With a renewed national focus on prematurity by public health organizations, and the severe global toll of preterm birth, in 2010 the Illinois General Assembly passed House Joint Resolution 111. The resolution stipulated that the Perinatal Advisory Committee of the Illinois Department of Public Health submit a written report by November 2012 providing findings and recommendations concerning the reduction of preterm births in Illinois. The report was intended to raise the awareness of policy makers, advocacy groups, providers, and the public about this serious problem, and to recommend proven strategies to move Illinois towards the reduction of premature births. The report provided legislators with an overview of the extent and costs of preterm births, outlined known medical and social risk factors of preterm birth, provided recommendations for evidence-based medical and public health strategies, as well as state system and policy changes, to reduce preterm births. The Perinatal Advisory Committee outlined seven recommendations with background, rationale, and required actions (See Below). For the full report please go to http://www.ilmaternal.org/ipihn/PrematurityTaskForceReport102912.pdf
CONSOLIDATE AND LINK DATA SYSTEMS T0 BETTER UNDERSTAND AND PREVENT PREMATURE BIRTHS IN ILLINOIS
Recommendation: Create a comprehensive dataset to enable a more systematic approach to understanding prematurity in Illinois.
ELIMINATE ELECTIVE (NON-MEDICALLY INDICATED) DELIVERIES BEFORE 39 WEEKS GESTATIONAL AGE
Recommendation: Provide resources to ensure Regional Perinatal Centers and all network hospitals implement a hard stop policy to eliminate elective, early term deliveries. Provide necessary clinician education to implement the change process and to monitor progress through ongoing data collection and rapid return of data reports. Implement a statewide consumer awareness campaign directed to women of child-bearing age consistent with the message that healthy babies are worth the wait.
IDENTIFY MEDICAID-ELIGIBLE WOMEN AT RISK OF ADVERSE PREGNANCY OUTCOMES (e.g., women who have had prior preterm birth, perinatal loss, low birthweight infant, baby with birth defect, or present with multiple gestations). PROVIDE ENHANCED PRENATAL CARE THAT LINKS THESE WOMEN TO A MEDICAL HOME AND CARE COORDINATOR AND PRENATAL EDUCATION.
Recommendation: Create and implement a risk-assessment system for identifying early in pregnancy Medicaid-eligible women who are at risk for preterm birth. Provide coordinated, enhanced prenatal care with a maternity medical home provider and intensive care management. Integrate clinical care with nutritional counseling; social support; referrals to appropriate community resources; psychosocial counseling; and coordinated links to WIC, smoking cessation, substance abuse, or other relevant programs that may reduce risk.
INCREASE NUMBER OF SITES AND ENHANCE IMPLEMENTATION OF CENTERING PREGNANCY GROUP MODEL OF PRENATAL CARE IN COMMUNITIES WHERE INCIDENCE OF ADVERSE PREGNANCY OUTCOMES IS HIGH
Recommendation: Pursue sources of funding to increase the capacity of current Centering Pregnancy sites that have been approved by Centering Healthcare Institute (CHI), and expand number of sites to additional Illinois communities where incidence of adverse pregnancy outcomes is high. Consider augmenting content of CenteringPregnancy groups for women at risk of preterm delivery, such as women with gestational diabetes or hypertension. Monitor outcomes of pregnancies of women participating in this group model of care and compare with outcomes of comparable women in traditional care.
PRECONCEPTION, WELL-WOMAN, AND INTERCONCEPTION CARE STRATEGIES
Recommendation: Provide well-woman preventive care for uninsured and underinsured women, and expand availability, access to, quality of, and utilization of a medical home for care during the pre and interconception periods.
ENHANCE REGIONAL PERINATAL SYSTEM TO ENSURE HIGH QUALITY CARE STANDARDS ARE CONSISTENTLY APPLIED IN ALL DELIVERING HOSPITALS AND PREGNANT WOMEN DELIVER THEIR BABIES AT THE RIGHT PLACE AND THE RIGHT TIME.
Recommendation: Provide additional support, personnel, resources, and expertise to develop, implement, and monitor perinatal quality improvement initiatives through the development of a Perinatal Quality Collaborative working in tandem with the Regional Perinatal System. Assess current perinatal system functioning to ensure pregnant women deliver at the right place at the right time and that consistent, high quality perinatal care is provided to mothers and babies.
ADVOCATE FOR INITIATIVES THAT PROMOTE SOCIAL EQUITY AND FOCUS ON REDUCING LONGSTANDING RACIAL AND ETHNIC DISPARITIES IN PREGNANCY OUTCOMES
Recommendation: Raise awareness in the health community of the effects of racism and marginalization on health outcomes. Ensure equal access to culturally-sensitive, patient- centered medical homes coupled with social support and linkages to community resources. Collaborate with and build upon efforts across the state to invest in communities, to provide job-skills training, adequate housing, access to nutritional food sources, and family-centered support services. Train the health care workforce in culturally and linguistically appropriate service delivery. Invest research dollars in determining strategies that are effective in increasing healthy pregnancy outcomes in women of color.
Shortly after the release of the report the Illinois Maternal and Child Health Coalition and the March of Dimes Illinois Chapter hosted a webinar regarding the findings and recommendations in the report, over 140 individuals participated. The webinar had three objectives:
- To understand the problem of premature births in Illinois, including an overview of the extent and costs;
- To be able to identify known medical and social risk factors for preterm birth;
- To learn about the seven recommendations for evidence-based medical and public health strategies, as well as state system and policy changes, to reduce preterm births in Illinois.
For a copy of the webinar slides please go to: http://www.ilmaternal.org/docs/webinars/PrematurityTaskForceReportP.pdf