Blog : Project to eliminate early elective deliveries transitions into statewide effort
Members of the Quest Healthy Babies, Healthy Moms team received an invitation to an unusual baby shower.
The team’s wrap-up meeting and mock baby shower was a time for celebration. However, the effort to eliminate early elective deliveries is just getting started in Illinois.
Research shows that scheduling babies for delivery prior to 39 weeks gestation is connected to a higher likelihood of death, admittance to a Neonatal Intensive Care Unit (NICU), and life-long health problems.
Yet, an astonishing number of deliveries occur too early with no medical need – 23 percent in Illinois, according to the Leapfrog Group. The numbers show wide variation among hospitals.
The Healthy Babies, Healthy Moms team wants to eliminate early elective deliveries in Illinois. The project’s kick-off meeting (inception) was held on March 3. The project formally concluded at the Dec. 1 meeting. Do the math and you come up with exactly 39 weeks.
“Amazing coincidence,” said the recently hired Quest Program Development Manager Bonnie Paris. “So it was a full-term project.”
The baby’s stats were listed on the invite: Weight (in project binders) – 6 lbs.10 oz. Length (average distance between team members’ locations) –166 miles.
The Healthy Babies, Healthy Moms project was the baby of many committed volunteers from all over the state. The more the team worked, the more they realized they were not alone in their mission. These forces came together at a series of events, where a consensus was reached to form a statewide steering committee that will adopt the Healthy Babies, Healthy Moms name. The efforts will include removing barriers of change, education, and public reporting.
The reason there are so many early elective deliveries is simple: Scheduling delivery makes the event predictable. The mother may choose to schedule delivery to make sure her husband can be present for the delivery before he is deployed overseas. Or, she may want to guarantee a unique birth date such as 11-11-11.
Considering the evidence, it seems like a no-brainer to end the trend. However, the structure of the healthcare system is designed in a way where change is sometimes difficult.
“If it was something that was easy to fix, it would already be practice,” Paris said.
The Quest team identified barriers that were out of their power. For example, a physician is compensated more when present for the delivery. Malpractice also plays a part. A very common contributor to obstetric litigation is failure to perform a C-section soon enough. Another contributor is that there are not enough hospitals instituting policies that bar the practice.
Changes in policy, payment systems, and benefit designs will be among the goals of the statewide steering committee. Different organizations have their own strengths to contribute to workgroups, which will focus on specific areas. Two important areas are education and public reporting.
March of Dimes has already developed a successful education campaign called Healthy Babies are Worth the Wait. Perhaps the most powerful educational piece is the “brain card”, illustrating the brain development at 35 weeks compared to 39 weeks. A baby’s brain at 35 weeks weighs only two-thirds of what it will weigh at 39 to 40 weeks.
Education is an essential ingredient to the effort. Many mothers choose to schedule delivery, unaware of the consequences. In a 2009 survey, only 8 percent of 650 insured women correctly identified 39 to 40 weeks as the earliest point in pregnancy where it is safe for a healthy woman to deliver a baby.
It will take a lot of outreach to etch the number 39 into the minds of expecting mothers.
“You think about a pregnancy being nine months. Then people think of a month as four weeks. You take that times nine and that gives you 36 weeks. Well, the baby should be ready. That is not the case because the weeks just don’t add up like that,” said Quest Project Coordinator Tracey Arahood.
Quest’s role in the committee will likely be in the arena of public reporting and expanding on current performance data available for this measure. Nurses on the team called everyone’s attention to the ePeriNet system, where nurses already enter the necessary data.
Quest saw an opportunity to collect data without asking hospitals to do anything new. In turn, Quest can work with the data to make it more useful. Currently, hospitals can only see their own data and cannot compare themselves to peers.
“Having the nurses on the team, who are in the trenches every day and who work with that system, gave us a different perspective on the data - how we can get it, how we can use it, and how we can help others use it,” Arahood said.
Model for change
The statewide steering committee is currently applying for grant funding, which will determine exactly how much can be done.
“Right now we are in a transition period. We are not stopping work, but there is more work that needs to be done in order to get the statewide initiative to move forward,” Arahood said. “Everyone wants to do it. Everyone is in agreement that it has to be done. But with our project ending formally and the data systems still being worked out, it will still be weeks, months to get everything moving.”
If successful, the Illinois effort may become a model that other states look to on how to affect change on this specific issue or other healthcare quality improvement issues.
“There are two ways that our statewide effort can make a big impact: One is showing that we can tackle something that is this big on different levels and the other way is actually changing the outcomes for the elective early term deliveries,” Paris said.
“We’re really lacking good infrastructure for creating system-wide change in healthcare, so I think this is a good opportunity for us to demonstrate how to change barriers at different levels, including policy, legislation, and education — all these things acting in concert,” she continued.
“There is also a need for the capacity to be able to manage collaborations – bring people together, support them with the tools they need to work effectively, and have that translate into changes — action and policy, that eventually changes outcomes for patients.”
Front row (sitting) (L-R): Lori Filock, Jenny Brandenburg, Dr. Rahmat Na'Allah, Tracey Arahood Back row (standing) (L-R): Robin Grubbs, Bonnie Paris, Darlene Hammond, Dr. Rick Horndasch, Dr. Gail Amundson, Allen Cooper