State, March Of Dimes Team Up To Reduce Premature Births

Topeka pediatrician Dr. Dennis Cooley, KDHE Sec. Dr. Robert Moser and Diane Daldrup with the March of Dimes discuss efforts to prevent premature birth March 8, 2013 at the Statehouse. (WIBW)

TOPEKA, Kan. (WIBW) - The state is teaming up with the March of Dimes to ensure babies aren't born too soon.

State health officials announced they've accepted a challenge to reduce the state's pre-term birth rate by 8 percent by 2014. That would translate to 350 more babies being carried to term, bringing the state's premature birth rate from 11.2 percent to 10.3 percent.

The effort includes the March of Dimes "39 Weeks Campaign," which educates parents and health professionals that "healthy babies can wait." The campaign stresses the importance of not delivering before 39 weeks gestation.

Dr. Robert Moser, Secretary of the Kansas Dept. of Health and Environment says, when he was in practice, he, too, didn't realize much difference between 36 and 38 weeks. However, he says new data shows babies carried to at least 39 weeks have a lower rate of hospitalization, respiratory distress, hospital readmission and other complications.

Improving the state's premature birth rate involves strategies such as improving access to health care for expectant moms, expanding education efforts for moms-to-be on measures they can take to ensure a full-term pregnancy and ending the practice of elective early deliveries.

Diane Daldrup, the March of Dimes State Program and Government Affairs Director, said if moms and families have the information, they will make the right decisions.

Several hospitals already have joined the effort by adopting "hard stop" policies on elective early deliveries. Topeka's Stormont-Vail and Geary Community Hospital in Junction City are among them.

Health problems from preterm birth cost the U.S. $26 billion annually. Prematurity is the leading cause of newborn death.

Additional information from KDHE and the March of Dimes:
The Greater Kansas Chapter of the March of Dimes, KDHE and numerous agencies and organizations will be implementing the following initiatives:

Kansas Blue Ribbon Panel on Infant Mortality (KBRP)

The Kansas Blue Ribbon Panel on Infant Mortality was formed in June 2009 with the charge to identify key issues contributing to Kansas infant mortality rates and to provide intervention recommendations to the director of the Kansas Department of Health & Environment. A statewide evaluation was conducted in the first six months to identify those communities with the combination of high infant mortality rates and a significant birth numbers. The counties identified were Sedgwick, Geary, Shawnee and Wyandotte. Key issues were identified and recommendations for possible interventions were developed and published. The identified leading causes for infant mortality in Kansas were premature birth/low birth weight, birth defects and Sudden Infant Death Syndrome (SIDS). The intervention recommendations covered four broad categories: 1) improve data and surveillance 2) expand research, 3) increase public awareness through education and 4) increase access to care and services through implementation of programs and targeted interventions. One key finding was that birth disparities in Kansas were significant with a 2:1 ratio for black/white infant death.

In response to the recommendations, stakeholders on the KBRP worked in partnership to develop resources and initiatives to address identified problems in the targeted communities. These initiatives include:

Ø Becoming A Mom/Comenzando bien Birth Disparities Programs

Ø SIDS Education Initiative

Ø Fetal Infant Mortality Review (FIMR)

Ø Kansas Perinatal Quality Collaborative (KPQC)

Ø Statewide Public Awareness Campaign

Becoming A Mom/Comenzando bien Birth Disparities Programs

Immediately following the release of the Kansas Blue Ribbon Panel recommendations, the Kansas Chapter of the March of Dimes developed plans for implementing birth disparities programs in targeted communities across the state. The philosophy was that every effort should be made to prevent the occurrence of preterm birth and reduce the associated infant mortality rate. The intent was to advance consumer education, assist and augment existing public health services, and clinically intervene in prenatal and pre/interconception periods. The primary goal was to decrease preterm birth by increasing awareness of causal factors while changing the attitudes and behaviors in order to impact community-specific risk factors and to implement prevention strategies.

