NICHQ Projects Highlighted in Research Journal

Posted January 31, 2017 by Josh Grant

Stethoscope On Medical Text
Two new articles feature NICHQ-led projects.

Promising results have led to two NICHQ projects being featured in the Maternal and Child Health Journal.

The Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN) and New York State Perinatal Quality Collaborative (NYSPQC) are projects  focused on improving health outcomes for women and newborns. While these journal articles are focused on specific portions of the two projects, they demonstrate a growing commitment within public health to improve systems for everyone by studying gaps created by current systems and finding innovative solutions to close the gaps. The results of both strengthen NICHQ’s commitment to working with its partners so that all children can reach their optimal health.

Quality Improvement in New York
One of the NYSPQC projects focused on reducing scheduled deliveries prior to 39 week in cases where they were not medically necessary through the application of quality improvement (QI) practices. The project was run for four years; strategies and potential solutions were tested and implemented in regional perinatal centers (RPCs) for the first two years and then expanded to affiliated hospitals throughout the state in the third and fourth years.

NYSPQC faculty and a NICHQ team led by Executive Project Director Pat Heinrich, RN, MSN, CLE, led RPCs through a Breakthrough Learning Series, including the creation of measures and key drivers for the project. The participating facilities focused on educating families on the risks and benefits of early-term birth, measuring gestational age using criteria set forth by the American College of Obstetricians and Gynecologists (ACOG), creating policies to prevent non-medically necessary delivers before 39 weeks of gestation and developing a safe culture for patients.

The QI approach led to strong results across New York state. At the outset of the project, RPCs reported 24.8 percent of births occurred before 36 weeks of gestation and were not medically necessary. That rate fell to 0.6 percent four years later when the initiative concluded. Affiliate hospitals saw a decline from 22.1 percent to 1.3 percent during their two years. (Read the full journal article.)

Preventing Preterm Birth
State teams participating in the NICHQ-led IM CoIIN participated in a study to identify the approaches for making 17-alpha hydroxyprogesterone caproate (17P) more readily available to patients because of its evidence-based ability to reduce the risk of recurrent preterm births. NICHQ connected researchers with teams and prepared an interview guide to better understand how access to 17P can be increased for at-risk populations.

In total, 16 representatives from 7 IM CoIIN teams spoke with the lead author about 17P and strategies for increasing accessibility. The result were six measures that could be used for educating patients about the intervention, but there was not a universal solution for giving 17P to eligible patients.

This comes from the strengths and limitations found in each identified measure. For instance, reviewing patient information in practices provided the most accurate insight into whom would benefit from 17P intervention. However, this was not population based and could not be used between institutions, making it difficult to study the larger picture.

However, understanding the benefits and challenges within each measure is a strong starting point for healthcare providers and health agencies at every level in their efforts to evaluate the use of 17P and improve its availability. Further, these results show that solutions must be tailored to address local challenges and better serve the target populations. (Read the full journal article.)

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