MEETING SUMMARY
Wednesday, April 16, 2014
CLINICAL INTERVENTIONS TO PREVENT PRETERM BIRTH

Prematurity is the most common cause of infant mortality in the United States; more than 34 percent of infant death is
caused by preterm birth.

Nationally, the preterm birth rate has been in decline because of system changes and public reporting of data
on preterm birth.

Over the last several years, physicians in our community have come together to increase use of clinical interventions that
have been proven to reduce preterm birth rates including:
o
o
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Use of progesterone (17P) for women who have a previous preterm birth:

Women who have had a preterm birth (PTB) are at increased risk of having another. Administering 17P to these
women reduces the chance of having another PTB by 33 percent.

Since 2008 the Ohio Better Birth Outcomes Initiative (OBBO), Franklin County hospitals, Columbus Public Health
and Neighborhood Health Centers have been working together to promote 17P use among pregnant women who
have had a PTB.

The number of women who benefit from 17P in our community has grown every year. In 2013, 171 women
received 17P through these providers, but challenges in medication access, provider and patient awareness of 17P
benefits and cost are barriers to increase uptake of this effective intervention.

Other states have adopted successful strategies to promote 17P use including: universal authorization forms and a
centralized website to streamline ordering of the medication.
Reduction in the number of births scheduled before 39 weeks without medical indication:

Research has shown that unless it is medically indicated, early elective delivery of babies before 39-weeks
gestation is linked to neonatal morbidities and is of no benefit to the mother or infant.

National quality organizations such as the Joint Commission, National Quality Forum and The Leapfrog Group
have identified elective deliveries prior to 39 weeks as a key quality indicator for obstetric hospital care.

Since 2008, hospitals in Franklin County have been working to reduce elective deliveries in our community. The
Ohio Perinatal Quality Collaborative (OPQC), a statewide, multi-stakeholder network dedicated to improving
perinatal health in the state, has led this effort.

Since the project’s inception, rates have elective deliveries have decreased significantly around in Franklin
County and the state.

As a result of this learning collaborative, many of the Franklin County health systems have “hard-wired” a review
of early elective deliveries into their systems to ensure progress is sustained.
These clinical interventions are crucial, but in the big picture they serve only as “Band-Aids” without a move upstream to
improve social and economic conditions that affect birth outcomes.
PERINATAL REGIONALIZATION

Extensive evidence indicates that infants delivered before 35-weeks gestation are more likely to survive if they are born
in hospitals with neonatology expertise, neonatal intensive care unit (NICU) capacity and higher patient volumes in
those units.

Regionalized approaches to delivering perinatal services increase the likelihood that the highest-risk newborns, for
example, require advanced technological support for survival are born in appropriately equipped hospitals.
o
Effective regionalization programs have defined “levels of care” for hospitals: Level I hospitals provide care for routine
deliveries; Level II hospitals offer some specialty care, such as short-term stabilization of infants; and Level III
hospitals provide subspecialty services such as high-risk obstetrics and complex neonatal intensive care.
o
In Columbus there are eight birthing hospitals and 11 NICUs or Special Care Nurseries (SCNs). With the exception of
Dublin Methodist Hospital, which has a Level II designation, all of the maternity units and NICUs in Franklin County
have been designated as Level III.
o
A national benchmark for assessing the overall delivery of care for premature infants is the measure of the percent of
very low birth weight (VLBW) infants delivered at facilities for high-risk neonates (Level III); currently the Ohio
Department of Health monitors this indicator across the state.
o
Between 2011-2013, 98 percent of VLBW infants in Franklin County were delivered at Level III facilities.

National studies show that, in addition to meeting level designations, NICUs with a higher volume of VLBW infants have
better outcomes than those with lower patient volumes.

There is currently no systematic effort to monitor volume or perinatal quality outcomes for VLBW babies across hospitals in
our community.
INFANT SAFE SLEEP

Sleep-related infant deaths are those that happen suddenly and unexpectedly in a sleep environment due to a variety of
causes, including: accidental suffocation, positional asphyxia, overlay, sudden infant death syndrome (SIDS) and
undetermined causes. These deaths are largely preventable.

In Franklin County, sleep-related infant deaths accounted for 16 percent of all infant deaths between 2009-2011, nearly half
of which were among black babies.

There is strong and consistent scientific evidence that placing babies in a safe sleep environment— ALONE, on their
BACKS and in a CRIB – is important to reducing the risk of sleep-related infant deaths.

Columbus Public Health will be implementing a local safe sleep public awareness campaign. This project is designed to
leverage and complement the statewide ODH campaign through the use of co-branded materials and expanded
deployment of messages, particularly in high-risk zip codes.

Other local initiatives to promote safe sleep include efforts to improve safe sleep practices in hospital nurseries,
development of a standard tool to assess and address safe sleep in home visiting programs, and individual organization’s
efforts to disseminate free cribs to families that can’t afford them.
SPECIFIC OPPORTUNITIES FOR GREATER COLUMBUS
Progesterone

Continue to promote progesterone and increase use of 17P among women who have had a previous preterm birth, track
use and outcome.

Target efforts to reach highest-risk women and to reduce disparities, and ensure that patient education and outreach efforts
are culturally sensitive and appropriate.

Assess opportunities to expand the progesterone promotion efforts to physicians in private practice.

Assess need to expand access to cervical ultrasounds.
Early Elective Deliveries

Standardize policies for early elective delivery across all Franklin County hospital systems.

We know from the experiences of other communities and several large health systems that we can continue to improve our
rate of early elective deliveries. Set goal to reduce early elective deliveries from 6 percent in our community to no more than
1 percent of resident births.

Report data publicly by institution.
Perinatal Regionalization

Regularly monitor the percent of VLBW babies born in Level III facilities in Franklin County.

Examine VLBW patient volume in all Level III facilities and explore opportunities to “regionalize” within hospital systems to
ensure the community is adhering to all evidence-based standards for perinatal care.
Safe Sleep

Promote safe sleep by adopting common image standards for media and businesses – showing appropriate sleeping
positions and conditions only.

Support safe sleep public health campaign for all with targeted message and outreach to high-risk neighborhoods and
populations. Use messages that reflect cultural sensitivities/biases where appropriate.

Ensure use of consistent messages and approaches for assessing and promoting safe sleep in prenatal and newborn home
visiting programs.

Coordinate system so that no family in need goes home from the hospital without a crib for safe sleeping.

Ensure education for caregivers in other settings where infants may be sleeping, such as childcare settings.
TASK FORCE PROCESS SUMMARY
 An ongoing series of community engagement workshops are currently underway. Dates of public speaking engagements and
information, including meeting summaries and videos from targeted stakeholder workshops are available at www.
gcinfantmortality.org.
 The Greater Columbus Infant Mortality Task force welcomes public input through comment cards available at each of the
meetings or via the Task Force website: www.gcinfantmortality.org.
Next Meeting: May 20, 2014 9 AM - 12 PM