Assessment of State Measures of Risk-Appropriate Care for Very Low Birth Weight Infants and Recommendations for Enhancing Regionalized State Systems
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The goal of this study was to examine state measurements and improvements in risk-appropriate care for very low birth weight (VLBW) infants. The authors reviewed state perinatal regionalization models and levels of care to compare varying definitions between states and assess mechanisms of measurement and areas for improvement. Seven states that presented at a 2009 Association of Maternal & Child Health Programs Perinatal Regionalization Meeting were included in the assessment. Information was gathered from meeting presentations, presenters, state representatives, and state websites. Comparison of state levels of care and forms of regulation were outlined. Review of state models revealed variability in the models themselves, as well as the various mechanisms for measuring and improving risk-appropriate care. Regulation of regionalization programs, data surveillance, review of adverse events, and consideration of geography and demographics were identified as mechanisms facilitating better measurement of risk-appropriate care. Antenatal or neonatal transfer arrangements, telemedicine networks, acquisition of funding, provision of financial incentives, and patient education comprised state actions for improving risk-appropriate care. The void of explicit and updated national standards led to the current variations in definitions and models among states. State regionalization models and measures of risk-appropriate care varied greatly. These variations arose from inconsistent definitions and models of perinatal regionalization. Guidelines should be collaboratively developed by healthcare providers and public health officials for consistent and suitable measures of perinatal risk-appropriate care.
KeywordsPerinatal regionalization Risk-appropriate care Very low birth weight infants Neonatal levels of care
We would like to acknowledge the Perinatal Regionalization Meeting participants and state Title V program representatives: Richard Nugent, MD, MPH, Chief, Family Health Branch, Arkansas Department of Health; Shabbir Ahmad, DVM, PhD, MS, Acting Division Chief, Maternal, Child, and Adolescent Health Programs, Center for Family Health, California Department of Public Health; Karen Trierweiler, MS, CNM, Director, Center for Healthy Families and Communities, Colorado Department of Public Health and Environment; Phyllis Sloyer, RN, PhD, PAHM, FAAP, Director, Division of Children’s Medical Services, Florida Department of Health; Ruth Ann Shepherd, MD, FAAP, CPHQ, Director, Division of Maternal and Child Health, Kentucky Department for Public Health; Wendy Shaw, RN, MS, Associate Director, Division of Family Health, New York State Department of Health; Cathy R. Taylor, DrPH, MSN, RN, Assistant Commissioner, Health Services Administration, Tennessee Department of Health; Maribeth Badura, MSN, RN, Director, Division of Healthy Start and Perinatal Services, Maternal and Child Health Bureau, Health Resources and Services Administration; Jeff Koshel, MA, Consultant; Victoria A. Freeman, PhD, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; Scott Berns, MD, MPH, FAAP, Senior Vice President, March of Dimes National Office; Lillian R. Blackmon, MD, Clinical Associate Professor, University of Maryland School of Medicine; Ray Cox, MD, FACOG, Chairman, Department of Obstetrics and Gynecology, St. Agnes Hospital, Member Representative, American College of Obstetricians and Gynecologists; Luella Klein, MD, FACOG, Vice President, Division of Women’s Health Issues, American College of Obstetricians and Gynecologists; Anne Stark, MD, Professor of Pediatrics, Baylor College of Medicine, Past Chair, American Academy of Pediatrics; and LuAnn Papile, MD, Professor of Pediatrics, Baylor College of Medicine, Chair, American Academy of Pediatrics Committee on the Fetus and Newborn. Thank you also to David Goodman, PhD, CDC MCH Epidemiology Assignee to the Georgia Department of Community Health; Kirk A. Bol, MSPH, Health Statistics Section and Sue Ricketts, PhD, Prevention Services Division, Colorado Department of Public Health & Environment; Rhonda Brown, RN, Children’s Medical Services, Florida Regional Perinatal Intensive Care Centers Program; and R. Whit Hall, MD, Antenatal and Neonatal Guidelines Education and Learning System, University of Arkansas for Medical Sciences for your assistance in organizing information for this paper.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, Health Resources and Services Administration, or the U.S. Department of Health and Human Services.
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