Regional Cooperation Agreements: Policy-making to enhance the delivery of risk-appropriate perinatal care

Perinatal regionalization strives to match patient needs to risk-appropriate level of care. Specifically, this provides a foundation for achieving optimal pregnancy and birth outcomes through early identification of potential complications and transport of mothers and newborns. Agreements between hospitals defining joint responsibilities for provision of risk-appropriate care are a critical element in coordinating health services and are required for designated neonatal intensive care units (NICUs) in California. A 2003 statewide survey assessed the status of maternal-fetal and neonatal systems and determined that only half of facilities were effectively utilizing Regional Cooperation Agreements (RCAs). To address these findings, Regional Perinatal Programs of California (RPPC) compiled a step-by-step guide to assist hospitals, at all levels of perinatal and neonatal care, in creating and utilizing these contractual agreements. Additionally, seven trainings coordinated by California Children's Services and RPPC were delivered throughout the state between January-April 2007. These workshops targeted hospital administration, maternal-fetal medicine, NICU, and contracting staff to ensure successful implementation and compliance with the RCA standard. Training curriculum incorporated facility self-assessments, creative ways to fulfill RCA requirements, and review of sample agreements. Preliminary pre-post test results yielded an increase in participant knowledge and skills related to developing and utilizing an RCA. Participants also reported that trainings effectively facilitated networking between partnering hospitals (93%) and better prepared attendees to establish RCAs (97%). Through collaborative quality improvement efforts such as these, hospitals can create policy for regionalized risk-appropriate care, thereby achieving increased cost effectiveness, appropriate use of personnel, and enhanced delivery of health services.