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Strengthening the evidence for maternal and child health programs

Find State ESMs


Displaying records 1 through 20 (23 total).

3.1 VLBW REDCap Data: Percent of reporting by hospital facilities where VLBW infants were delivered (Utah)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Increase the percentage of reporting by hospital facilities where VLBW infants were delivered

Numerator: Total number of VLBW infants entered into VLBW Database

Denominator: Total number of VLBW infants born in Utah

Significance: Perinatal regionalization classifies hospitals at risk-appropriate levels in regards to care for both mothers and infants. This ensures that high-risk pregnancies and LBW, preterm or other at-risk infants have access to the most appropriate care. In Utah, hospitals self-designate their levels of care and because of this, there is not uniformity with Utah’s leveling. In an attempt to dig past the surface of a self-proclaimed level and see what is actually happening in our facilities, a database has been created that all Utah hospitals report the outcomes of every VLBW infant either delivered or transferred to their facility. This data will allow Utah to have a more informed conversation about the importance of Perinatal Regionalization through the eyes of some of our most ill and vulnerable infants.

Data Sources and Data Issues: Program Specific Data from VLBW Infant Morbidity REDCap Database

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.1 Percentage of non-Regional Perinatal Center hospitals that had at least one formal meeting with staff from their Regional Perinatal Center to discuss the functioning of the Perinatal Regionalization System in their region. (South Carolina)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to producing a count

Goal: Monitor function of the Perinatal Regionalization System at the state (licensing visits) and regional (MOA meetings, regular communication) levels.

Numerator: Number hospitals that staff from Regional Perinatal Centers met with annually.

Denominator: Total number of non-Regional Perinatal Center hospitals delivering live births annually.

Significance: Meetings to assess the functioning of the Perinatal Regionalization System locally and the sharing of strategies statewide drive overall improvements in the SC Perinatal Regionalization System.

Data Sources and Data Issues: SC Perinatal Regionalization System data

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.1 Percentage of birthing hospitals re-designated with updated standards. (New York)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Update NYS perinatal regionalization standards and designations and implement updated performance measures for Regional Perinatal Centers and affiliate birthing hospitals.

Numerator: Number Birthing Facilities Re-designated

Denominator: Total Number Birthing Facilities in the state

Significance: It is imperative for NYS to ensure all perinatal hospitals are functioning in accordance with current standards of care for both maternal and infant outcomes. The last comprehensive review of NY’s regionalized system was in the early 2000s.

Data Sources and Data Issues: NYS Title V Program records - current list of birthing facilities and updated list as birthing hospitals are re-designated.

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.1 Percentage of birth facilities with documented level of care using the LOCATe tool (Mississippi)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Increase access to risk appropriate care for very low birth weight (VLBW) infants and high risk mothers.

Numerator: The number of birth facilities in the state that completed the LOCATe tool to document level of care

Denominator: The total number of birth facilities in the state

Significance: Very low birth weight infants (<1,500 grams or 3.25 pounds) are the most fragile newborns. Although they represented less than 2% of all births in 2010, VLBW infants accounted for 53% of all infant deaths, with a risk of death over 100 times higher than that of normal birth weight infants (≥2,500 grams or 5.5 pounds). VLBW infants are significantly more likely to survive and thrive when born in a facility with a level-III Neonatal Intensive Care Unit (NICU). Assessing the capabilities of birth facilities allows for the development of state-specific acion plans to getting high-risk infants to the correct site of care. LOCATe - The CDC Levels of Care Assessment Tool (CDC LOCATe) is designed to help states and other jurisdictions monitor neonatal and maternal risk appropriate care. CDC LOCATe uses the minimum information necessary to identify a facility’s neonatal level of care, based on criteria by American Academy of Pediatrics, and maternal level of care based recently published criteria by the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine.

