Members in Action Case Study: Northern New England Perinatal Quality Improvement Network

Dartmouth-Hitchcock Medical Center | Lebanon, N.H.


Sixteen years ago, Victoria Flanagan, R.N., M.S., and Michele Lauria, M.D., M.S., became increasingly alarmed as provider after provider closed vaginal-birth-after-a-caesarean (VBAC) programs across northern New England. In their clinical work, Flanagan and Lauria witnessed the burden such closures placed on women. Thus, what began as a collaborative project to investigate the VBAC issue for their master’s degree program evolved into what is now known as the Northern New England Perinatal Quality Improvement Network (NNEPQIN).

Today, NNEPQIN consists of 43 organizations throughout New Hampshire, Vermont, and Maine involved in perinatal care, including hospitals, state health departments, professional midwifery organizations, and the March of Dimes. The mission of NNEPQIN, a voluntary consortium that fosters interdisciplinary collaboration, is to:

  • Develop best practice guidelines and help its members adapt them for local implementation. Currently, these multidisciplinary guidelines range from “Labor Induction: Elective and Indicated” and “Postpartum Hemorrhage” to “Care of the Newborn at Risk for Neonatal Abstinence Syndrome.”
  • Facilitate benchmarking for excellence in care. In 2012, the state of New Hampshire delegated to NNEPQIN the functions of collecting, analyzing, and disseminating causes of pregnancy-related and pregnancy-associated maternal deaths. Based on these findings, NNEPQIN helps advocate for public health programs and initiatives to address these causes.
  • Develop consistent quality improvement parameters for use throughout the region. NNEPQIN is working with the state health departments in New Hampshire, Vermont, and Maine to develop a regularly updated hospital-level report of aggregate measures drawn from birth certificate and hospital discharge datasets. Sharing a common data set will enable NNEPQIN to track outcomes over time for quality improvement projects.
  • Provide independent and confidential case review of unanticipated perinatal outcomes with structured feedback for participating organizations. NNEPQIN launched an initiative in 2010 that became known as the Confidential Review and Improvement Board (CRIB). CRIB performs multidisciplinary case reviews of unanticipated adverse outcomes under the protection of the Quality Assurance statutes in New Hampshire and Vermont. NNEPQIN uses lessons learned from these reviews to identify topics for regional education and guideline development.
  • Offer state-of-the-science continuing education conferences. NNEPQIN offers 3,500 continuing education credits each year through three annual conferences, two of which are provided free of charge to NNEPQIN members.

“Most of our member organizations practice in small units that serve small communities. We view our role as a translator of national guidance so that our members can operationalize various guidelines and make them applicable to the settings in which they practice,” says Timothy Fisher, M.D., M.H.C.D.S., medical director of NNEPQIN. “Part of the value we bring to our members is that we are ‘honest brokers’ providing a neutral space for people who share common work to come together.”

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