Conference Abstract Compendium Examples from the ... - CityMatCH

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2009 CityMatCH Urban MCH Leadership ConferenceBeing born at the right place: Definitions and data collection on neonatal levels of carePRIMARY CONTACT:Wanda D Barfield, MD, MPHTeam Leader, MCH EpidemiologyProgramCenters for Disease Control andPrevention4770 Buford HighwayMailstop K-22Atlanta, GA, 30341Phone: (770) 488-6231Fax: (770) 488-6291Email: wjb5@cdc.govCATEGORYPrematurity / Preterm birth / BirthweightInfant mortality and morbidityFOCUSProgram Policy FocusBACKGROUNDCO-PRESENTER(S)/AUTHOR(S):Ann Stark, arstark@bcm.edu (Author)Lillian Blackmon, Lblackmon@comcast.net(Author)Perinatal regionalized systems, to include obstetrical transport and appropriate referral to neonatalintensive care, have been an important mechanism for improving outcomes for preterm and medicallycomplex infants. However, regionalized systems have deteriorated and regulatory language defininglevels of neonatal care vary significantly. Maternal Child Health Bureau National Performance Measure#17, which measures the percent of very low birth weight infants delivered at facilities for high-riskdeliveries and neonates, has been below the goal of 90% for many states. Recent increases in infantmortality may, in part, be an unintended consequence of deficiencies in regional organization of perinatalcare.Setting:Regional, state, and national organizations evaluating neonatal levels of care to improve birth outcomes.METHODSWe studied how states assess National Performance Measure #17 using three data sources. First, wecollected data from states on definitions of levels of newborn care including language from the AmericanAcademy of Pediatrics’ 2004 policy statement. Second, using birth certificate data (2003 revision), wecompared the percentage of very low birth weight infants born in facilities with a neonatal intensive careunit (NICU) by states. Third, state-specific reports of the National MCHB Performance Measure #17 from2002-2006 were assessed to see if they met performance goals.6
2009 CityMatCH Urban MCH Leadership ConferenceRESULTSReview of the state data revealed that no consensus exists for definitions of neonatal levels of care. Statesvaried in infant gestational age and birth weight criteria, healthcare provider criteria, transportresponsibilities, and, enforcement of standards used. The 2003 revised birth certificate provided new dataon NICU admission as well as use of effective therapies, such as antenatal steroids and surfactant. Only10 states reported reaching the national goal of 90% of VLBW infants delivered in appropriate facilitieswith all states ranging from 33% to 92%.LESSONS LEARNEDImproving perinatal regionalized systems of care requires better data and involvement from multiplestakeholders.CONCLUSIONS/IMPLICATIONSHealth departments have an opportunity to participate in defining newborn levels of hospital care and leadin the development of methods to monitor the quality of maternal, perinatal, and newborn care throughpolicy, data collection, and analysis.7
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