Data Sources and Data Issues: MSDH Infant Health Program

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.1 Percent of facilities with a plan for transport out of complicated obstetric/ maternal patients. (California)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Increase the no. of women at high risk to receive care in facilities that are prepared to provide the required level of specialized car

Numerator: no. of facilities in the survey that identified that they have a writtern transport out plan for complicated obstetric/ maternal patients

Denominator: no. of facilities completing the survey

Significance: There is an increased risk of neonatal mortality for very low birthweight infants born outside a level III hospital. Studies have demonstrated that timely access to risk-appropriate neonatal and obstetric care could reduce perinatal mortality. Numerous studies have shown that improved neonatal outcomes were achieved through application of risk-appropriate maternal transport systems. Because all facilities cannot maintain the breadth of resources available at subspecialty centers, interfacility transport of pregnant women or women in the postpartum period is an essential component of a regionalized perinatal health care system.

Data Sources and Data Issues: Data Source: Baseline information will use data collected by the 2016 COIIN Risk-appropriate Perinatal Care Environmental Scan. Data Issue: The data is self-reported at a point in time. To track changes in the percent of facilities with a written plan for transport out of complicated obstetric/ maternal patients, a question from the 2016 Environmental Scan will be asked of facilities annually as part of a follow-up survey. The question to be asked annually is: Does your facility have a written plan for transport out of complicated obstetric / maternal patients?

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.1 Percent of birthing hospitals who complete the CDC Levels of Care Assessment Tool (CDC LOCATe) annually (North Carolina)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: To accurately identify the neonatal and maternal level of care provided at the birthing hospitals in North Carolina

Numerator: Number of birthing hospitals who complete the CDC Levels of Care Assessment Tool (CDC LOCATe) annually

Denominator: Number of birthing hospitals in North Carolina

Significance: Ensuring that infants are born at facilities that are equipped to meet the need of both the infant and the mother is important to improve both maternal and neonatal outcomes. The LOCATe tool is a hospital survey on obstetric and neonatal practices and services which classifies maternal and neonatal levels of care based on responses to survey questions that are tied to criteria found in the 2015 ACOG/SMFM maternal levels of care and the 2012 AAP neonatal levels of care

Data Sources and Data Issues: The Women’s Health Branch will keep an internal log of hospitals that complete the LOCATe tool within each calendar year.

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.1 Number of hospitals provisionally surveyed to determine Obstetric and neonatal level of care. (Indiana)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Provisionally survey 100% of all Indiana hospitals that deliver babies.

Numerator: Number of hospitals surveyed since 2015.

Denominator: Number of hospitals in Indiana with an obstetric service line.

Significance: The level of care designation process will provide a level of confidence that infants born in Indiana are delivered and cared for post delivery at a hospital that can best support their gestational age and medical diagnosis and related risk.

Data Sources and Data Issues: Hospital surveyed as determined by nurses surveyors. Percent of hospitals in Indiana with an obstetric service line as determined by licensure filed with the state.

Year: 2017/2019

Unit Type: Ratio, Unit Number: 1

3.1 Number of communities participating in Every Woman Connecticut (Connecticut)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Implement Every Woman CT Learning Collaborative to give babies across CT a healthy start and ensure that all women and men are as healthy as they can possibly be throughout the course of their life whether they want to start a family or not.

Numerator: # of communities participating in Every Woman CT

Denominator: N/A

Significance: Nearly 3 out of 10 pregnancies in Connecticut in 2013 were unplanned. Only 56.6% of women who were not trying to get pregnant at the time, were using some form of birth control at the time they got pregnant. 40.7% of postpartum women using birth control, were using less or least effective methods of birth control. Only 27.4% of women reported having a “preconception health” discussion with their health care provider prior to becoming pregnant, to help them prepare for a healthy pregnancy. 48.5% of women were overweight or obese prior to becoming pregnant. 19.8% of women were taking medication other than birth control prior to becoming pregnant. 12.8% of mothers received late or no prenatal care, while 22.9% received inadequate prenatal care. Non-Hispanic Blacks, Hispanics, younger women (<20 and 20-24 years), and women who were on Medicaid or uninsured were disproportionately affected by poor health status before, during, and after a pregnancy, unintended pregnancies, and poor birth outcomes. (PRAMS data from Every Woman CT Fact Sheet)

