Background

According to the March of Dimes,the number of live births happening after 37 weeks but before 39 weeks of gestation hasincreased from 19.7% in 1990 to 28.9% in 2006. A large percentage of scheduled early term births (either induction of labor or planned cesarean delivery) may be due to non-medical or non-obstetrical indications (early-term elective delivery,or EED).

Induction of labor or scheduled cesarean delivery before 39 weeks is recognized by the American College of Obstetricians and Gynecologists (ACOG) as appropriate only for justified medical or obstetrical indications. These include conditions that require prompt delivery regardless of the gestational age, such as severe preeclampsia, or those for which early delivery reduces the likelihood of complication, such as with diabetes. However, in a recent Leapfrog survey elective early term deliveries without a medical indication range from less than 5% to over 40% of all deliveries between 37 to 39 weeks. NC hospitals that responded to the survey had EED rates varying from 0% - 67.9%. The recommended national rate is less than 5%.

EEDs carry a significantly increased risk to the baby as compared to births between 39 and 41 weeks. Complications may result in more NICU admissions for increased transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), ventilator support, suspected and proven sepsis and/or newborn feeding problems.

In 2009, the Perinatal Quality Collaborative of North Carolina (PQCNC) established the “39 Weeks Project.” The goal of the initiative was to eliminate EEDs. Forty-one NC hospitals participated in this one-year collaborative which successfully reduced EEDs by 43%.

In April 2011, the North Carolina Pregnancy Medical Home program was launched as a three-way partnership among Community Care of North Carolina (CCNC), the Division of Medical Assistance (Medicaid), and the Division of Public Health to improve birth outcomes and quality of care and to reduce costs in the Medicaid population. One of the key performance expectations for maternity care providers participating in the program is the avoidance of EED.

In March 2012, the Centers for Medicare and Medicaid Serveries (CMS) announced Strong Start, a new initiative to reduce early elective deliveries at the federal level among Medicaid patients. The programis built upon the infrastructure of the Partnership for Patients and is a joint effort amongmany national organizations devoted to the health of women and children. CMS is further supporting the reduction of EED efforts through the 26 Hospital Engagement Networks (HENs)that are working directly with hospitals to reduce EEDs.

Also in 2012, the federal Maternal and Child Health Bureau of the Health Resources Services Administration (HRSA) established the Collaborative Improvement and Innovation Network (COIN) to Reduce Infant Mortality in partnership with the Association of State and Territorial Health Officials (ASTHO), CMS, CDC, CityMatch, March of Dimes, and the Association of Maternal and Child Health Programs (AMCHP) in the 13 southeastern and southern states comprising Public Health Regions IV and VI. One of five key strategy priorities is the reduction of elective early term deliveries.

Purpose/Objective

The purpose of NC39 Weeks is to bring together organizations across North Carolina committed to preventing harm to mothers and babies by reducing early elective deliveries, furthering the work begun by PQCNC.

Partners

  • FOX50/MIX101.5 WRAL FM
  • NC Hospital Association (NCHA)
  • NC Quality Center (NCQC)
  • NC/VA Hospital Engagement Network (NoCVA HEN)
  • Perinatal Quality Collaborative of NC (PQCNC)
  • NC March of Dimes (NCMOD)
  • Community Care of North Carolina (CCNC) – Pregnancy Medical Home
  • State of NC, Division of Medical Assistance (Medicaid) – Pregnancy Medical Home
  • State of NC, Department of Public Health (NC DPH) – Pregnancy Care Management
  • Carolinas Healthcare System Hospital Engagement Network (CHS HEN)
  • North Carolina State team for HRSA Collaborative Improvement and Innovation Network (COIN) to reduce infant mortality

Aim

Reduce the EED rate in NC to < 1%.

Plan

  • Public Service Announcements on FOX50/MIX101.5 WRAL
  • Outreach to hospitals through NCHA, NCQC, CHS HEN, PQCNC
  • Outreach to OB Providers through Pregnancy Medical Home programs, North Carolina/Virginia HEN,Carolinas Health SystemHEN
  • Promote Awareness to Women/Moms/Families throughPregnancy Care Managers, NC March of Dimes

Timeline

  • Through December 2013

Measurement

  • Joint Commission measure PC-01 as listed on Hospital Compare and endorse by CMS, the Joint Commission and the National Quality Forum (drawn from administrative data)