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Strengthening the evidence for maternal and child health programs

Find State ESMs


Displaying records 1 through 14 (14 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: Bottom level: public health services and systems

Service Recipient: Activities related to systems-building

Goal: 100% of VLBW infants reported to Utah Department of Health database.

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: 2018/2020

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: Bottom level: public health services and systems

Service Recipient: Activities related to systems-building

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: 2018/2020

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: Bottom level: public health services and systems

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: 2018/2020

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: Bottom level: public health services and systems

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: 2018/2020

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: Bottom level: public health services and systems

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: 2018/2020

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

Service Type: Bottom level: public health services and systems

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: 2018/2020

Unit Type: Ratio, Unit Number: 1

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

Service Type: Middle level: enabling services

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: 2018/2020

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: Bottom level: public health services and systems

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: 2018/2020

Unit Type: Percentage, Unit Number: 100

3.2 Ensure risk appropriate care for high risk infants by increasing the number of hospitals with a formal written plan for transport of complicated obstetric/maternal patients to reduce infant mortality/morbidity. (Missouri)

Measure Status: Active

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

Service Type: Bottom level: public health services and systems

Service Recipient: Activities related to systems-building

Goal: By June 30, 2020, MO DHSS will increase the number of hospitals with a formal written plan for transport of complicated obstetric/maternal patients from 58.6 to 75.0%.

Numerator: Number of facilities with a formal written transfer plan for complicated obstetric/maternal patients.

Denominator: Number of birthing facilities with known status on transfer policy, as reported through the CDC Levels of Care Assessment Tool (CDC LOCATe) annually.

Significance: 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. The goal of regionalized maternal care is for pregnant women at high risk to receive care in facilities that are prepared to provide the required level of specialized care. Each facility should have a clear understanding of its capability to handle increasingly complex levels of maternal care, and should have a well-defined threshold for transferring women to health care facilities that offer a higher level of care. These proposed categories of maternal care are meant to facilitate this process. These guidelines also are intended to foster the development of equitably distributed resources throughout the country. To ensure optimal care of all pregnant women, all birth centers, hospitals, and higher-level facilities should collaborate to develop and maintain maternal and neonatal transport plans and cooperative agreements capable of managing the health care needs of women who develop complications; receiving hospitals should openly accept transfers. The appropriate care level for patients should be driven by their medical need for that care and not limited by financial constraint. Because of the importance of accurate data for the assessment of outcomes, all facilities should have requirements for data collection, storage, and retrieval. An important goal of regionalized maternal care is for higher-level facilities to provide training for quality improvement initiatives, educational support, and severe morbidity and mortality case review for lower-level hospitals. Transfer of the complicated pregnant

Data Sources and Data Issues: CDC LOCATe, MO DHSS.

Year: 2018/2020

Unit Type: Percentage, Unit Number: 100

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 related to systems-building

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: 2018/2020

Unit Type: Text, Unit Number: Yes/No

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: Bottom level: public health services and systems

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: 2018/2020

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: 2018/2020

Unit Type: Text, Unit Number: Yes/No

3.4 Development and launch of the perinatal regionalization website (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 related to systems-building

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

Numerator: Development and launch of the perinatal regionalization website

Denominator: Development and launch of the perinatal regionalization website

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: 2018/2020

Unit Type: Text, Unit Number: Yes/No

3.7 The use of LOCATe as an instrument to promote quality improvement in Neonatal and Maternal Care services by September 2020. (Puerto Rico)

Measure Status: Active

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

Service Type: Bottom level: public health services and systems

Service Recipient: Activities related to systems-building

Goal: 1.To visit 85% of participating hospitals in LOCATE to promote quality improvement in Neonatal and Maternal Care Services by September 2020.

Numerator: Number of LOCATe participating hospitals visited by MCAH personnel.

Denominator: Number of hospitals that participated in LOCATe.

Significance: LOCATe’s primary goals are to produce a standardized assessment, facilitate stakeholder conversations and minimize burden for respondents. Furthermore, LOCATe addresses gaps in the evidence, identifies opportunities to improve guideline wording that supports more consistent translation into state policy and increases opportunities for quality improvement efforts at the facility and state level. Thus, in order to achieve quality improvement in maternal and neonatal care provided by PR’s birthing facilities it is necessary to have an open communication with these facilities and share the information LOCATe provides and epidemiologic data relevant to maternal neonatal care of their institution. Institutions may recognize their limitations in providing higher level care when needed and therefore the importance of establishing a network of hospitals to refer and transfer high risk pregnant women. The goals is to visit at least 85% of participating hospitals by September 2020 taking into consideration that 84% of all the birthing facilities of PR consented to participate en LOCATe.

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

Year: 2018/2020

Unit Type: Percentage, Unit Number: 100

   

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.