Robert W. Yelverton, MD, FACOG
Was the Formation of ACOG District XII (Florida) a Good Thing?
Robert W. Yelverton, MD-Chair
This article will be my last newsletter publication as your humble ACOG District XII (Florida) Chair. All ACOG Districts have newsletters; most have quarterly columns authored by their District Chairs. Our newsletter is sent to every ACOG District XII (Florida) member, Fellow, and Junior Fellow by snail mail and email — at least to all who have an email address on file with ACOG. I have tried to keep my column blog-like, discussing topics that needed discussing, occasionally approaching subjects that are controversial and, on occasion, even digressed into personal opinions or shared long engrained thoughts. I have no idea how many read my column, but based on the responses I get, very few. As the publisher and editors of this newsletter are well aware, writing does not come easy for me. I have chronic, near fatal “writer’s cramp” and always with an ADD approach to meeting deadlines. That is why the winter addition comes in early spring and the summer addition approaches the fall. The staff will be delighted when the very organized, always on time and precise Dr. Karen Harris assumes the chair position in August.
Fortunately for me, there is much more to being a District Chair then sweating out a newsletter deadline. You are probably aware that District XII is the newest District of ACOG, formed three years ago as a split-off from District IV consisting then of all of the South Atlantic States, including Maryland and the District of Colombia. District IV is still the most populous district in ACOG, even after approximately 3,300 fellows shifted to District XII. Florida then joined New York, California and Texas as single state Districts. Even though we are now the smallest District in ACOG, when number of fellows and dues revenue are the comparisons, there are huge advantages. Three years ago, when Florida was only a Section of District IV, we had little national representation in ACOG; now, as a District Chair, I serve on the ACOG Executive Board, the Council of District Chairs and the Committee on Government Affairs. We have the opportunity to position more Florida Fellows on national committees. Florida now has more input into ACOG national affairs and, in particular, a stronger voice in the national legislative agenda and advocacy activities.
Becoming an ACOG single state District created many new responsibilities and some challenges. We, as a District, had to assume the responsibilities previously met by the Florida Obstetric and Gynecologic Society (FOGS). FOGS, however, was more oriented toward CME, fellowship and legislative advocacy. By consensus, District XII created a committee structure designed to promote these same functions but also adopted a mission to work toward improvement of women’s health statewide through advocacy and direct action. The District quickly formed strong collaborative relationships with the newly formed Florida Perinatal Quality Collaborative (FPQC), the March of Dimes (MOD), the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and many others.
Once given the green light to begin operations in January, 2013, the District went to work. The best thing about committees is that you can empower them as action teams and claim credit for all their accomplishments but then blame them when we occasionally fail. The following activities represent a remarkable amount of work and dedication by these committees in the last 2 ½ years:
The FPQC and District XII, through its collaborative relations with several other organizations, implemented a statewide program designed to reduce the frequency of elective obstetrical deliveries prior to 39 weeks and in part, were responsible for a change in the standard of care on elective deliveries and a significant reduction in early elective deliveries throughout the state. The District followed this initial effort by partnering with the MOD to create a Banner Award that would be presented to all Florida Hospitals achieving the goal of reducing EED to 5 percent or less. To date, (64) of hospitals have proudly raised this banner.
