Directions: To formally join the PA PQC, please complete this survey to identify the core team from your health system or birth center that will participate in the PA PQC. In the survey, you can also suggest community-based organizations that you would like to include in the PA PQC to help your health system or birth center lower maternal mortality and improve care for OUD and NAS. The team roster identified in this survey will: (1) Participate in quarterly, in-person Learning Collaborative sessions; (2) Launch Plan, Do, Study, Act (PDSA) quality improvement cycles in-between the Learning Collaborative sessions; (3) Attend virtual sessions to support their quality improvement projects; (4) Access the Vermont Oxford Network (VON) NAS Universal Training Program and the VON Day Quality Audit to help your organization become a VON Center of Excellence in NAS; and (5) Provide their own data and report the aggregate information through an online data portal, which will trend the outcomes over time and compare it to the outcomes of other health systems in the PQC. After you complete this PA PQC registration form, please go to https://www.whamglobal.org/papqc/get-involved to register for the March 11 1230pm - 2pm Introductory Webinar and for the April 24 830am - 4pm Learning Collaborative session. 

Question Title

* 1. Please name the health system that is joining the PA PQC.

Question Title

* 2. Please list the names of the birth hospitals/centers, NICUs, or perinatal clinics that will participate in the PA PQC.

Question Title

* 3. Please provide contact information for the Provider Champion for your PA PQC's Women's Health Team (e.g., a physician, nurse, or midwife champion who will help lead the maternal mortality and OUD-related quality improvement projects).

Question Title

* 4. Please provide contact information for the Neonatal or Pediatric Provider Champion for your PA PQC Neonatal/Pediatric Team (e.g., a physician or nurse champion who will help lead the quality improvement projects related to improving care for opioid-exposed newborns in your health system).

Question Title

* 5. Please provide contact information for the Administrative Champion for your PA PQC Team who will provide project management assistance.

Question Title

* 6. Please provide contact information for the Data Collection and Reporting Lead for your PA PQC team who will lead the work to internally collect data for your team's quality improvement projects and report aggregate information through an online portal. (This person would also assist with the VON Day Audit if your health system elects to participate in the VON Day Audit.)

Question Title

* 7. Please list the other members of your Multi-Disciplinary Team for Quality Improvement and Learning Activities. For each team members, please enter information using the following syntax: first name, last name, credentials, title, organization, and email. (The champions listed above and the additional team members listed below will be invited to participate in all the PA PQC's activities and resources that were mentioned in this survey's directions.)

Question Title

* 8. Do any of your champions or multi-disciplinary team members have experience with quality improvement and patient safety principles, methods, and tools?

Question Title

* 9. Please suggest community-based organizations outside of your health system that you would like us to invite to join the PA PQC to help lower maternal mortality and improve perinatal care for OUD and NAS.

T