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Delivery
EED
A policy action plan to reduce the
rate of non-medically indicated
early deliveries in Illinois
Anna Calix
Definition
NQF: a delivery before 39 weeks of gestation without
medical or obstetrical indicationis linked to neonatal
morbidities and mortalities with no benefit to the mother or
infant
AWHONN: on-medically related choicescalled
electiveinclude inducing labor without cause, as well as
birthing via cesarean without a medical reason for surgical
delivery. When these choices are made without cause
before your pregnancy is term, theyre called elective,
early deliveries. Theyre also called dangerous for the
many immediate and life-long risks documented in research
for both you and your baby.
ACOG: performed for a nonmedical reason. Some
nonmedical reasons include wanting to schedule the birth
of the baby on a specific date or living far away from the
Neonatal Morbidity
Source: ACOG,
2013
Morbidities by GA
Neonatal Mortality
Health risks
Moms
Babies
Birth by cesarean,
including the risks of
uncontrolled bleeding
(hemorrhage)
Longer hospital stays
and longer recovery
Anemia
Endometriosis
Urinary tract infections
Sepsis
Prematurity
Low or lower birth
weight
NICU admission
Health complications,
now and life-long
Death, especially in
the first year of life
Solution
Implementation of a policy to decrease the rate of
EEDworks! 50% reduction2
Hard stop policies: most effective
Soft stop policies
Educational programs
Solution: Illinois
Medicaid policy change as has been done in
other states, Medicaid will require hospitals to
establish a policy to reduce EED
Exa: Ohio, California
Sample letter of
support
Source: CA toolkit
Stakeholders
Governmental
CMS: Medicaid
HHS
IDPH
Nongovernmental
Hospitals &
physicians
Insurance
companies
Non-profit &
community based
organizations
March of Dimes
AWHONN
ACOG
IL - EverThrive
Policy paramours
Partner with community, non-profit, and hospital
based organizations to promote policy change
March of Dimes, ACOG, AWHONN
Marketing approach
Existing marketing:
AWHONN Healthy Mom
& Baby: Go the full 40
campaign1
Strong Start Initiative
CMS initiative focusing
on 3 major activities:
Promote awareness,
spread best practices,
promote transparency9
EverThrive, March of
Dimes initiatives
Source: GotheFull40 Toolkit
AWHONN Gothefull40
campaign ads
Marketing approach
Print, electronic
& social media
Education
Awareness
Partnerships
Hospitals &
providers
Insurance
companies
General
public/mothers
Legislators
Marketing approach
Education!
A survey of insured women who recently gave birth
found that only 25.2% of women defined full term as
39-40 weeks. But, more importantly, 92.4% of women
reported that giving birth before 39 weeks was safe.
- California toolkit
Resources
Leapfrog Group
Childbirth Connections
March of Dimes
ACOG
AWHONN
Lamaze international
NQF Playbook for the successful reduction of EED
California toolkit for reducing EED
CMS Strong Start toolkit
ACOG list of other relevant organizations:
http://www.acog.org/About-ACOG/ACOGDepartments/Deliveries-Before-39-Weeks/OtherOrganizations
References:
1. 40 reasons to go the full 40. (n.d). Health 4 Mom. Retrieved from:
http://www.health4mom.org/zones/go-the-full-40
2. Avoiding early elective deliveries. Sep 17, 2014. Healthy mom & baby. Retrieved
from: http://www.health4mom.org/avoiding-early-elective-deliveries
3. Elective delivery before 39 weeks. FAQ 181. American College of Obstetricians
and Gynecologists. 2013. Retrieved from: http://www.acog.org/-/media/Forpatients/faq181.pdf?dmc=1&ts=20150713T0028547127
4. Elimination of non-medically indicated (elective) deliveries before 39 weeks
gestational age toolkit. California Department of public health. 2011. Retrieved
from: http://www.leapfroggroup.org/media/file/LessThan39WeeksToolkit.pdf
5. GoTheFull40 campaign toolkit. March 2015. Retrieved from:
http://www.health4mom.org/wp-content/uploads/2015/03/GoTheFull40-Toolkit_V21.pdf
6. Hospital rates of early scheduled deliveries. 2014. The Leapfrog Group.
Retrieved from: http://www.leapfroggroup.org/tooearlydeliveries
7. Important information on HB 1983. 2011. American Congress of Obstetricians
and Gynecologists. Retrieved from: http://www.acog.org/About-ACOG/ACOGDistricts/District-XI/Important-Information-on-HB-1983-and-Less-than-39-Weeks
8. Nonmedically indicated early-term deliveries. Committee Opinion No. 561.
American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;
121:911-5.
9. Strong Start for Mothers and Newborns Initiative: Effort to Reduce Early Elective
Deliveries. (n.d). Center for Medicare & Medicaid. Retrieved from
http://innovation.cms.gov/initiatives/Strong-Start-Strategy-1/index.html