The Committee on Maternal Mortality was charged with evaluating and implementing strategies designed to reduce the incidence of maternal mortality. For several decades Florida has conducted maternal mortality review and collected maternity mortality statistics through the activities of a committee, Pregnancy Associated Mortality Review (PAMR). PAMR, an excellent review organization, lacked the funding or staff to convert these findings into programs designed to reduce the incidence maternal death. With the formation of the FPQC and significant support of our district organization, programs designed to reduce maternal mortality were are now a reality. Postpartum hemorrhage and hypertensive disorders were the most prevalent conditions associated with maternal death in Florida. Maternal hemorrhage is considered the most preventable cause of maternal death worldwide. There is no reason to believe that this was not the case in Florida. Improved quality of medical care is the most important factor for the prevention of mortality due to obstetric hemorrhage. The FPQC, working through a grant from the Florida Department of Health (DOH) teamed with District XII and other organizations to organize a collaborative effort, known as the Obstetrical Hemorrhage Initiative (OHI). With Drs. Tony Gregg, Chair of the Committee on Maternal Mortality, Karen Harris, District XII Vice Chair and Bruce Breit, Chair of the Committee on Quality and Safety leading the effort, 31 Florida hospitals and 4 North Carolina hospitals participated in an 18 month pilot phase of the OHI. Hospitals were asked to spend 18 months implementing the recommended changes and 6 months institutionalizing them in their facilities. FPQC provided administration, a tool kit, data accumulation, and educational webinars. District XII provided clinical leadership and a 20 physician speaker panel. The program has exceed all expectations and is now entering phase II consisting of additional hospitals. Further information on the OHI can be found at http://health.usf.edu/publichealth/chiles/fpqc/OHI.htm. A similar project designed to reduce mortality associated with hypertensive disorders in pregnancy is in the planning phase.
The Committee on Health Care for Underserved Women, chaired with great energy by Dr. Julie DeCesare, recognized that Florida had a problem in supporting HPV vaccinations. In fact, when the committee was formed in 2013, Florida ranked near the bottom of the 50 states in the percentage of qualified adolescents receiving the full HPV immunization series (29%). Her committee was concerned that there was little organized support for state and local programs and a need for programs to educate patients, parents and their clinicians on taking every opportunity to vaccinate adolescents. They recognized that collective efforts remain critical to promoting vaccination so that our nation’s adolescents are protected again vaccine-preventable disease including cancers caused by HPV. The committee developed a series of educational pieces directed toward our patients, their parents and clinicians. Every attendee at the 2014 Annual District Meeting was given a HPV Education Kit that included a power point presentation that was designed to educate the adolescent patient.
Since 2007, perinatal champions from five of the most populous states, California, Florida, Illinois, New York, and Texas, which represent nearly 40% of the births in the United States., have been working together to improve birth outcomes. The FPQC and District XII leadership have been active in the “Big 5 Group.” Following the initial success of the Big 5 State early elective delivery pilot, leaders have been planning the launch of the next Big 5 State initiative, improving the utilization of antenatal corticosteroids. While the use of antenatal steroids at 23-34 weeks in women likely to have preterm birth during this interval has been recommended for years with data demonstrated improved perinatal morbidity and mortality, analysis reveals that in a significant number of women, steroids are not given or that optimal timing of the medication was not achieved. The Committee on Perinatal Morbidity and Mortality, chaired by Dr. Jerry Yankowitz will be working with the FPQC and will provide the clinical leadership in this effort, now in its planning phase.
Maureen Whelihan, MD, Chair of the Committee on State Legislation and Professional Liability and her committee continue to work diligently with our legislative consultant Amy Young. Amy’s article on legislative events (or the lack of) appears elsewhere in this newsletter. Trust me, District XII has the best lobbyist in Florida. Maureen and Amy, along with her committee have met the constant challenges to our patients and our profession ever present in Tallahassee.
I can assure you that ACOG District XII will be in good hands with the very capable officers assuming office in August. Dr. Karen Harris, Chair; Dr. Guy Benrubi, Vice Chair; Dr. Shelly Holmstrom, Treasurer and Dr. Cole Greves, Secretary are all extremely capable and dedicated physicians equal to the task. Thanks also to the District XII management team from Compass Management, particularly our Project Manager, Colleen Filbert.
Finally, I would like to thank the immediate Past Chair, Dr. Alfred Moffett for demonstrating that you can still successfully mentor a 74-year-old physician. Al answers my distress calls promptly and patiently.
The creation of ACOG District XII was a good thing!