Data Sources and Data Issues: Baseline data collected through assessment survey prior to implementation of One Key Question (OKQ). Survey will assess organizational needs and goals surrounding upcoming implementation of OKQ, as well as baseline data for current services provided related to pregnancy intention screening, pre-/inter- conception health care, and birth spacing/contraception care. 30, 60, and 90-day opportunities for sites to receive targeted technical assistance informed by optional PDSA cycles. PDSA worksheet data will be collected from participating sites and shared on a quarterly basis with members of the collaborative during sharing opportunities (webinars/conference calls/training sessions). Mid-project assessment survey (for comparison with baseline data, identification of outstanding training and technical support needs) End of project assessment survey will be administered to assess changes in practice and successful integration of pregnancy intention screening into regular practice and program workflow. Statewide population data indicators will also be monitored to inform future directions (Inter-Pregnancy Interval, early entry into PN care, unplanned pregnancies, premature birth, and LARC utilization rates). ~ A project of CT MCH Coalition, supported by the March of Dimes CT and Western MA.

Year: 2017/2019

Unit Type: Count, Unit Number: 169

3.1 Number of CenteringPregnancy sites in Michigan (Michigan)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Support and maintain the existing CenteringPregnancy sites in Michigan

Numerator: N/A – This is a count measure

Denominator: N/A – This is a count measure

Significance: The CenteringPregnancy group prenatal care model has been proven effective in reducing premature births and eliminating racial disparities. Funding for new CenteringPregnancy sites is not secured beyond FY2017; therefore, the goal of this ESM currently focuses on maintenance and support of existing sites. Maintaining and helping to strengthen the current sites in Michigan will assist in improvements in the NPM and associated NOMs.

Data Sources and Data Issues: Centering Healthcare Institute https://centeringhealthcare.secure.force.com/WebPortal/ListOfCenteringSites?stateName=MI

Year: 2017/2019

Unit Type: Count, Unit Number: 100

3.1 Implement a quality improvement initiative to increase the number of very preterm maternal transports to Level III or IV facilities prior to delivery (Illinois)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Bottom level: public health services and systems

Service Recipient: Activities related to systems-building

Goal: To ensure that pregnant women and infant at high risk of poor outcomes are appropriately transferred to a Level III or IV facility prior to delivery

Numerator: not applicable

Denominator: not applicable

Significance: This ESM will measure an output of strategy #2-B: Maintain a strong system of regionalized perinatal care by supporting perinatal network administrators and outreach/education coordinators and identifying opportunities for improving the state system. IDPH is currently collecting and analyzing data on very preterm births that occur outside level III facilities to understand the reasons why maternal transports do not occur prior to delivery. Based on the findings of this study, the CoIIN Risk Appropriate Care workgroup will develop a quality improvement initiative to increase the percentage of very preterm infants (<32 weeks) delivered in Level III facilities. This QI initiative will be implemented through the regionalized perinatal system, likely with collaboration from the Illinois Perinatal Quality Collaborative. By ensuring high-risk pregnant women are appropriately transferred to Level III facilities, we would anticipate that the percent of infants delivered in risk-appropriate facilities (NPM #3) would increase. (Measure added September 2016)

Data Sources and Data Issues: CoIIN Risk-Appropriate Care workgroup

Year: 2017/2019

Unit Type: Text, Unit Number: Yes/No

3.1 Ensure risk appropriate care for high risk infants by increasing the number of Missouri birthing hospitals implementing the March of Dimes Preterm Labor Assessment Toolkit (PLAT) to reduce infant mortality/morbidity. (Missouri)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Missouri will increase the number of birthing hospitals implementing the March of Dimes Preterm Labor Assessment Toolkit.

Numerator: Number of birthing hospitals implementing the March of Dimes Preterm Labor Assessment Toolkit.