The Kansas Chapter of the March of Dimes developed a pilot birth disparities program in Salina, Kansas in 2010. The foundation for this pilot was the development of a community collaborative bringing together the county health department, the federally qualified health center (FQHC), the Smoky Hills Family Medicine Residency Program and Salina Regional Medical Center. The community collaborative model creates a long-term, sustainable public/private partnership among clinical and public health partners at the local and state level. It leverages existing resources (staff, educational materials, facilities, clinical services, etc.) supported by Title V funding, Medicaid and foundation grants. Since 2010, the March of Dimes has invested approximately $250,000 to develop and replicate this very successful community collaborative pilot in Sedgwick, Shawnee and Geary counties. MOD’s committed financial investment in these collaborative efforts will continue through 2014 at a minimum.

In Kansas, the birth disparities projects focus on two priority areas – eliminating birth disparities and eliminating elective birth procedures (c-sections/inductions) prior to 39 weeks gestation. The community health education component (provided by county health departments) utilizes the March of Dimes Becoming a Mom and Comenzando bien curricula - each tailored to a specific ethnic group. The hospital component utilizes the March of Dimes 39 Weeks Toolkit (see below) – a tested program that provides a road map to assist with system evaluation and implementation of “hard stop” policies to prevent elective birth procedures and reduce the instance of early-term births and subsequent neonatal intensive care (NICU) admissions. Both programs have standardized evaluation tools and systems are being created to measure outcomes at the community and statewide levels.

Eliminating non-medically indicated deliveries before 39 weeks

As a leader in maternal and infant health for more than 70 years, with a proven track record in perinatal quality improvement, the March of Dimes is a trusted source of information for women, families, clinicians and hospitals. Efforts to improve the quality and safety of perinatal care have received increased focus during recent years and with the publication of Toward Improving the Outcome of Pregnancy III in 2010 ( Research has shown that early elective delivery without medical or obstetrical indication is linked to neonatal morbidities with no benefit to the mother or infant. In 2010, The Joint Commission released a new set of perinatal quality measures that includes the

reduction of non-medically indicated deliveries performed before 39 weeks gestational age. Concurrently, the March of Dimes, in partnership with the California Maternal Quality Care Collaborative (CMQCC) and the California Maternal Child

and Adolescent Division within the state Department of Health, created a toolkit entitled Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age1. This toolkit outlines steps that hospitals can take to begin a quality improvement initiative to eliminate elective deliveries prior to 39 weeks.

The toolkit:

• Helps make the case for eliminating elective deliveries before 39 weeks

• Outlines an implementation strategy

• Describes suggested data collection and quality improvement measurement tools

• Provides recommendations for clinician and patient education including March of Dimes materials

• Includes hospital case studies, a clinician slide presentation and references

Numerous Kansas hospitals have implemented “hard stop” policies and developed 39 week initiatives. In Kansas City these include ten Health Corporation of America (HCA) hospitals, three hospitals in the Saint Luke’s Health System, Shawnee Mission Medical Center and North Kansas City Hospital. Wesley Medical Center (Wichita), Stormont Vail HealthCare (Topeka), Geary Community Hospital (Junction City) and Salina Regional Medical Centerospital(Junction City)

(Salina) have implemented programs as well. These institutions are represented in the Kansas Perinatal Quality Collaborative and will promote statewide implementation and development of a universal evaluation system.

Kansas Perinatal Quality Collaborative (KPQC)

The Greater Kansas Chapter of the March of Dimes is coordinating the formation of the Kansas Perinatal Quality Collaborative to improve service quality and access to care for women and babies statewide. Among the top priorities will be hospital quality improvement projects related to preterm and early term births. One of the first projects of the Kansas Perinatal Quality Collaborative (KPQC) will be the elimination of elective deliveries before 39 weeks of gestation. A contracted consultant through the March of Dimes will be developing KPQC infrastructure, working with KPQC leadership to develop a prioritized, strategic plan that highlights a statewide 39 weeks Initiative, convening quarterly KPQC as well as annual stakeholders meetings, and coordinating regular communication between collaborative members and partners that facilitate development and attainment of goals. The March of Dimes three-year financial investment is $60,000.