NPM: 3: Perinatal Regionalization
Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation Training, Educational Material
Intervention Description: This study was designed to examine the trends for NPM #17 for each State and for all States
combined and to explore reasons that States report for change in this marker. In the first part of
this report, nine years of NPM #17 data are examined to look at trends in the rate of VLBW
deliveries in the appropriate hospital on a State-by-State basis and for all States, calculating the
change in rate over the nine-year period. Part II describes in some detail on information obtained
from both a review of State Title V Application/Annual Reports and from follow-up conversations
with MCH staff in a sample of states. States with rates that have improved, worsened or remained
the same are included.
Primary Outcomes: N/A
Conclusion: Monitoring the NPM #17 rate and addressing barriers to high-risk care is a small part of the perinatal health picture, but, nonetheless, an important one. The rate for all States combined, as well as the rate for most individual States, has not reached the Healthy People 2010 goal of 90% and some rates have changed little since 2000. True improvement is hard to assess, though, when there are many challenges to accurate measurement. States are making efforts to improve their data and are using data to drill down and better target interventions. They are exploring where VLBW births occur and why some do not occur in facilities for high-risk deliveries. Further, they are looking more broadly at fetal and infant mortality through FIMRs. These comprehensive review processes are important because they involve community leaders and explore all contributors to mortality to identify the most appropriate interventions. In the case of VLBW infants, understanding if health care system factors have played a role in a poor outcome and which factors can be modified can be an important contribution to improving this indicator. Surveillance of VLBW births is necessary for the quality improvement initiatives that were frequently mentioned by States as processes by which they hoped to improve neonatal health and health care. Many activities to promote perinatal health and positive birth outcomes are evident in a review of State Title V Annual Reports and also reported by State officials. All States promote and most of them provide early and comprehensive prenatal care that includes screening for risk for premature delivery. Education for consumers, obstetricians, family physicians, nurse midwives, maternity care nurses and others is provided by Title V agencies and by their partners in academic centers and in work groups, task forces, and other organizations devoted to perinatal health. Formal and informal regionalized perinatal care has ensured the availability of facilities for care of high-risk mothers and infants, consultative services to assess the need and co-manage care, agreements for transfer of care and transport services to ensure a smooth transition of care. The value of this National Performance Measure to States ranges from a perception of NPM #17 as a valuable marker of performance and useful tool for program evaluation to a less valuable but necessary monitoring requirement.
Study Design: Systematic Review
Significant Findings: Yes
Setting: Data from all 50 states and PR
Data Source: NPM 17 data and State Title V Application/Annual Reports and from follow-up conversations
with MCH staff in a sample of states
Sample Size: Data from all 50 states and PR
Age Range: N/A