Denominator: N/A

Significance: Preterm birth is the leading cause of infant death, with most preterm-related deaths occurring among babies who were born before 32 weeks. Preterm birth is also a leading cause of other long-term disabilities in children. The State of Missouri has a preterm birth rate of 9.8% (2014). On average, 1,100 infants are born at very low birth weight and about 1,500 infants are born very preterm each year in Missouri. Up to 19% of these babies are NOT born at a facility with a neonatal intensive care unit specifically equipped for their care. Risk appropriate care is a formal system of assessing a facility’s ability to deliver specialized care to both pregnant moms and newborns. It establishes a clear network for appropriate referrals based on hospital assessments, with the goal of ensuring moms and babies receive the right care, at the right time, and at the right place. Overall, national infant mortality rates have declined since 1995. In spite of our state’s rate decline, Missouri’s infant mortality rate is 6.1 per 1,000 live births (2014) compared to the United States at 5.82 per 1,000. Although the infant mortality rate has steadily declined, there is still more that can be done, especially with the racial and ethnic disparities that exist. Each premature birth in Missouri costs the State an average of $75,000 in immediate and short-term costs. These costs are in addition to the immeasurable emotional and psychological costs suffered by those coping with the extended effects of prematurity and infant mortality. A goal of Healthy People 2020, is to reduce the infant mortality rate to 6.0 per 1,000 live births. Missouri chose to increase the number of hospitals implementing the March of Dimes Preterm Labor Assessment Toolkit to standardize the assessment and treatment of women presenting at hospitals with preterm labor signs and symptoms. This toolkit incorporates advances in research and best practices to ensure women are treated for preterm labor appropriately.

Data Sources and Data Issues: Missouri Hospital Association yearly survey.

Year: 2017/2019

Unit Type: Count, Unit Number: 100

3.2 To improve the system of perinatal regionalization statewide in order to increase the number of very low birthweight (VLBW) deliveries at an appropriate level of care facility. (Alabama)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Bottom level: public health services and systems

Service Recipient: Activities related to systems-building

Goal: To improve the system of perinatal regionalization statewide in order to increase the number of very low birthweight (VLBW) deliveries at an appropriate level of care facility.

Numerator: VLBW deliveries in Level 3 and Level A hospitals

Denominator: Number of VLBW births statewide

Significance: Alabama continues to focus on preterm births with the selection of a new ESM to address improving the system of perinatal referral and transfer for high risk mothers and infants. In collaboration with the CoIIN Perinatal Regionalization Workgroup, the Alabama Hospital Association, the Alabama Chapter-American Academy of Pediatrics, the Alabama Section-American Congress of Obstetricians and Gynecologists, and others the Alabama Perinatal Regionalization System Guidelines were established. The State Perinatal Advisory Committee made a recommendation to the State Health Officer in August 2017 to endorse the Alabama Perinatal Regionalization System Guidelines as best practice for providing care to high risk women and infants. In September 2017, the State Committee of Public Health approved and signed a Resolution that acknowledged the Guidelines as best practice. In December 2017, a small subset of the CoIIN work group met to determine next steps in moving the initiative forward. A data collection tool was created for Level 1 and Level 2 hospitals to collect information on the number of VLBW infants born in their facility. Utilizing the Alabama Public Health Training Network, Dr. Scott Harris, State Health Officer, recorded a five minute video reviewing the four neonatal levels of care. The Alabama Hospital Association has developed a one page informational flyer and survey to allow all delivering hospitals in Alabama to self-declare their neonatal level of care. Hospitals will be provided the data collection tool and asked to complete the tool for any infant born in a Level 1 or Level 2 hospital that weighs less than 1,500 grams or is less than 32 weeks gestation. This tool is for hospital use only. Alabama is a state that does not regulate delivering hospital’s neonatal levels of care. Annually the hospitals are surveyed by the State Health Planning and Development Agency (SHPDA) and self-declare the neonatal level of care. The ADPH will collaborate with SH

Data Sources and Data Issues: Alabama Department of Public Health's Center for Health Statistics

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.2 Percent of very preterm infants born in a non-Level III hospital with a VPT review form submitted to IDPH (Illinois)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Top level: direct services

Service Recipient: Activities directed to families/children/youth

Goal: To collect information on the reasons why women are not transported to a risk-appropriate facility prior to delivery

Numerator: # of VPT infants born in a non-Level III facility with a VPT form submitted to IDPH

Denominator: # of VPT infants (22-31 weeks gestation) born in a non-Level III facility

Significance: This ESM will measure an output of strategy #2-B: Maintain a strong system of regionalized perinatal care by supporting perinatal network administrators and outreach/education coordinators and identifying opportunities for improving the state system. IDPH is currently collecting and analyzing data on very preterm births that occur outside level III facilities to understand the reasons why maternal transports do not occur prior to delivery. Based on the findings of this study, the CoIIN Risk Appropriate Care workgroup will develop a quality improvement initiative to increase the percentage of very preterm infants (<32 weeks) delivered in Level III facilities. This QI initiative will be implemented through the regionalized perinatal system, in collaboration with the Statewide Quality Council and Illinois Perinatal Quality Collaborative. By ensuring high-risk pregnant women are appropriately transferred to Level III facilities, we would anticipate that the percent of infants delivered in risk-appropriate facilities (NPM #3) would increase. (measure added June 2017)

