Wednesday, May 30, 2012

Ohio marks stretch past 39 weeks

Between 1990 and 2006, the rate of U.S. babies delivered before 39 weeks of gestation rose sharply, from 30.3 percent to 41.7 percent. Infants delivered before they have reached full gestational term, 39 to 41 weeks, are more likely to get sick or die. The last few weeks of gestation are vitally important in a baby’s development. Major organs such as the brain, lungs and liver are in the final crucial stages of growth.

Several months ago, I wrote about some new efforts in Massachusetts to avoid pre-39 week elective births and cited some previous work along those lines done by Intermountain Health.  Now, Barbara Rose, from Cincinnati Children's hospital, who is program director at the Child Policy Research Center and the Ohio Perinatal Quality Collaborative, writes to say:

We are one of many statewide perinatal collaboratives using QI science and methods to improve perinatal outcome at the population level.  Our colleagues in Tennessee, North Carolina, New York and other states are doing similar terrific work.

Here is a summary of the process:.

From September 2008–June 2010, QPQC worked closely with 20 Ohio maternity hospitals, which deliver more than 47 percent of babies born in the state, to prevent unnecessary scheduled early deliveries. Some of the strategies that OPQC helped hospitals and providers implement included:
• Recommending best practice pregnancy dating with an ultrasound before 20 weeks gestation;
• Establishing a peer-reviewed written policy that provides clear guidelines and criteria about when deliveries can be scheduled;
• Recruiting physician champions who can manage and reinforce the policy systematically;
• Publicly sharing hospital-level data on the prevalence of scheduled deliveries less than 39 weeks.

Not to beat my favorite dead horse, but please note the importance of transparency in this list. The QPQC understood that public reporting of results helps hospitals hold themselves accountable to the standard of care they are trying to meet.  Here is a slide show used in presentations by the QPQC, showing the overall methodology in more detail. 

As seen the the chart above, to date, nearly 23,000 babies that would have been delivered at 36-38 weeks were delayed to 39 weeks, representing an increase of 8 percent in full-term deliveries. This shift helped prevent approximately 500 admissions to neonatal intensive care units and 34 infant deaths. In addition, this project has saved approximately $27 million in health care costs through avoided NICU (neonatal intensive care unit) admissions.

Funding for these efforts is blended, with various state and private entities providing.  Three states (including Ohio) have CDC funding from the Maternal and Infant Health Branch in the Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), headed by William Callaghan.  Bravo to the CDC for providing important support to this effort!


Amy Romano said...


Early elective deliveries are the tip of the iceberg of overuse, misuse, and unwarranted practice variation in maternity care. We need much more data-driven improvement and my sincerest hope is that the amazing, rapid successes of QI efforts aimed at eliminating elective deliveries will motivate many more improvements.

Lisa McElaney said...

From Facebook:

Check out "Waiting for Baby" which Vida Health Communications ( produced in collaboration with the March of Dimes and has licensed to Aetna. Web and video messaging goes to all second trimester enrollees promoting the health benefits of spontaneous delivery at term - for Moms and babies. Cesareans and inductions need to be the life-saving interventions they are - not the mode of delivery for over 33% of childbirths.