In 2007, Ohio ranked 34th in preterm (less than 37 weeks gestation) births among all states, and problems related to preterm birth were the state’s leading cause of infant mortality.1 In reaction to the reported ranking, a group of leaders in perinatal health—doctors and nurses, policymakers, and representatives from the Ohio Department of Health and Ohio’s Medicaid Agency—partnered to create the Ohio Perinatal Quality Collaborative (OPQC). This collaborative group is committed to reducing preterm births and improving outcomes of preterm newborns through evidence-based practices and data-driven strategies.
The statewide, multi-stakeholder network has implemented several strategies and programs to improve maternal, infant, and child health. OPQC’s work includes decreasing the number of deliveries between 36 and 39 weeks gestation that are scheduled without a valid medical indication (not medically necessary) and decreasing catheter-associated infection among infants born between 22 and 29 weeks gestation. These programs aim to increase healthy birth outcomes and help prevent death and disability among infants. One Ohio project has already received national attention.
From September 2008 to June 2010, OPQC worked closely with 20 Ohio maternity hospitals, which deliver more than 47% of babies born in the state, to prevent unnecessary scheduled early deliveries between 36 and 39 weeks gestation. Some of the strategies that OPQC helped hospitals and providers implement included:
- Recommending best practices for pregnancy dating with an ultrasound before 20 weeks gestation
- Promoting the American College of Obstetricians and Gynecologists’ Guidelines regarding when deliveries can be scheduled
- Recruiting physician champions who can manage and reinforce the policy systematically
- Publicly sharing hospital-level data on the incidence of scheduled preterm deliveries
These efforts were accompanied by a substantial shift, with an estimated 31,600 births moving from 36–38 weeks to 39 weeks or more between September 2008 and March 2013. Based on recent Ohio experience and data, this decrease in near-term births can be estimated to have prevented as many as 950 neonatal intensive care unit (NICU) admissions, with an estimated cost savings of as much as $19 million. These estimates are based upon expected NICU admissions and previously documented mortality rates for this subset of births in Ohio.
Since February 2012, OPQC has engaged an additional 61 maternity hospitals in an expanded 39-Weeks Project that includes an emphasis on not only the clinical topic of decreasing non-medically indicated early scheduled deliveries, but also on improving birth registry data accuracy. OPQC is on target to engage all Ohio maternity hospitals in this work before the end of 2013.
The Association of State and Territorial Health Officials (ASTHO) recognized OPQC’s efforts to improve maternal, infant, and child health with the 2010 ASTHO Vision Award. This award recognizes health department programs and initiatives that use innovative approaches to address public health needs or problems. OPQC’s collaborative, evidence-based, and data-driven strategies are key to reducing prematurity and improving infant health in Ohio.
1Ohio Perinatal Quality Collaborative. Homepage. Cincinnati, OH: Cincinnati Children’s Hospital Medical Center, Division of Biomedical Informatics; 2013 [cited 2013 Jul 11]. Available from: https://opqc.net/