Toward Improving the Outcome of Pregnancy III - March of Dimes

Toward Improving the Outcome of Pregnancy,
the 90s and Beyond (TIOP II), the
1993 publication produced by a reconstituted
ad hoc Committee on Perinatal Health,
also convened by the March of Dimes,
broadly expanded the operational definition
of perinatal care to include preconception
through the post-neonatal period. Implicit
in TIOP II was the realization that perinatal
care has a direct impact on an individual’s
health long after birth. 2
Table 1: Summary of TIOP I and TIOP II Publications
Year Published
Focus
Primary
Recommendations
TIOP I
1976
A regional perinatal care system
Levels of care
As Table 1 shows, a major difference
between TIOP I and II was a strong emphasis
in the latter on data, documentation
and evaluation. TIOP II, with its broader
operational definition of the perinatal period,
gave more attention to ambulatory care,
while continuing to underscore the need for
improvement of hospital care. TIOP II also
emphasized concepts, such as accountability
and availability. Quality improvement was a
major message and recommendation in TIOP
II, and, as seen in the discussion to follow, it
has evolved to be increasingly dynamic in the
perinatal care system environment.
Level I — Uncomplicated maternity and
newborn
Level II — Uncomplicated and majority of
complicated
Level III — Uncomplicated and all serious
complications
Preparatory and continuing education in
regional system
Coordination and communication in regional
system
Major task ahead — financing, education,
initiating action
Evolution of Quality
Improvement
in Perinatal Care
TIOP II
1993
Care before and during pregnancy
Care during birth and beyond
Data documentation
and evaluation
Financing
Health promotion and education
Reproductive awareness
Structure and accountability
Preconception and interconception care
Ambulatory prenatal care
Inpatient patient care
Infant care
Improving the availability of perinatal providers
Data, documentation and evaluation
Financing perinatal care
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