MCHbest. NPM 3: Risk-Appropriate Perinatal Care
Strategy. Adopt Standard Definitions for Hospital Level of Care
Approach. Define Hospital Levels of Neonatal care and Levels of Maternal Care using AAP and ACOG/SMFM guidelines.*
Overview. Perinatal Regionalization of care ensures that mothers and newborns who are at highest risk for morbidity or mortality deliver at birthing facilities that are equipped with appropriate personnel, resources, and capabilities to meet their needs.
Evidence. Moderate. Evidence suggests that uniform definitions and consistent standards are necesary to implement and monitor regional systems. A 2014 Neonatal assessment identified 22 states that had a policy on regionalized care. Levels vary in consistency with the AAP Policy.1 A 2018 Maternal assessment identified 17 states that are incorporating maternal care policies. Levels vary in consistency with the SMFM/ACOG guidelines.2 (Read more about understanding evidence ratings).
Target Audience. Hospitals.
Outcome. Percent of Very Low Birth Weight (VLBW) infants born in the hospital within a Level III hospital + NICU.
Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.
In addition, the Texas DHHS has made the following advances in adopting standard definitions for hospital level of care:
- A perinatal advisory council with stakeholder input recommended criteria for levels of care and a process for designation of hospitals with division of state into regions.
- 2013 legislation required neonatal designation.
- 2018 legislation required maternal designation.
Role of Title V. Title V agencies can design, fund, and manage implementation of perinatal systems in partnership with hospitals and perinatal profesionals:
- Convene partners in defining the needs states have and the strategy to address the specific need.
- Adopt state specific guidelines, aligning wiht national criteria for Neonatal and Maternal Levels of Care.
For additional suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies.
Sample ESMs. Using the approach "Define Hospital Levels of Neonatal care and Levels of Maternal Care using AAP and ACOG/SMFM guidelines,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:
Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):
Note and References:
* American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and Society for Maternal-Fetal Medicine (SMFM).
1 Kroelinger CD, Okoroh EM, Goodman DA, Lasswell SM, Barfield WD. Comparison of state risk-appropriate neonatal care policies with the 2012 AAP policy statement. J Perinatol 2018;38:411-420.
2 Vladutiu CJ, Minnaert JJ, Sosa S, Menard MK. Levels of Maternal Care in the United States: An Assessment of Publically Available State Guidlines.