1998-1999


Focus: Medical Informatics, Neonatology, Perinatology, Neonatal Resuscitation

• The Partners


• Partnership Objectives


• Key Events and Achievements


• Partnership Data


• Participating Institutions

The Partners

US Partners: Mary Bridge-Chelyabinsk Affiliation is the voluntary US administrative organization for the partnership. Mary Bridge Children's Hospital and Health Center includes an in-patient facility, 24 pediatric specialty clinics, satellite clinics located in areas of southwest Washington, and ancillary services. Tacoma General Hospital, a general medical and surgical facility, includes a 72-bed neonatal intensive care unit, a perinatal unit, and consultation services. MULTICARE is the corporate organization which includes Tacoma General Hospital and Mary Bridge Children's Hospital and also includes the Regional Medical Library, the Family Practice Residency Program, and the University of Washington Medical Student Rotation and
Instruction Program. Tacoma-Pierce County Health Department is the regional health department for a population of 650,000 people. Pierce County Medical Society is the regional medical society with a
membership of 725 physicians and includes among its programs the College of Medical Education.

Russian Partners: Public Fund Chelyabinsk-Tacoma is the voluntary NIS administrative organization for the partnership. It includes the Ural State Medical Academy for Postgraduate Education; Chelyabinsk City
Children's Hospital No. 8; Chelyabinsk City Clinical Hospital No. 1; Children's Diseases Clinic No. 1; Chelyabinsk City Clinical Hospital No. 9, Maternity Division; Chelyabinsk City Clinical Hospital No. 10;
Chelyabinsk City Clinical Hospital No. 8; Chelyabinsk City Maternity Hospital No. 5; Chelyabinsk Oblast Maternity Hospital; Chelyabinsk Regional Administration; Chelyabinsk City Administration; and central district hospitals in Kusa, Kyshtym, Miass, Satka, and Troitsk.


Partnership Objectives

Key Events and Achievements

Clinical Organization and Capacity Building

In August 1998, AIHA and the US partners completed an initial shipment of equipment for one neonatal resuscitation program training station and began procurement of additional, much-needed equipment and supplies for local institutions.

Partners printed additional copies of the Russian translation of AIHA’s Neonatal Resuscitation Program Providers Manual in Chelyabinsk in response to local needs.

A nurse educator from Tacoma traveled to Chelyabinsk in August 1998 to conduct the first neonatal resuscitation training course held under the auspices of the partnership. A total of 18 healthcare professionals completed the course, including three instructors.

Partners developed a regional plan of neonatal resuscitation training and neonatal care that included community hospitals in Kishtim, Magnetogorsk, Miass, Troitsk, and Zatoust.

Partners at the Ural State Medical Academy for Continuing Education in Chelyabinsk published a 168-page manual titled “Intensive Care of Neonates,” and published a 92-page manual titled “Classification of Diseases of Infants and Children” in 1998.

In 1999, key policymakers and healthcare providers from Chelyabinsk traveled to Tacoma for extensive training on a broad range of newborn survival and care topics.

Through the partnership, Northwest Medical Teams International assisted with the shipment of a 40-foot container of medical supplies and pharmaceuticals valued in excess of $200,000. These critically needed supplies arrived in Chelyabinsk in September 1999 along with a second shipment of neonatal resuscitation training equipment and neonatal care supplies and greatly contributed to the strengthening of institutional capacity at partner facilities in Russia.

Partners focused on continuous quality improvement activities, including ongoing monitoring of the teaching and practice of neonatal resuscitation; collection and analysis of data related to newborn
mortality and morbidity; more effective documentation of rates of nosocomial infections in the newborn intensive care units at partnership hospitals; implementation of quality improvement procedures at
neonatal intensive care units; assessment of current practices on the stabilization and transport of sick and distressed newborns in Chelyabinsk City and region; development of routine procedures for
determining and documenting perinatal risk factors; and implementation of perinatal morbidity/mortality conferencing between obstetricians and neonatologists.

NRTC staff trained 100 percent of the neonatologists working in all Chelyabinsk City children's and maternity hospitals. These centers collectively deliver more than 11,100 infants annually. A total of 52
obstetricians also completed the neonatal resuscitation training.

Partners at Chelyabinsk City Children's Hospital No. 8 implemented new infection control protocols for the Neonatal Intensive Care Unit, which provides care for some 240 patients each year. Prior to 1999 there was no reliable information on the rate of infections in the NICU, but baseline data indicated that 47.8 percent of all patients had urinary tract infections, 8 percent had blood infections, and 30 percent had pneumonia.

Partners completed new protocols related to the education of Chelyabinsk medical professionals in neonatal resuscitation.

