Better Care for High-Risk Babies: Improving Perinatal Regionalization in Illinois

Posted March 10, 2016 by Elizabeth Baker

Baby In Intensive CareWhen the Illinois Department of Public Health’s Risk Appropriate Care Task Force formed, its mission was succinct: to ensure that very preterm infants get delivered in the right place at the right time. Considered the most fragile newborns, very preterm babies make up more than half of infant deaths in the U.S. While many hospitals lack the capabilities to care for such infants, high-risk babies born in specialized perinatal facilities face a far greater likelihood of surviving and thriving.

An ongoing effort from the Illinois team involved in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN), the task force’s central goal is to get 90 percent of very preterm infants in Illinois delivered in Level 3 perinatal facilities. These facilities feature neonatal intensive care units (NICUs), where a combination of leading-edge technology and specially trained staff can vastly improve health outcomes for high-risk babies. According to 2014 data, just 81.2 percent of very preterm infants born in Illinois were delivered at a Level 3 facility (leaving 476 very preterm babies born elsewhere).

“When we looked at the data, we wanted to find out exactly why this was going on,” says task force co-chair and perinatal nurse Trishna Harris, DNP. “We needed more information as to why more very preterm babies aren’t being delivered at the right facilities, so that we can use that information to develop policy recommendations and interventions that would improve our systems of care.”

To gather that information, Harris and task force chair Raye-Ann de Regnier, MD, teamed up with Senior Epidemiologist Amanda Bennett, PhD, to collect data from hospitals on factors affecting delivery of very preterm infants. Those factors include matters related to perinatal regionalization, a system set up to transfer high-risk patients to hospitals providing risk-appropriate care. Launched in 1976, Illinois’s perinatal regionalization system now operates through 10 perinatal centers (including a St. Louis-based center that handles Southern Illinois, a region lacking in Level 3 facilities) and 122 obstetric hospitals.

“Part of the work of the perinatal centers is to provide education to nurses and doctors on monitoring issues like hemorrhaging and hypertension so that they know whether to transfer the patient, and when and how to make that transfer,” notes Harris.

Still, only 56 percent of the 476 of the very preterm infants born outside Level 3 hospitals in Illinois in 2014 were transferred within 24 hours of delivery. The Illinois’ IM CoIIN team seek to create a clearer picture of issues interfering with perinatal regionalization and—along with the state Department of Public Health—have commissioned a special study to review all cases of very preterm deliveries occurring in hospitals below Level 3.

The team is also working to boost patient awareness of the importance of risk-appropriate care. In partnership with the Illinois Department of Healthcare and Family Services, for instance, they’re developing information notices for Medicaid providers to post in their offices, including lists of nearby hospitals and their designated care levels.

With increasingly common health problems like obesity, diabetes and high blood pressure among the factors closely linked to very preterm delivery, those awareness-raising strategies are becoming more and more urgent, according to Harris.

“If we can get more providers to let their patients know what Level 3 facilities are and where they’re located, more women will understand that if they’re at 28 weeks and having contractions, they should try to get to the Level 3 hospital—even if it’s a little further away,” says Harris. “It’s something most women probably aren’t knowledgeable about, so we really need to increase mothers’ awareness.”

Learn more about the IM CoIIN initiative and how you can get involved.


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