Data Sources and Data Issues: Data Source: birth certificates, e-Perinet (hospital reporting system) Issues: will use all infants born at gestational age 22-31 weeks on birth certificate as denominator. Form submission is counted in numerator if any of the following are true: a) hospital submitted VPT form to IDPH b) hospital verified that birth certificate gestational age was incorrect, and infant was not actually very preterm c) hospital verified that delivery was a fetal death (and should not have had a birth certificate filed)

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.2 Evaluation and classification of the hospitals in Puerto Rico according to the maternal and perinatal care guidelines will be completed by September 2018 (Puerto Rico)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: A report regarding the findings of the hospitals classification levels assessment in Puerto Rico will be completed by September 2018.

Numerator: N/A. This is a qualitative measure regarding the completeness of a product or an action in a specific date.

Denominator: N/A. This is a qualitative measure regarding the completeness of a product or an action in a specific date.

Significance: The maternal and perinatal care guidelines for the classification of Hospitals in PR adapted from the American College of Obstetrician Gynecology and the American Academy of Pediatrics will be developed by a group of stakeholders and interdisciplinary experts on maternal and newborn care. These guidelines will be used to evaluate and reclassify hospitals in Puerto Rico in an effort to identify resources and needs of the health care delivery system available for optimum maternal and newborn care. Regionalization of perinatal care is one strategy chosen by COIIN in an effort to improve Maternal and Infant Death rates. Evaluating hospitals is a first step in implementing changes.

Data Sources and Data Issues: Program logs, reports and produced documents.

Year: 2017/2019

Unit Type: Text, Unit Number: Yes/No

3.2 Development and distribution of a perinatal regionalization educational fact sheet for legislators (Arkansas)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to professionals

Goal: To ensure that higher risk mothers and newborns deliver at appropriate level hospitals.

Numerator: Development and distribution of a perinatal regionalization educational fact sheet for legislators

Denominator: Development and distribution of a perinatal regionalization educational fact sheet for legislators

Significance: Related to Maternal, Infant, and Child Health (MICH)-33: Increase the proportion of very low birth weight (VLBW) infants born at Level III hospitals or subspecialty perinatal centers. Low birth weight or premature infants born in risk-appropriate facilities are more likely to survive. Multiple studies indicate VLBW infant mortality is lower for infants born in a Level III center (higher level of care), and higher for infants born in non-Level III centers.

Data Sources and Data Issues: Program Information

Year: 2017/2019

Unit Type: Text, Unit Number: Yes/No

3.2 Develop facility specific reports describing NPM 3, the LOCATe tool, their results and their outcomes for neonatal births, deaths and <32 week transfers. (Mississippi)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Increase access to risk appropriate care for very low birth weight (VLBW) infants and high risk mothers.

Numerator: not applicable

Denominator: not applicable

Significance: Very low birth weight infants (<1,500 grams or 3.25 pounds) are the most fragile newborns. Although they represented less than 2% of all births in 2010, VLBW infants accounted for 53% of all infant deaths, with a risk of death over 100 times higher than that of normal birth weight infants (≥2,500 grams or 5.5 pounds). VLBW infants are significantly more likely to survive and thrive when born in a facility with a level-III Neonatal Intensive Care Unit (NICU). Assessing the capabilities of birth facilities allows for the development of state-specific acion plans to getting high-risk infants to the correct site of care. LOCATe - The CDC Levels of Care Assessment Tool (CDC LOCATe) is designed to help states and other jurisdictions monitor neonatal and maternal risk appropriate care. CDC LOCATe uses the minimum information necessary to identify a facility’s neonatal level of care, based on criteria by American Academy of Pediatrics, and maternal level of care based recently published criteria by the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine.

