Ohio Perinatal Quality Collaborative, Cincinnati Children's Hospital Medical Center, and TriHealth, Cincinnati, The Ohio State University and the Ohio Department of Medicaid, Columbus, Aultman Hospital, Canton, MetroHealth, Cleveland, and Miami Valley Hospital, Dayton, Ohio.
Obstet Gynecol. 2017 Feb;129(2):337-346. doi: 10.1097/AOG.0000000000001841.
To promote use of progestogen therapy to reduce premature births in Ohio by 10%.
The Ohio Perinatal Quality Collaborative initiated a quality improvement project in 2014 working with clinics at 20 large maternity hospitals, Ohio Medicaid, Medicaid insurers, and service agencies to use quality improvement methods to identify eligible women and remove treatment barriers. The number of women eligible for prophylaxis, the percent prescribed a progestogen before 20 and 24 weeks of gestation, and barriers encountered were reported monthly. Clinics were asked to adopt protocols to identify candidates and initiate treatment promptly. System-level changes were made to expand Medicaid eligibility, maintain Medicaid coverage during pregnancy, improve communication, and adopt uniform data collection and efficient treatment protocols. Rates of singleton births before 32 and 37 weeks of gestation in Ohio hospitals were primary outcomes. We used statistical process control methods to analyze change and generalized linear mixed models to estimate program effects accounting for known risk factors.
Participating sites tracked 2,562 women eligible for treatment between January 1, 2014, and November 30, 2015. Late entry to care, variable interpretation of treatment guidelines, maintenance of Medicaid coverage, and inefficient communication among health care providers and insurers were identified as treatment barriers. Births before 32 weeks of gestation decreased in all hospitals by 6.6% and in participating hospitals by 8.0%. Births before 32 weeks of gestation to women with prior preterm birth decreased by 20.5% in all hospitals, by 20.3% in African American women, and by 17.1% in women on Medicaid. Births before 37 weeks of gestation were minimally affected. Adjusting for risk factors and birth clustering by hospital confirmed a program-associated 13% (95% confidence interval 0.3-24%) reduction in births before 32 weeks of gestation to women with prior preterm birth.
The Ohio progestogen project was associated with a sustained reduction in singleton births before 32 weeks of gestation in Ohio.
通过在俄亥俄州开展孕激素治疗项目，将早产率降低 10%。
俄亥俄州围产期质量合作组织于 2014 年启动了一项质量改进项目，与 20 家大型妇产医院的诊所、俄亥俄州医疗补助计划、医疗补助保险公司以及服务机构合作，采用质量改进方法来确定符合条件的女性，并消除治疗障碍。每月报告符合预防条件的女性人数、20 周和 24 周前接受孕激素治疗的比例以及遇到的障碍。要求诊所采用方案来确定候选者并迅速开始治疗。对系统进行了调整，以扩大医疗补助的资格范围，确保孕期医疗补助的覆盖，改善沟通，并采用统一的数据收集和高效的治疗方案。俄亥俄州医院单胎妊娠 32 周和 37 周前的分娩率是主要结果。我们采用统计过程控制方法分析变化，并采用广义线性混合模型估计项目效果，同时考虑已知的风险因素。
参与的机构在 2014 年 1 月 1 日至 2015 年 11 月 30 日期间共跟踪了 2562 名符合治疗条件的女性。治疗过程中发现的障碍包括入组时间晚、对治疗指南的解释存在差异、维持医疗补助覆盖范围以及医疗保健提供者和保险公司之间的沟通效率低下等。所有医院的 32 周前分娩率下降了 6.6%，参与医院的下降了 8.0%。所有医院中，有过早产史的女性的 32 周前分娩率下降了 20.5%，非裔美国女性下降了 20.3%，而享受医疗补助的女性下降了 17.1%。37 周前的分娩率受影响较小。调整医院间的风险因素和分娩聚类因素后，确认项目与有过早产史的女性的 32 周前分娩率降低 13%（95%置信区间 0.3-24%）相关。
俄亥俄州孕激素项目与俄亥俄州 32 周前单胎分娩率的持续降低有关。
