466.00 27,466.00 -2) Information Management Special Purpose Funds 103,385.48 311,952.62 208,567.14a) Working Group Meetings 1,124.42 20,000.00 18,875.58b) Trial revised paper prenatal record andmaternal screening tool 3,211.01 20,000.00 16,788.99c) Consultation 99,050.05 271,952.62 172,902.573) Preconception Health Special Purpose Funds 31,495.60 150,000.00 118,504.40Salary & Benefits 31,495.60 123,629.00 92,133.40Consultation - 18,371.00 18,371.00Committees - 8,000.00 8,000.004) Managing Obstetrical Risk Grant 1,584,108.00 1,601,430.00 17,322.00a) Tuition 1,076,880.00 1,026,630.00 (50,250.00)b) Administrative Costs 75,545.00 75,000.00 (545.00)c) Coordinator costs 104,327.00 80,000.00 (24,327.00)d) Develop & Implement a Rural Strategy 77,936.00 100,000.00 22,064.00e) MORE OB Provincial Core Training Team 249,420.00 254,800.00 5,380.00f) Evaluation - 65,000.00 65,000.00Total $ 3,133,857.49 $ 3,563,382.62 $ 429,525.1318ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT

ACRONYMS AND TERMSAcronyms and TermsAARN -Alberta Association of RegisteredNurses (now known as College andAssociation of Registered Nurses ofAlberta [CARNA])ACoRN - Acute Care of at-Risk NewbornsAHFMR - Alberta Heritage Foundation forMedical ResearchAHTDP - Alberta Health TechnologyDecision ProcessAMA - Alberta Medical AssociationAHW - Alberta Health and Wellness, theprovincial ministry whose mandateincludes perinatal healthCHR - Calgary Health RegionCH - Capital HealthDSRT - Decision Support ResearchTeam (Calgary)FHS - fetal health surveillanceFOIPP - Freedom of Information andProtection of Privacy ActHISCA - Health Information StandardsCouncil of AlbertaIM - Information ManagementLBW - low birth weightMCAD - medium-chain acyl CoAdehydrogenaseMOR - Managing Obstetrical RiskMORE OB - "Managing Obstetrical RiskEfficiently", a patient safety programNeonatal - newbornNRP - Neonatal Resuscitation ProgramNCAPOP - Northern and Central AlbertaPerinatal Outreach ProgramPA - Partnership AccordPerinatal Health - Health of mothers andinfants during the period frompreconception up to the firstyear of lifePOSP -QA -QI -RFP -RHA -RSHIP -Physicians’ Office Support ProgramQuality AssuranceQuality ImprovementRequest for ProposalRegional Health AuthorityRegional Shared HealthInformation ProgramSAPOP - Southern Alberta PerinatalOutreach ProgramSOGC - 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 workALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 19

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 CommitteeDr. William Hnydyk, Senior MedicalAdvisor, Professional Affairs, AlbertaMedication Association (CHAIR)Laurie Blahitka, Director, Women'sHealth, Calgary Health RegionCorine Frick, Director, Alberta PerinatalHealth ProgramSelikke Janes-Kelley, Patient CareDirector, Women's Health Program,Royal Alexandra Hospital, Capital Health20ALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT

Advisory CommitteeCo-chairs:Dr. Reg Sauve, Professor, Departmentof Community Health Sciences,University of CalgaryNeil MacDonald, Executive Director,Population Health Strategies Branch,Alberta Health and WellnessMembers:Dr. Nestor Demianczuk, Division ofMaternal Fetal Medicine, RoyalAlexandra Hospital, EdmontonDr. Phil Etches, Neonatologist, RoyalAlexandra Hospital, EdmontonDr. Charlotte Foulston, Pediatrician,Medicine HatLinda Lacny, Director, Women's Health,Lethbridge Regional Hospital, ChinookHealth RegionDr. Carolyn Lane, Family PracticePhysician, CalgaryDr. Ian Lange, Regional ClinicalDepartment Head, Obstetrics andGynecology, Calgary Health RegionDr. Martin Lavoie, Medical Officer ofHealth, David Thompson Health Region,Red DeerPenny Lightfoot, Director, PopulationHealth and Research, Capital HealthDr. Beverley O'Brien, Professor, Facultyof Nursing, University of Alberta,EdmontonDr. Carol Rowntree, Family PracticePhysician, SundreMarianne Stewart, Senior OperatingOfficer, Primary Care Division CapitalHealth, EdmontonDr. Suzanne Tough, Associate Professor,Department of Community HealthSciences & Pediatrics, University ofCalgary, CalgaryHeather Young, Director of NursingServices, Health Canada, AlbertaRegion, First Nations and Inuit HealthBranch, EdmontonEx Officio MembersLaurie Blahitka, Director, Women'sHealth, Calgary Health RegionJoan Berezanski, Director, Medical CareConsultant, Alberta Health and WellnessXinjie Cui, Manager, SubpopulationSurveillance, Public Health Surveillance& Environmental Health Branch, AlbertaHealth and WellnessCorine Frick, Director, Alberta PerinatalHealth ProgramDr. William Hnydyk, Senior MedicalAdvisor, Professional Affairs, AlbertaMedication AssociationSelikke Janes-Kelley, Patient CareDirector, Women's Health Program,Royal Alexandra Hospital, Capital HealthDr. Gloria Keays, Provincial HealthOfficer, Alberta Health and WellnessIrene Mazurenko, Project Manager,Population Health Strategies Branch,Alberta Health and WellnessJonathan Robb, Acting Manager,Subpopulation Surveillance, PublicHealth Surveillance & EnvironmentalHealth Branch, Alberta Health andWellnessALBERTA PERINATAL HEALTH PROGRAM 2005-2006 ANNUAL REPORT 21

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