Chelyabinsk NRTC instructors completed training of 100 percent of their target providers in the region. As a result of the project, significant improvements in neonatal outcomes were achieved at Chelyabinsk area hospitals whose staff had received neonatal resuscitation training. For example, NICU mortality rates decreased from 26.6 percent in 1996 to 15.6 percent in 2000. The overall neonatal mortality rate decreased from 11.4 percent in 1998 to 10 percent in 2000, while early neonatal mortality rates decreased from 7. 3 percent in 1998 to 6 percent and the perinatal mortality rate decreased from 12.8 percent to 9.3 percent during the same time period.

Through the partnership, the director of the Chelyabinsk regional cystic fibrosis program traveled to Tacoma for training, which was provided by staff at the Southwest Washington Regional Cystic Fibrosis Program, as well as to attend the International Cystic Fibrosis Congress.

Asthma

In response to local needs, partners established an asthma school in Chelyabinsk for the education of medical personnel, as well as the development and provision of asthma education programs for both clinicians and patients. A local physician was selected as director of the asthma school and provided advanced training at McGill University Medical Center.

Partners developed and implemented new training protocols for the asthma school in 2000 and began training Chelyabinsk physicians in pediatric asthma care using World Consensus Conference and NHLBI asthma guidelines.

Partners worked with the American Lung Association to establish a citizen organization in Chelyabinsk.

Partner institutions improved documentation of the number of pediatric asthma clinic visits, the number of hospital admissions, and the hospital length of stay to better inform decision-making.

Partners assisted Chelyabinsk physicians and school officials in the implementation of a survey of asthma symptoms among 6,000 local school children.

Partners helped implement internationally accepted clinical standards and protocols, making these pathways more widely available to Chelyabinsk physicians. As a result, there was a significant increase in nebulizer treatments that use beta agonists and corticosteroids.

Neonatology

Partners tracked and documented neonatal outcomes in major delivery hospitals in Chelyabinsk, as well as in regional hospitals at Kishtim, Magnetogorsk, Miass, Troitsk, and Zatoust.

Partners established a neuro-developmental follow-up program that included all infants discharged from the Neonatal Intensive Care Unit at Children's Hospital No. 8.

Partners trained seven additional physicians as neonatal resuscitation instructors.

In 1999-2000, US partners assisted the Chelyabinsk-Tacoma Fund to further develop procedures and protocols for the regional neonatal care center at Chelyabinsk City Clinical Children's Hospital No. 8 and other regional hospitals.

Members of the partnership evaluated facilities at other regional hospitals and developed plans for future neonatal resuscitation training.

Perinatology and Obstetrics

Partners conducted a neonatal resuscitation provider course for 75 obstetricians and facilitated the inclusion of obstetricians in the Chelyabinsk-Tacoma Fund to improve goal setting, planning, and
implementation of activities.

US partners helped establish routine procedures to document perinatal risk, to provide advance notice of risks to neonatologists, and to effectively plan neonatal resuscitation and transport.

Partners established perinatal morbidity and mortality conferencing between obstetricians and neonatologists at major Chelyabinsk delivery hospitals and Children’s Hospital No. 8.

Medical Informatics

Partners established computer stations at affiliated institutions with modem, CD-ROM capability, and Internet to improve communication capabilities and access to evidence-based clinical resources.

AIHA assisted the Chelyabinsk-Tacoma’s efforts to obtain funding for the establishment of an inter-hospital modem and computer-based network.

AIHA and its partners contributed subscriptions to five American pediatric and neonatology journals and the New England Journal of Medicine, Audiodigest Pediatrics tapes, current editions of five American pediatric and neonatology texts, and monthly transmission of the Sparling Pediatric Abstracts to the Ural State Medical Academy library.

The Chelyabinsk partners developed and implemented a detailed plan for establishment of a modem- and computer-based network based at the Ural State Academy. This network, which includes city and regional hospitals, operates with technical support from the Chelyabinsk Technical University. Initially, partners purchased three computers and modems. The oblast administration approved the plan and budget for development of the Regional Medical Information Center and its location at the Ural State Medical Academy. The Academy, along with the oblast and city government promised more than $15,000 out of the projected budget of $53,649 for its implementation.

Cystic Fibrosis

The director of the Chelyabinsk regional cystic fibrosis program was instructed in Tacoma by Southwest Washington regional cystic fibrosis program staff and he also attended the International Cystic Fibrosis Congress held in Seattle.

The Tacoma co-director lectured on cystic fibrosis diagnosis and care at the postgraduate medical school.

Partnership Data

• Chelyabinsk Regional Health Administration
• Chelyabinsk City Clinical Hospital No. 1
• Chelyabinsk City Children's Hospital No. 8
• The Ural State Medical Academy for Postgraduate Education
• Mary Bridge Children's Hospital and Health Center
• Mary Bridge-Chelyabinsk Affiliation
• Multicare Medical Center
• Tacoma-Pierce County Health Department
• Tacoma General Hospital

Read more about this partnership...

NRTC Sets Regional Standards for Training, Continuing Education (PDF)

Updated: March 13, 2009