Data Sources and Data Issues: MSDH Infant Health Program

Year: 2017/2019

Unit Type: Text, Unit Number: Yes/No

3.2 3.6.1. Proportion of Regional Perinatal Centers that receive a process evaluation (Georgia)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to professionals

Goal: Increase the proportion of RPCs that receive a process evaluation to ensure maintenance of subspecialty services and other components consistent with Level III designation from 0 to 6 each year for five years

Numerator: Number of RPCs receiving one annual evaluation

Denominator: Number of RPCs

Significance: Very low birth weight infants (<1,500 grams or 3.25 pounds) are the most fragile newborns. Although they represented less than 2% of all births in 2010, VLBW infants accounted for 53% of all infant deaths, with a risk of death over 100 times higher than that of normal birth weight infants (≥2,500 grams or 5.5 pounds). VLBW infants are significantly more likely to survive and thrive when born in a facility with a level-III Neonatal Intensive Care Unit (NICU), a subspecialty facility equipped to handle high-risk neonates. In 2012, the AAP provided updated guidelines on the definitions of neonatal levels of care to include Level I (basic care), Level II (specialty care), and Levels III and IV (subspecialty intensive care) based on the availability of appropriate personnel, physical space, equipment, and organization. Given overwhelming evidence of improved outcomes, the AAP recommends that VLBW and/or very preterm infants (<32 weeks’ gestation) be born in only level III or IV facilities. This measure is endorsed by the National Quality Forum (#0477).

Data Sources and Data Issues: Women's Health Program Data, Regional Perinatal Center Data

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.3 Standardized guidelines: Percent of Level III NICU facilities providing support to build a consensus-based model of Utah Standardized Level of Care (Utah)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Increase the percent of hospitals facilities providing support to build a consensus-based model of Utah Standardized Level of Care to 100%

Numerator: The number of level III NICU facilities providing support/consensus

Denominator: The total number of level III hospital facilities in the State (UT)

Significance: A survey carried out by the Maternal and Child Health (MCH) Bureau several years ago provided objective criteria that indicates Utah currently has ten hospitals that self-designate as level III neonatal intensive care units (NICU) while the survey data collected indicate that number is much smaller based on the published Guidelines. Currently, Utah regulations that designate Levels of Care for Perinatal Services are imprecise and there is no regular oversight of NICU services by the Department. Through collaboration, the MCH Bureau has worked on developing Utah specific Guidelines for Neonatal Care based on the 7th edition of Guidelines for Perinatal Care; however, these guidelines have remained in draft form for the last few years. With the collection of Utah specific data on VLBW infants, creation of these guidelines will be able to be reapproached.

Data Sources and Data Issues: Program-specific data of agreement collected at meetings and/or email

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.3 Percentage of very low birth weight births in Level I and II hospitals that had a completed VLBW Assessment Tool. (South Carolina)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to producing a count

Goal: Level I and Level II hospitals will report 90% of all live born very low birth weight babies from a baseline of 73% of all reportable births being reported.

Numerator: VLBW births for which the DHEC QI tool was completed from all Level I and Level II facilities for every birth.

Denominator: All VLBW births in the state born at Level I and Level II facilities.

Significance: Reporting using the new VLBW tool and process will improve and MCH will be able to use the data to identify gaps and trends in the detailed functioning of the SC Perinatal Regionalization System.

Data Sources and Data Issues: SC Perinatal Regionalization System data

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

3.3 Development and distribution of a perinatal regionalization educational fact sheet for expectant mothers (Arkansas)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to families/children/youth

Goal: To ensure that higher risk mothers and newborns deliver at appropriate level hospitals.

Numerator: Development and distribution of a perinatal regionalization educational fact sheet for expectant mothers

Denominator: Development and distribution of a perinatal regionalization educational fact sheet for expectant mothers

Significance: Related to Maternal, Infant, and Child Health (MICH)-33: Increase the proportion of very low birth weight (VLBW) infants born at Level III hospitals or subspecialty perinatal centers. Low birth weight or premature infants born in risk-appropriate facilities are more likely to survive. Multiple studies indicate VLBW infant mortality is lower for infants born in a Level III center (higher level of care), and higher for infants born in non-Level III centers.

Data Sources and Data Issues: Program Information

Year: 2017/2019

Unit Type: Text, Unit Number: Yes/No

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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.