Cincinnati Children's Blog

Collaboration Advances Preemie Care and Lowers Costs

Not long ago, hospitals worked independently and information about medical advances in patient care was shared only in professional journals or at medical conferences. Today, however, evidence-based collaboration is the name of the quality improvement game that’s advancing child health and reducing its related costs – as proven once again by the Ohio Perinatal Quality Collaborative (OPQC).

The underlying problem OPQC wanted to improve was preterm birth, which is the leading cause of infant mortality in Ohio. In fact, the state ranks in the bottom half in America both in terms of prematurity and infant mortality.  And while effective interventions are used in Ohio, they are not used consistently.

Twenty-four level 3 newborn intensive care units in Ohio have been working together on a statewide project that led to a dramatic 20 percent reduction in infections in preterm infants after researchers created a standard set of guidelines governing the use of catheters in infants born at 22 to 29 weeks gestation. The guidelines covered everything from assessing the need for catheters to their insertion and maintenance over time. The project infrastructure and results were so successful, it was published online on February 21 in Pediatrics, the journal of the American Academy of Pediatrics.

In addition, a second OPQC quality improvement project has been working to reduce “unwarranted” near-term births (between 36 and 38 weeks gestation,) which are births scheduled early without a solid medical reason. Full term is considered to be after 39 weeks, and babies are usually born healthier if they are permitted to reach full term in a normal, healthy pregnancy.

The two projects are credited with preventing more than 8,000 late preterm and near-term births and saving Ohio about $20 million in healthcare costs. Also remarkable is that of the 22 states that have applied for similar project funding from the federal government, Ohio was the only one that received it. This is not entirely accurate- Ohio was the first and largest funded federally funded state perinatal improvement collaborative

The magnitude of both OPQC projects was also impressive; 44 obstetric and neonatal provider teams at 24 hospitals, representing 50% of Ohio births and 97% of Ohio infants born between 22 and 29 weeks, Ohio’s Department of Health and their six perinatal regions, and the Ohio Department of Job and Family Services (Medicaid) were all involved. Now that’s a collaboration to brag about! Next on OPQC’ list of improvement topics: antenatal cortico steroids for pregnant women at risk of delivering early and increased use of human milk for premature infants in the NICU.

Barbara Rose is the program director for the Ohio Perinatal Quality Collaborative.

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