Late Preterm Infant (LPI) Quality Improvement Project
With support from the Vermont Department of Health, the University of Vermont and the March of Dimes, participating obstetrical and pediatric care practitioners collaborated with the Vermont Regional Perinatal Health Project (VRPHP) of VCHIP to develop and implement practice changes that would potentially decrease the rate of late preterm births and ensure high quality care for those infants born during the late preterm period (between 34+0 and 36+6 weeks gestation). With a particular focus on women insured by Medicaid; this initiative required an innovative approach of collaboration among obstetric and pediatric practitioners and nursing staff.
Standards for best practice with the newborn population were collaboratively defined and focus on assessing maternal risk for preterm delivery, elective induction of labor, elective cesarean section, and the care management of the LPI. Partnering with community support services to create a comprehensive medical home for this population of at-risk infants was a key element of this project.
To prevent the incidence and reduce rates of mortality and morbidity in infants between 34-39 week's gestation by:
- Eliminate elective inductions of labor and elective cesarean sections prior to 39 week's gestation;
- Identify maternal risk for late preterm delivery;
- Ensure appropriate, timely, effective and efficient surveillance and intervention;
- Provide a structure for comprehensive parent education;
- Individualize standards for discharge planning to a comprehensive medical home including coordinating follow-up services with the community.
- 100% of low risk, elective inductions and elective cesarean sections will be done at > 39 week's gestation
- 100% of late preterm newborns will be identified for their potential of risk and will receive an appropriate surveillance based on risk assessment, including a comprehensive discharge and follow-up plan.
- 100% of mothers and families of LPI will receive education concerning the unique risks of the late preterm infant with a discharge plan of care in place.
- Participants: 11 of 12 eligible hospitals
- Four Learning Sessions were facilitated to assess and discuss implementation of standards of care: 2009-2011
- Final Data Collection: Summer 2012
- Final Data Report Out: Fall 2012
Charles Mercier, MD