A new, statewide collaborative of health professionals, health organizations, hospitals and clinics has committed to reducing the death and disease associated with childbirth and the first month of life.
The Nebraska Perinatal Quality Improvement Collaborative’s initial efforts will focus on:
•reducing the number of first-time cesareans;
•increasing the numbers of new mothers who breastfeed;
•and conducting education to prevent and increase newborn screening for congenital cytomegalovirus, an infection that occurs before birth.
Through Legislative Bill 233, the Nebraska Legislature is funding the initiative with $100,000 a year for two years. The collaborative will provide resources to enable health professionals to provide care that will improve birth outcomes and reduce costs.
Support also comes from the March of Dimes, the Nebraska Medical Association, Arbor Health, Copic, University of Nebraska Medical Center Department of Pediatrics, Nebraska Medicine, the American Academy of Pediatrics, Methodist Women’s Hospital and CHI Health.
This year, Nebraska became the 44th state to form a collaborative. Members of the statewide collaborative will work closely with Nebraska organizations, including the Nebraska Department of Health and Human Services, the Visiting Nurses Association, and county health departments.
“Our new collaborative will work to ensure that Nebraska will be a state where a great life starts with healthy moms and healthy babies,” said Ann Anderson Berry, M.D., Ph.D., co-medical director of the collaborative. “As health providers, we all share a common goal of providing care of the highest quality for our patients. Nebraska’s mothers and babies need and deserve the attention to quality care delivery given in other states that are already benefiting from the work of perinatal collaboratives.”
Dr. Anderson Berry is an associate professor of pediatrics at the University of Nebraska Medical Center and medical director of the Nebraska Medicine neonatal intensive care unit.
Robert Bonebrake, M.D., a perinatologist at Methodist Health System, is co-medical director of the collaborative and Peggy Brown, D.N.P., a women’s & children’s clinical quality lead at Nebraska Medicine, is program administrator for the collaborative.
“Our first initiative will support health professionals in their efforts to eliminate elective delivery in infants less than 39 weeks estimated gestational age. There are too many C-sections and resulting complications such as high wound infection rates and increased time in the hospital,” Dr. Anderson Berry said. “This is of great importance to women. It will result in fewer complications and less death.”
The group has a growing list of more than 90 percent of hospitals across the state committed to the project.
“It speaks greatly of the need and the impact it will have in Nebraska,” Dr. Bonebrake said. “Collaboratives improve health care practices and patient outcomes as well as reduce costs. We will use evidence-based medicine, which we know improves health outcomes and provides the highest quality care.”
Dr. Brown said the collaborative will share the most current and best practices. “The knowledge in medicine isn’t static. We have to constantly update, and it’s difficult to keep up with all these changes if you’re a provider trying to care for three or four communities. There are limited resources and challenges. Providers can adapt these practices to their own circumstances and build on their successes.”
Breastfeeding is another focus of the grant.
Dr. Anderson Berry said Nebraska is ranked 47th in rates of breastfeeding. She said if 60 percent of babies were fed exclusively with breast milk for the first six months of life, it could result in hundreds of thousands of dollars saved in health care costs in Nebraska.
“Increased rates of breastfeeding in the first year of life could prevent complications such as ear infections, pneumonias requiring hospitalizations, and colds — because babies are getting some immunity protection from the mom,” Dr. Anderson Berry said. “If we keep babies well, parents miss less work, fewer antibiotics are used and health costs are reduced.”
Funding for the collaborative will pay for resources, database development, and statistical support, a program administrator with expertise in quality improvement as well as implementation and education costs. The state funding has potential for renewal.
Nebraska statistics
•About 2,752 infants were born prematurely in Nebraska in 2013.
•According to research, the cost of care for preterm infants ranges from more than $100,000 for extreme prematurity to $4,500 for late prematurity.
•Very low birth weight infants are at risk for costly complications, adding $12,000 to $31,000 to their already expensive care.
•Prematurity is costly to Nebraska. Medicaid programs bear a large burden of this cost. Collaboratives have the ability to impact this, for example, in Tennessee, where a collaborative has been active for six years, they have saved $11 million a year in state funds.