Statewide collaborative to reduce early elective deliveries

Background:  Elective deliveries before 39 weeks gestation (EED) are associated with infant morbidity and mortality and increase costs by $1 billion annually.  Many groups, including ACOG, have called for a reduction in EED to improve infant and maternal health.  As part of a CoIIN, Illinois built a wide network of public and private groups and used public health resources and data to support continued reduction in EED.

Methods:  Using 2010-2012 birth certificate data and a nationally-vetted algorithm based on the Joint Commission measure, hospital-specific rates of EED were compared overall, within regional perinatal networks and hospital level, and over time.  Letters were sent to each hospital with the data and QI resources.  Hospitals were encouraged to develop a hard stop policy and to work through the perinatal networks to address hospital and community reasons for EED.

Results:  The rate of EED in Illinois declined from 29.6% in 2010 to 25.0% in 2012.  Rates were higher among non-Hispanic white women, women who had insurance, and hospitals located in rural counties.  Rates did not differ according to level of care, but did vary by perinatal network from 13.7% to 32.4%. 

Conclusions:  Through the perinatal networks and the CoIIN, Illinois has begun efforts to improve data quality on the birth certificate, to explore adding clinical and social determinant items to the birth certificate and to implement linkage with hospital discharge data.  Data resources and partnerships established for this project can be used for ongoing efforts to improve maternal healthcare and reduce infant mortality.